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Assessing Suicide Risk Will Joel Friedman, Ph.D., Psychologist Page

Will Joel Friedman, Ph.D.

Psychologist • California License No.: PSY 10092

275 Rose Avenue, Suite 212, Pleasanton, CA 94566

• E-mail: • Website:

Assessing Suicidal Risk

[1st assessment: Checks in pen; Reassessments: New Date in another color pen]

Eating Disorders ___ Major Affective Disorders ___ Substance Abuse ___ // OCD ___ [Less]

Mortality rates: 23.14 X 20.35 X [1 for general population] 19.34 X 11.54 X

Harris-Younggren Risk Management Taxonomy [Two types of Cases]

Serious attempter:With appropriate treatment, medication, suicide risk often substantially eliminated

• Agitated Depression ______

• Bipolar/Psychotic ___* 1st & 2nd degree relatives who have

• Rigid thinking, no other way out ___* made Suicide attempts / completions:

• Usually enters through medical system ___*

• Psychiatrist managed ___*

• Acute risk, must be hospitalized ___*

*

Chronic attempter: DBT substantially reduces risk*______

• Cluster B patient [Antisocial P.D, Borderline P.D., Histrionic P.D., & Narcissistic P.D.] ___

• Suicide part of character structure as means of escaping intractable pain ___

• Attempts often gestures of varying lethality ______• Secondary gain ___ * What do you want to live for?

• Often managed by psychologists ___*

• Frequent risk management call ___*

• Very difficult to treat ___*

Judd-Joiner Taxonomy of Suicidal Risk*

______

Eight factors to consider in assessing suicidality + Seven more factors:

• Predisposition to suicidal behavior (Static Factors) ___

• Previous suicidal behavior ___

• Nature of suicidal thinking (Resolved Plan & Preparation) ___

• Precipitators or stressors (Aggravating Factors) ___

• Symptomatic Presentation ___

• Hopelessness ___

• Impulsivity ___

• Protective Factors ___ [Writing about suicide? (lowers risk) / Do you see a future?]

• Demographic Factors: Male ___ [Male/Female completion rate 3:1]

• Previous attempts ___ [10 to 20 times completion rates]

• Older European males, particularly widowed/divorced ___

• White males over 85 ___ [Have highest suicide rates]

• Adolescents ___

• Chronic medical condition with poor prognosis ___

• Divorced ___

Assessing Suicidal Risk

Lanny Berman, Ph.D., ABPP, Executive Director, American Association of Suicidology, Washington,

D.C. [APA Independent Practice Div., Independent Practitioner,Winter 2010, 15-18, list:p. 17]

Consensus list empirically supported near-term risk factors for suicide: Mnemonic: IS PATH WARM?

I: Suicide Ideation ___ [Threatened, communicated, or otherwise hinted at such by looking for

ways to kill oneself]

S: Substance Use ___ [Excessive or increased use of alcohol or drugs]

P: Purposeless ___ [Feelings of lacking in purpose, value, or meaning; seeing no reasons for

living]

A: Anxiety ___ [Increased anxiety, agitation, or insomnia]

T: Trapped ___ [Feeling like there is no alternative, no way out, other than suicide, to escape

intolerable feelings – need to terminate oneself to end feelings of shame or guilt]

H: Hopelessness ___ [Feeling and/or thinking that nothing can or will ever change for the better]

W: Withdrawal ___ [Increased isolation from family, friends, work, or usual activities]

A: Anger ___ [Feelings of rage, wish to seek revenge against alleged evil others, uncontrollable

anger]

R: Recklessness ___ [Acting with disregard for consequences, engaging in risky activities

seemingly without thinking]

M: Mood Change ___ [Experiencing dramatic mood changes, whether rapid cycling or not]

Ken Pope, Ph.D., ABPP & Melba J.T. Vasquez, Ph.D., ABPP, Responding to Suicidal Risk

Assessing suicidal risk: 21 factors

  1. Direct verbal warning ___
  2. Plan ___ [The more specific, detailed, lethal, and feasible the plan, the greater the risk]
  3. Past attempts ___
  4. Indirect statements and behavioral signs ___ [e.g., “going away”, speculating on what death would be like, giving away their most valued possessions, or acquiring lethal instruments]
  5. Depression ___
  6. Hopelessness ___
  7. Intoxication ___
  8. Clinical syndromes ___ [Especially depression or alcoholism / DSM IV-TR diagnosis]
  9. Sex ___[Suicide rate for men is about four times that for women]
  10. Age ___ [Suicide risk increase over the adult life cycle/adolescents/ Mid-50’s-mid 60’s highest]
  11. Race ___ [Caucasians tend to have one of the highest suicide rates / Native Americans, especially

in the age range of 15-24 years old is greater than that of any other ethnic group in the U.S.]

Assessing Suicidal Risk

  1. Religion ___ [Suicide rates among Protestants tend to be higher than those among Jews and Catholics]
  2. Living alone ___
  3. Bereavement ___ [Widowed have higher rates than married, especially among elderly men]
  4. Unemployment ___
  5. Health status ___ [Illness and somatic complaints are associated with increased suicidal risk, as are disturbances in patterns of sleep and eating]
  6. Impulsivity ___ [Those with poor impulse control are at increased risk of suicide]
  7. Rigid thinking ___
  8. Stressful events ___ [Excessive numbers of undesirable events with negative outcomes, women who experienced frequent, unwanted sexual touching, and multiple-incident victims of sexual assault have greater risk of suicide]
  9. Release from hospitalization ___ [Greatest risk of suicide during weekend leaves from the hospital and shortly after discharge]
  10. Lack of a sense of belonging ___ [Jointer’s review point to suicidal desire with relationships that are unpleasant, unstable, infrequent, without proximity, not feel connected to others or cared for]

Suicide Risk: Low: _____ Moderate: _____ High: _____ Extremely High: _____ DATE: ______

Reassessment: Low: _____ Moderate: _____ High: _____ Extremely High: _____ DATE: ______

Reassessment: Low: _____ Moderate: _____ High: _____ Extremely High: _____ DATE: ______

Reassessment: Low: _____ Moderate: _____ High: _____ Extremely High: _____ DATE: ______

Precautions(Pope & Vasquez)

__1. Arrange environment w/o easy access to weapons & remove lethal agents / quantities of medication

__2. Work with client to create an actively supportive environment (Agencies / grp-fam therapy)

__3. Recognize and work with the client’s strengths and desire to live.

__4. Make every effort to communicate and justify realistic hope (a positive vision for life).

__5. Explore any fantasies the client may have regarding suicide.

__6. Ensure communications are clear and evaluate the probable impact of any interventions.

__7. With considering hospitalization, explore drawbacks and benefits, immediate and long-term

effects of this intervention.

__8. Be sensitive to negative reactions to the client’s behavior. [Don’t react with boredom,

malice or hatred, especially when very fatigues, frustrated or out of sorts].

__9. Possibly most important, COMMUNICATE CARING // __10. Increase frequency of sessions

__11. 24 hr availability __12. Daily check-ins __ 13. Regular psychiatric/medical consultation