Timothy Spruill – Disarming the Suicidal Mind: Evidence-Based Assessment and Intervention

Outline

INTRODUCTION TO THE GROWING PROBLEM OF SUICIDE IN AMERICAINTRODUCTION TO THE GROWING PROBLEM OF SUICIDE IN AMERICA

• Need for concern: statistics revealing the increasing trend in suicidal ideation, attempts, deaths Need for concern: statistics revealing the increasing trend in suicidal ideation, attempts, deaths
  • National dataNational data
  • State-specific dataState-specific data
  • Career risks for the professional counselorCareer risks for the professional counselor
• Factors contributing to the failure of adequate assessment and triage Factors contributing to the failure of adequate assessment and triage
  • Inadequate training of physicians and professional counselorsInadequate training of physicians and professional counselors
  • Inadequate funding for mental health (despite numerous parity laws)Inadequate funding for mental health (despite numerous parity laws)
  • Shifting of the burden of assessment to emergency roomsShifting of the burden of assessment to emergency rooms
  • Poorly trained law enforcement officers initiating involuntary admissionsPoorly trained law enforcement officers initiating involuntary admissions

EPIDEMIOLOGY — CONTRIBUTING FACTORSEPIDEMIOLOGY — CONTRIBUTING FACTORS

• Risk factors Risk factors
  • Demographic risk factors (age, gender, ethnicity, etc.)Demographic risk factors (age, gender, ethnicity, etc.)
  • Environmental risk factors (adverse childhood experiences)Environmental risk factors (adverse childhood experiences)
  • AddictionsAddictions
  • Mental illnessMental illness
  • Economic risk factors (employment)Economic risk factors (employment)
• Warning signs Warning signs
  • Feeling alone—isolated from family/friendsFeeling alone—isolated from family/friends
  • Feeling like a “burden” to othersFeeling like a “burden” to others
  • Little or no fear of deathLittle or no fear of death
• Red herrings Red herrings
  • Suicide notesSuicide notes
  • Contingent suicide threatsContingent suicide threats
  • CuttingCutting
  • Pending divorcePending divorce
• Limitations of the research and potential risksLimitations of the research and potential risks

ASSESSMENTS/MEASURES TO AID IN DETERMINING RISK LEVEL — A COMPREHENSIVE STRATEGYASSESSMENTS/MEASURES TO AID IN DETERMINING RISK LEVEL — A COMPREHENSIVE STRATEGY

• Mental status examMental status exam
• Collateral informationCollateral information
• Adults Adults
  • Relative lethality of plans/attempt (Risk/Rescue Scale)Relative lethality of plans/attempt (Risk/Rescue Scale)
  • Hopelessness (Beck Hopelessness Inventory)Hopelessness (Beck Hopelessness Inventory)
  • Reasons for living (Brief Reasons for Living Scale)Reasons for living (Brief Reasons for Living Scale)
  • Adverse childhood experiences (A.C.E. Questionnaire)Adverse childhood experiences (A.C.E. Questionnaire)
• Teens and children Teens and children
  • Predictive/protective factors identified in the researchPredictive/protective factors identified in the research
• Special populations Special populations
  • VeteransVeterans
  • LGBTLGBT
• Promising, novel methods for assessing risk Promising, novel methods for assessing risk
  • Implicit cognitions—measuring implicit associations with death and suicideImplicit cognitions—measuring implicit associations with death and suicide

COMMON INTERVENTIONS, MISTAKES, THINKING ERRORS & ETHICAL ISSUESCOMMON INTERVENTIONS, MISTAKES, THINKING ERRORS & ETHICAL ISSUES

• Our natural tendencies to err Our natural tendencies to err
  • Feelings of “rightness” are not reliable indicatorsFeelings of “rightness” are not reliable indicators
• External factors contributing to errorsExternal factors contributing to errors
• Internal factors contributing to errors Internal factors contributing to errors
  • Self-care is criticalSelf-care is critical
  • Two types of thinking (fast and slow)Two types of thinking (fast and slow)
  • Dangers of lazy, “fast” associative thinkingDangers of lazy, “fast” associative thinking
  • Substitution of easy-to-answer question for more difficult and complex questionSubstitution of easy-to-answer question for more difficult and complex question
• Type 1 vs. Type 2 errors (legal liability and ethical issues) Type 1 vs. Type 2 errors (legal liability and ethical issues)
  • Patient autonomy and self-determinationPatient autonomy and self-determination
  • Confidentiality limitsConfidentiality limits

INTERVENTIONS AND TREATMENT PLANNINGINTERVENTIONS AND TREATMENT PLANNING

• Non-judgmental, empathic listeningNon-judgmental, empathic listening
• Acknowledging reason for concernAcknowledging reason for concern
• Taking advantage of ambivalenceTaking advantage of ambivalence
• Evidence-based interventions to reduce subsequent suicide attemptsEvidence-based interventions to reduce subsequent suicide attempts
• DSM-5® new definitions and terminology DSM-5® new definitions and terminology
  • Assess suicidal ideation at the start of every visitAssess suicidal ideation at the start of every visit
  • DSM-5 level one screening questionnaireDSM-5 level one screening questionnaire
  • Suicidal Behavior DisorderSuicidal Behavior Disorder
  • Non-Suicidal Self-injuryNon-Suicidal Self-injury

CHALLENGES TO ACHIEVING SUCCESSFUL TREATMENT OUTCOMESCHALLENGES TO ACHIEVING SUCCESSFUL TREATMENT OUTCOMES

• Means restrictionMeans restriction
• Social support — supervisionSocial support — supervision
• Follow-up counselingFollow-up counseling
• Exploring alternative responses should suicidal thoughts increase in frequency/intensityExploring alternative responses should suicidal thoughts increase in frequency/intensity

WHEN LOSING A PATIENT TO SUICIDE — REMAINING RESILIENT AND MOVING FORWARDWHEN LOSING A PATIENT TO SUICIDE — REMAINING RESILIENT AND MOVING FORWARD