Suicide Protocol

Question 1

Step 1 - If you think the Caller is considering suicide, ask DIRECTLY (with emphatic tone)

Answer 1

PC

from what you are saying, … I am wondering if you are thinking of killing yourself

Question 2

Hints or indications that the Caller might be considering suicide

Answer 2

Caller
I have never felt so discouraged/depressed/low before.
I am so tired of "IT" all.
I wish I could just disappear/evaporate.
I can not go on.
I can't see the use in going on.
I have called to say goodbye to someone.
I won't be around when the divorce goes through.

Question 3

Caller says:

I have never felt so discouraged/depressed/low before.

I am so tired of “IT” all.

I wish I could just disappear/evaporate.

I can not go on.

I can’t see the use in going on.

I have called to say goodbye to someone.

I won’t be around when the divorce goes through.

Answer 3

PC can answer:

You are so unhappy that you are even thinking of killing yourself, that must be frightening.

You sound desperate. I would like to help you, could you tell me more about what is happening?

I can hear how desperate you are, let’s talk about it?

You sound incredible over whelmed at the moment, I am glad you called, I am here to listen.

Usually when people are feeling the way you do, there are a number of things going on to make them feel that way, can you help me understand what is going on?

Question 4

Step 2 - Check if the Caller has a plan

Answer 4

PC

I am wondering if you have thought about how you will do this (kill yourself), or if you have a plan?

Question 5

Step 3 - Do the Caller has the means to kill him/herself, can the Caller carry out this plan?

Answer 5

PC

I am wondering do you have the means to do this (to kill yourself)?

Question 6

Step 4 - Putting the means (to commit suicide) out of sight or away
FIRST REFLECT FEELINGS (perhaps frustration, desperation, sadness, trapped, etc), when you feel the PC and Caller have a rapport, tell the Caller to put means away while you are both talking.

Continue as a counseling call:
reflect the Caller’s feeling (specially intensity)
paraphrasing the Caller’s story
regularly SUMMARIZING to show you understand and are following
regularly IDENTIFY THE ISSUES, to help Caller identify the source of distress and make it more manageable in his/her mind
massive doses of UPR (Unconditional Positive Regard)

Later in the call as the Caller has build a strong rapport with the PC then attempt to ask the Caller if he/she are ready to throw or destroy their means (to commit suicide).

Answer 6

PC first has to RF:
Could you help me understand what is going on for you?
Can you tell me about your pain, does it seem unbearable?
Everything you say sounds full of anger, can you help me understand your anger?
I would like to know more about what happened with (your job) . Could you tell me more about it?
You sound really enraged now. Is there something you can do to feel calmer?
Suicide is one option. What are other options you can think of?
I wonder if you really want to die OR if you really want the pain to stop.

Then after RF and building rapport, PC can ask:

I do not feel comfortable talking with you knowing that you have … (pills, knife, etc) there, could you please put them away out of sight while we talk …
OR …step away from the platform, window, edge of building etc.

Question 7

Spet 5 - Check for supports that the caller might have: Friends, Family, Places the Caller can go, things the Caller can do

Answer 7

PC might say:
I am wondering about people you have around you that you trust or you can turn to?
Is there anybody the you believe might be able to help you?

Question 8

Step 6 - Take any appropriate opportunity to suggest Face to Face counseling as an option

Answer 8

PC

I would like to suggest for you to consider Face to Face counseling in the near future.

Question 9

Step 7 - Before ending the call, make a CONTRACT for the caller to ring again:

1. the same day in the evening or next morning
2. whenever the Caller is feeling this way again
3. before the Caller will do anything to harm him/herself

Answer 9

PC

• I would like you to promise me that if you are feeling this way again or if you need to talk that you will call TELL again. Can you promise that?
• I would like you to promise me that you will call TELL or one of your friends before you do anything to harm yourself, can you promise me?
• Do you have someone else that you trust, whom you can call when the line is not open?
• I am concerned for you, when the line is closed; can you promise me that you will call someone when you are feeling this way again?

Question 10

Step 8 - Intake - Red Dot

Answer 10

Put a red dot on the intake when you write it up and also write a brief account in the workers’ folder with a red dot so that PCs on the following shifts will be aware this person may call again.