Suicide Assessment

Effective suicide prevention counseling can literally save a life. With timely interventions, treatment and support, suicides and suicide attempts can be prevented. In crisis counseling, how you encounter the suicidal client may differ from the traditional face-to-face interactions we typically consider for long-term care. Some suicidal clients reach out with a phone call or online messaging. Other times we are given a written case referral and asked to consult for immediate safety planning. Since we encounter suicidal clients in a variety of platforms, this discussion is designated to help you not only perfect your skills in determining how to assess and intervene with a suicidal client, but also to consider the impact of how the client information is presented on our decision making regarding best client care.

In this Discussion, you will be assigned a particular case presentation to review. Students with the last name A–I will watch the video recording as if working with a face-to-face or online client. Students with the last name J–R will review the transcript as if given a written referral. Students with the last name S–Z will listen to the audio recording as if speaking to a client by phone. Based on your assigned format, you will assess for risk factors and begin safety planning for your client.

To Prepare:

• Download the transcript and review the video Facilitative Response Activity. You can download the transcript for future reference with clients.
• Review the video How to accurately assess and help a client by Dr. Sue Banks and Dr. Michelle Slater.
• Based on your last name, review the case presentation for Robert in the Suicide assessment and safety planning link using the format assigned.

Note: When the media resource is accessed and appears, please make certain that you choose the format that coincides with the group you are assigned. Students with the last name A–I will watch the video recording. Students with the last name J–R will use the written transcript. Students with the last name S–Z will listen to the audio recording.

By Day 3

Post your responses to the following:

• The type of interaction you reviewed of Robert (i.e., written, video, or audio)
• Risk factors for Robert
• Things you would like to know about Robert (i.e., what information is missing?)
• Components you think will be important to include in a safety plan for Robert

Note: For this discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Post to Discussion Question link, then select Create Thread to complete your initial post. Remember, once you click Submit, you cannot delete or edit your own posts – and cannot post anonymously. Please check your post carefully before clicking Submit!

Suicide Assessment and Safety Planning

Suicide Assessment and Safety Planning Program Transcript

FEMALE SPEAKER: So, Robert, did you understand the confidentiality I just presented?

ROBERT: Yeah. Yeah. I got it. It’s fine.

FEMALE SPEAKER: Do you have any questions before we get started?

ROBERT: No, no. I mean, that was pretty clear.

FEMALE SPEAKER: OK. So why don’t you tell me a little bit about your background growing up?

ROBERT: Background. Well, growing up was– I mean, it was– what do people do? We grow up, right? It wasn’t– it was tough. My dad, he was really tough on me. I was the oldest. Little sister. So she didn’t see much of what happened.

And eventually what happened was, we left. They were never married, so my mom didn’t feel a commitment to stay. They had me. That didn’t keep them together, so we left. Went to stay with some cousins in Virginia. Norfolk.

FEMALE SPEAKER: So your dad was abusive?

ROBERT: Very, I would say. I mean, I would get– there was this one Christmas where I opened up a packet. And all I think was to open up the package, right? And he was like, did you give me the finger? I’m like– I’m like a kid, right? And I’m like, this isn’t even– I knew as a child that it didn’t make any sense, right? He’s like, how would I give a– I didn’t even know what a finger was. I mean. It was just scary to live in the house.

So you would just get beat for nothing. And my mom would stop it. She would come in time to try to stop him from spanking me. So she did what she– she did the best she could. Everybody did the best they could with what they had at the time. So–

FEMALE SPEAKER: Yeah. So it says on your intake form that you were in the military. Can you tell me a little bit more about your experience in service?

ROBERT: Yeah. Well, we didn’t have any money and I knew that they would pay for schooling. So I was always taking things apart and putting them back together. So I went into combat engineering. We would build things and blow things up. That was always fun.

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Suicide Assessment and Safety Planning

Now, I like to know how people think, so my backup was like psy-ops, which is– people hear psy-ops. They think, oh, crazy strange stuff. But it’s not crazy strange. It’s just how people think. The methodologies and modalities of how people make decisions. So combat engineers was first, psy-ops was second.

I grew up near Norfolk. And I don’t know if you ever been to the area, but it’s nothing but jets all the time, right? So I never wanted to fly, but I think that’s what pushed me towards the military. So I chose the Army and enlisted when I was 18. Went on from there.

FEMALE SPEAKER: And when you enlisted, where did you head from there? What were your experiences?

ROBERT: I had two tours. The first one was Afghanistan, the second was Iraq. And the second one is where I ended my career and left.

FEMALE SPEAKER: I can see as you’re talking about that that it’s painful. I’m wondering if you’d be willing to talk to me a little bit about that.

ROBERT: What would you like to know?

FEMALE SPEAKER: I guess I’m most interested in what you experienced there. It’s part of who you are sitting in front of me today. And I’d like to understand what that experience was like for you.

ROBERT: [CLEARS THROAT] OK. Yeah. We can. So headed back to base. Not far away, like five clicks. There was debris on the road in front of us. It wasn’t enough that it looked like it was intentionally placed, but I knew that it didn’t belong there. We could not sit there because, of course, they could come on our six, have us trapped. So what we did was we reversed about 50 feet, made a k- point turn.

And when we made the k-point turn, that was when we hit the IED. And the way the vehicle slipped back onto its left side. I was pinned down. My mother says– [LAUGHS BRIEFLY] she always talks about how she would pray for me and stuff, but– so not everybody that day was protected, though.

FEMALE SPEAKER: Yeah. And you carry that pain with you.

ROBERT: Yeah. I would say so. Ramirez– and he was having a baby girl. I don’t know why I– I was allowed to live, you know? That’s– I mean, it’s not fair.

FEMALE SPEAKER: Yeah.

ROBERT: But I don’t make the rules, so–

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Suicide Assessment and Safety Planning

FEMALE SPEAKER: Yeah. But you ask yourself that. Why? Why him? Why them? Why not me?

ROBERT: I do. I mean, I do. I– what makes me deserving? You know? It sounds cliche when people say survivor’s guilt. I mean, it’s– I’m not guilty, it just doesn’t make– what if I was sitting on the right-hand side, you know? It’s little decisions like that that makes you think about what you do and don’t do.

FEMALE SPEAKER: Yeah. And does it matter at all? Sounds like it’s left you with a lot of confusion and questions, and now what?

ROBERT: [LAUGHS BRIEFLY] Exactly. I mean, like, now what?

FEMALE SPEAKER: You were protected and it sounds like you’re struggling even to understand why or what you’re supposed to do with this life that you got saved.

ROBERT: Yes, ma’am.

FEMALE SPEAKER: So, I’m sorry. I’m sorry to hear about that experience for you. And I can’t imagine what it’s been like to cope with that. And can you tell me a little bit about what it’s been like since you came home? After you had discharged?

ROBERT: [EXHALES] Not the same. [EXHALES]

FEMALE SPEAKER: Yeah. How could that be?

ROBERT: I have no freaking idea how that could be. My joy is there. John is fine. You know? I mean, I missed his birth, but he’s good. Tess is great. She works at the hospital. She’s what keeps us going because where we’re at is rural, so there’s not a lot to do. It’s farms, it’s this– it’s– she’ll always have a job. I mean, nurses can go anywhere. Backwoods, they’ll be fine.

Me, like I said, with the combat engineering, I’m good with my hands, right? With the psy-ops, that’s like marketing. Big city, New York stuff, so– we’re not in the big city, we’re not in New York, work is hard to come by. I just had a online sites Craigslist list to try to find stuff to do.

And we fight a lot because she– I mean, she didn’t sign up to be the breadwinner. That’s my job. I’m the man. I’m supposed to do that, so–

FEMALE SPEAKER: Yeah. And it sounds like you’re having a hard time finding your place.

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Suicide Assessment and Safety Planning

ROBERT: It’s tough. I mean, I get to see John all the time because I’m the babysitter, but I’m not supposed to be the babysitter, you know? I was supposed to be out there and doing, so–

FEMALE SPEAKER: Yeah. It’s creating a lot of tension at home?

ROBERT: We go at it. [LAUGHS] We do go at it. It gets intense. The other day, it was about, like, nothing, you know? She said something, I said something, he’s crying, and then it just blew up into a whole bunch of nothing. And it was like all this red flash, right? And then I blanked out for a second. Not blanked out like on the floor. Just like I wasn’t me and like I just saw– I just saw my hand like moving towards her and I was like, I– I can’t do that. It’s– you know?

FEMALE SPEAKER: Like it was happening outside of you. And that’s not the person–

ROBERT: No.

FEMALE SPEAKER: you want to be, that you know yourself to be.

ROBERT: No, no. That’s totally– that’s totally out of character for me. That’s not–

FEMALE SPEAKER: What else is different since you’ve gotten back?

ROBERT: No friends. Nothing happening. No hanging out. I mean, it’s TV. I would never even start video games because I know my addictions. [LAUGHS]

You know? Just trying to find stuff to do. Trying to find work.

FEMALE SPEAKER: Pretty isolated.

ROBERT: That’s a very good word. Isolated. And she comes home and she doesn’t want to talk because she’s had a tough day. I don’t want to talk. So she’ll eat, I’ll eat downstairs. She’ll go to bed and then she would be like (IMITATING FEMALE VOICE) can you go to bed? And then I’m like, I’m coming to bed, but– I’ll go to bed but I’ll get back out of bed because I can’t sleep, right?

So then, what will happen next is– let’s open a beer. It’s beer, beer, beer, beer. And just– you know, six, eight. Even numbers is good, right? So a 12 pack, you know? Just–

FEMALE SPEAKER: Whatever it takes to be able to get to sleep. Shut it off.

ROBERT: Shut it off. Yeah. That’s a good way to put it.

FEMALE SPEAKER: That’s causing problems at home.

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Suicide Assessment and Safety Planning

ROBERT: Oh, definitely. Because, I mean, how can you pay for beer when you don’t have work, right? [LAUGHS] So it’s like a cycle, you know? Trying to break the cycle.

FEMALE SPEAKER: Yeah. So, tell me, Robert, I’m getting this picture of some of the trauma that you’ve gone through and what you’ve experienced since you were discharged. What specifically caused you to seek help today?

ROBERT: I almost hit my wife.

FEMALE SPEAKER: It scared you.

ROBERT: It scared the hell out of me. That’s not me. Like, I know that’s not me. So that’s not me.

FEMALE SPEAKER: What else is not you? Are there other things that you’re concerned about? Sounds like there’s a lot of things you’ve said a couple of times that are out of character for you.

ROBERT: But– I mean, why– my thing is, why– I’m sorry. I’m just thinking about the confidentiality thing. What I share between you and I, right?

FEMALE SPEAKER: Everything that you share in here is confidential unless you’re talking about hurting yourself or someone else, then we would have to have another conversation. Is there’s something that you’re afraid to share, that you’re afraid you can’t talk about with me?

ROBERT: It’s not that I’m afraid to talk about it, it’s just– sometimes I feel like why even keep going on, you know? Like, why– I guess it goes back to that whole protection thing. Like, why was I protected? Why was I spared? Maybe it would just be better for everybody, you know– Tess will always have work. John will always be OK. We have a family that will take care of them, you know? Like, if I’m the problem, well, you do the math, right? You solve the problem. So if I wasn’t around, it would be– maybe it would be better for everybody. You know?

FEMALE SPEAKER: If you took yourself out of the equation.

ROBERT: Yes, ma’am. I mean, I have a gun. I would– I’m not saying I’m going to walk around and do anything crazy, I’m not just– I’m not saying that, but I’m just saying, why?

FEMALE SPEAKER: Because you’re having a hard time understanding why you’re here and why it’s all worth it. Or thinking that it’s not.

ROBERT: Is it even worth it?

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Suicide Assessment and Safety Planning

FEMALE SPEAKER: Yeah.

ROBERT: That’s question, right?

FEMALE SPEAKER: Sounds like you really are struggling with that. Trying to answer that question.

ROBERT: Yes, ma’am.

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