Lesson 11: Ongoing Risk Management
Ongoing risk management for suicidal ideation is a critical aspect of mental health care. It involves implementing strategies and interventions to monitor, assess, and mitigate the risk of suicide in individuals who are experiencing or have a history of suicidal thoughts. As a therapist, it is important to continue evaluating for risk with clients that have reported any history of suicidal ideation or suicide attempts.
Here are some important factors when considering ongoing risk assessments with your clients:
Regular assessments: Continuously assess the individual’s mental health status, including their current level of distress, thoughts of suicide, and any changes in their circumstances. It is important to check in each session with your client, to be sure they are equipped with the appropriate resources, are confident in their safety plan, and have the appropriate level of care for their current risk level. Here are examples of appropriate ways to check in during session:
Ask Open-Ended Questions: Start the conversation with open-ended questions that encourage the individual to express their emotions and thoughts. For example:
- “How have you been feeling since our last session?”
- “Have there been any changes in your mood or thoughts?”
Directly Ask About Suicidal Thoughts: Don’t shy away from asking direct questions about suicide. Although it can be intimidating to have a direct conversation regarding suicide, this can help normalize the conversation and give the individual an opportunity to share their struggles. Asking about suicide does not put the thought in their head, or cause them to think about suicide. For example:
- “Have you had any thoughts of suicide since our last session?”
- “Have you thought about killing yourself in any way?”
Assess Suicidal Ideation: If the individual acknowledges any suicidal thoughts, assess the severity, frequency, and intent of those thoughts. You can utilize the assessment tools as mentioned in the prior lessons to help guide the appropriate questions and determine the appropriate level of care.
Explore protective factors that are currently providing the individual with reasons to live, such as support systems, coping strategies, and future goals. From example:
- “Are there any goals or dreams that you’re working towards?”
- “What motivates you to keep moving forward in life?”
Evaluate Recent Events: Discuss any recent life events, stressors, or changes that might be contributing to the individual’s distress or suicidal thoughts.
Identify Stressors and Triggers: Explore any current or upcoming stressors that might increase the risk of suicidal ideation.
Review Coping Strategies: Inquire about the strategies the individual has been using to cope with distress. Discuss the effectiveness of these strategies and suggest additional coping mechanisms if necessary.
Safety Plan Review: If a safety plan has been established, review it with the individual. Discuss whether they’ve been using the strategies outlined in the plan and if they’ve encountered any difficulties.
Plan for the Time Between Sessions: Discuss what the individual can do if they experience heightened distress between sessions, emphasizing the importance of reaching out for support.