Read the three scenarios below carefully. For each scenario, complete an abbreviated suicide risk assessment and intervention form using the attached template. Determine the client’s risk level by analyzing the person’s desire, intent, capability, and buffers, then document what an ideal plan of action would be based on their risk level (HINT: See the intervention chart in the Week 3 guided reading). For the purposes of this assignment, you should assume that the client is willing to acknowledge ambivalence.
Scenario A: Sal is 62 years old and recently retired from his job as a police captain in a small suburban town. He took an early retirement because his wife recently died of liver cancer and also because of a knee injury he sustained about five years ago. He has been seeing you for grief counseling since the loss of his wife, but today he seems more upbeat than usual. Sal still experiences a lot of pain from his injured knee. He has been given Percocet for pain, which he will often take in order to get to sleep. Sal was very proud of being a policeman and feels he has been “useless” since his injury. He did feel good about taking care of his wife during her battle with cancer but feels lonely and empty since she died. Sal visits her grave every day and says he cannot wait until he “joins” her. Sal still sees some of his coworkers from the police department and every so often they will go to the shooting range together. He mentions that he has been clearing out his home, saying “I don’t want my kids to have to deal with all that junk when I’m gone.” When you ask him about suicide he admits to some ideation but denies having a specific plan.
Scenario B: Maria is a 19-year-old college student in her sophomore year. She told her roommate that she has been feeling depressed over problems she was having with her boyfriend. Recently, Maria found out that her boyfriend was cheating on her with a mutual friend. When she confronted her boyfriend, he denied the accusations and told Maria that she was “just being paranoid and crazy,” but seized the moment to break up with her. Maria is feeling angry, sad, and hopeless. She won’t get out of bed and has been missing classes. She did well in her freshman year but is receiving a scholarship and is afraid that if her grades drop she’ll lose the scholarship which means that she’ll have to return home and attend a local community college. Maria reports that she feels overwhelmed. She thinks that nothing she does will make things any better. She reached you by calling the hotline of a mental health clinic today because she felt so “upset” that she was considering taking her roommate’s prescription medication and washing it down with vodka. Maria mentions to you that she was in counseling while she was in high school after her parents separated. Maria describes feeling “lifeless and hopeless,” having no energy or motivation to do anything. She also reports that nothing is really enjoyable to her anymore and that as a result, she has become increasingly reclusive, preferring to be alone. Maria also states that she has not been eating or sleeping very well. She states that since the problems with her boyfriend began she feels she doesn’t have anything to live for.
Scenario C: Beth is a 24-year-old separated mother of a 10-month-old daughter. She called the hotline of the local mental health clinic today because she felt so depressed that she could not get out of bed. Beth explained to the hotline crisis worker that she has felt this way for the past six months. Beth described feeling hopeless and says that she has no energy to do anything. She also said that nothing is really enjoyable to her anymore, and as a result, she has become increasingly reclusive and prefers to be left alone. Since Beth’s husband left her to run off with one of her best friends, Beth thinks she doesn’t “have anything to live for.” When questioned directly about suicide she admits to “thinking that at least death would take this pain away,” but denies intent. She later mentions that she tried to cut her wrists a few days ago when she received a copy of the divorce papers, but “lost the nerve” and could not go through with it. “Besides,” she said, “I could never leave my baby all alone, with no one to look out for her.”
Watch this video:
https://youtu.be/ENN50LGdwbg
1. What risk factors did Jake have for violence?
2. What did you think the counselor did well?
3. What would you do differently? (you cannot answer that you would not change anything)
Student Name:
Week 4 Assignment Template
Part 1 – Suicide Risk Assessment and Intervention
Scenario A, Sal
| Desire
☐Suicidal/violent ideation ☐Psychological pain ☐Hopelessness ☐Helplessness
☐Perceived burden on others ☐Feeling trapped ☐Feeling intolerably alone |
| Notes:
|
| Capability
☐History of suicide attempts ☐Exposure to suicide or violence in the past ☐Extreme agitation or rage
☐History of/current self-harm or violence toward others ☐Availability of means
☐Substance abuse ☐Currently intoxicated ☐Sleep deprivation ☐Acute symptoms of mental illness |
| Notes:
|
| Intent
☐Attempt in progress ☐Preparatory behavior ☐Client expressed intent
☐Client has a plan (time and/or method) Always ask the client directly whether they have a plan |
| Notes:
|
| Buffers/Connectedness
☐Immediate supports ☐Social supports ☐Planning for the future
☐Engagement with crisis worker ☐Core values/beliefs ☐Sense of purpose
☐Client verbalizes reasons for living/no violence ☐Client acknowledges ambivalence |
| Notes:
|
Risk level
☐Low Risk (desire only)
☐Low-Moderate Risk (desire + capability + numerous buffers)
☐Moderate Risk (desire + capability)
☐Moderate-High Risk (desire + capability + intent + numerous buffers)
☐High Risk (desire + capability + intent)
| Plan of Action
· The Plan of Action should be as detailed as possible and driven by the client.
· The checkboxes below are to guide you. You should detail each step in the numbered section.
☐Self-care (specify) ☐Referrals ☐Medication evaluation ☐Removal of means
☐Involve family or other social supports ☐Verbal no-suicide/violence agreement
☐Hospitalization ☐Follow-up with counselor within 48 hours ☐Other (specify) |
| 1.
2.
3.
Add more steps if needed |
Scenario B, Maria
| Desire
☐Suicidal/violent ideation ☐Psychological pain ☐Hopelessness ☐Helplessness
☐Perceived burden on others ☐Feeling trapped ☐Feeling intolerably alone |
| Notes:
|
| Capability
☐History of suicide attempts ☐Exposure to suicide or violence in the past ☐Extreme agitation or rage
☐History of/current self-harm or violence toward others ☐Availability of means
☐Substance abuse ☐Currently intoxicated ☐Sleep deprivation ☐Acute symptoms of mental illness |
| Notes:
|
| Intent
☐Attempt in progress ☐Preparatory behavior ☐Client expressed intent
☐Client has a plan (time and/or method) Always ask the client directly whether they have a plan |
| Notes:
|
| Buffers/Connectedness
☐Immediate supports ☐Social supports ☐Planning for the future
☐Engagement with crisis worker ☐Core values/beliefs ☐Sense of purpose
☐Client verbalizes reasons for living/no violence ☐Client acknowledges ambivalence |
| Notes:
|
Risk level
☐Low Risk (desire only)
☐Low-Moderate Risk (desire + capability + numerous buffers)
☐Moderate Risk (desire + capability)
☐Moderate-High Risk (desire + capability + intent + numerous buffers)
☐High Risk (desire + capability + intent)
| Plan of Action
· The Plan of Action should be as detailed as possible and driven by the client.
· The checkboxes below are to guide you. You should detail each step in the numbered section.
☐Self-care (specify) ☐Referrals ☐Medication evaluation ☐Removal of means
☐Involve family or other social supports ☐Verbal no-suicide/violence agreement
☐Hospitalization ☐Follow-up with counselor within 48 hours ☐Other (specify) |
| 1.
2.
3.
Add more steps if needed |
Scenario C, Beth
| Desire
☐Suicidal/violent ideation ☐Psychological pain ☐Hopelessness ☐Helplessness
☐Perceived burden on others ☐Feeling trapped ☐Feeling intolerably alone |
| Notes:
|
| Capability
☐History of suicide attempts ☐Exposure to suicide or violence in the past ☐Extreme agitation or rage
☐History of/current self-harm or violence toward others ☐Availability of means
☐Substance abuse ☐Currently intoxicated ☐Sleep deprivation ☐Acute symptoms of mental illness |
| Notes:
|
| Intent
☐Attempt in progress ☐Preparatory behavior ☐Client expressed intent
☐Client has a plan (time and/or method) Always ask the client directly whether they have a plan |
| Notes:
|
| Buffers/Connectedness
☐Immediate supports ☐Social supports ☐Planning for the future
☐Engagement with crisis worker ☐Core values/beliefs ☐Sense of purpose
☐Client verbalizes reasons for living/no violence ☐Client acknowledges ambivalence |
| Notes:
|
Risk level
☐Low Risk (desire only)
☐Low-Moderate Risk (desire + capability + numerous buffers)
☐Moderate Risk (desire + capability)
☐Moderate-High Risk (desire + capability + intent + numerous buffers)
☐High Risk (desire + capability + intent)
| Plan of Action
· The Plan of Action should be as detailed as possible and driven by the client.
· The checkboxes below are to guide you. You should detail each step in the numbered section.
☐Self-care (specify) ☐Referrals ☐Medication evaluation ☐Removal of means
☐Involve family or other social supports ☐Verbal no-suicide/violence agreement
☐Hospitalization ☐Follow-up with counselor within 48 hours ☐Other (specify) |
| 1.
2.
3.
Add more steps if needed |
Part 2 – Violence Risk Assessment and Intervention
What risk factors did Jake have for violence?
What did you think the counselor did well?
What would you do differently? (you cannot answer that you would not change anything.)
