Casestudy3
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Handout #9
Behavioral Health Training Partnership University of Wisconsin – Green Bay Page 1 of 1
Suicide and Risk Assessment April 2015
May be reproduced with permission for training purposes
Scenarios for Practicing Screening
Scenario #1
Virginia is a 28 year old single Hispanic mother of two young children. She has a history of
mental health issues since she was a teenager – mostly depression that has been treated with
medication and counseling in the past following a suicide attempt where she took a bottle of
pills and then called 911. The treatment helped her in the past and she has had no recent
suicide attempts.
Virginia’s mother has been helpful and supportive, but recently remarried and has been less
available to help Virginia. Virginia’s oldest child, Jesse, age 4 was recently dismissed from the
child care center for behavioral problems and Virginia had to miss work to care for him. Her
paycheck will not cover the upcoming bills and she is concerned she will be evicted. Even if she
is not evicted, she is fearful that she will not be able to hold on to her job as she doesn’t know
what to do with Jesse during the day. She is feeling overwhelmed.
Virginia has had sleeping difficulty for the past few weeks and everything seems to be closing in
on her. She is having anxiety attacks day and night. She is not currently on medication, has not
been in therapy for three years and has had “crazy” thoughts about the children being better
off without her. She does feel like killing herself but does not have a plan to kill herself. She
was tearful and panicky on the phone and states she feels like disappearing.
Scenario #2
Keith is a 20 year old college student who was recently diagnosed with schizophrenia. He was
hospitalized, started on medications, but quit taking them because he couldn’t stand the side
effects. He’d rather medicate himself by smoking pot. He continues to hear voices and is not
able to pay attention in his classes because he feels tormented by the voices. His grades, which
were always straight A’s, are dropping and he may end up failing this semester.
He is embarrassed by the voices and by his diagnosis and feeling hopeless that he can ever
finish college, get a job or function as an independent adult.
He lives at home with his parents and 2 younger brothers. They are concerned about him and
have noticed that he is much more withdrawn from them. They live on a farm and they hunt,
so there are guns in the home. One of the guns belongs to Keith and he has refused to let them
take it from him. That’s when they brought him in to be evaluated by crisis. He says he would
rather be dead than to be dealing with these voices and flunking out of school. He reports that
he has had the gun to his head several times, but has been afraid to pull the trigger. He loves
his family and doesn’t want to hurt them.
=Scenario Activity Questions
Review the scenarios and
answer the below questions utilizing the attached material and resources.
Name some of the suicidal risk factors for the individuals:
Are either patient actively exhibiting any suicidal behaviors? If so, explain.
What assessment items are you able to answer based on the information you have already been provided?
What are some assessment questions you may want to ask this individual to obtain more information?
What level of risk would you consider these individuals to be? Should suicide precautions be put in place for either patient? If so, what precautions would you implement?
Table 27-2
Levels of Suicidal Behaviors
|
Suicidal ideation |
Expressed thoughts or fantasies with no definite intent—may express ideas directly or symbolically |
|
Suicidal threats |
Verbal or written expressions of intent without actual actions |
|
Suicidal gestures |
Actions that result in little or no injury, but communicate the message of suicidal intent |
|
Parasuicidal behaviors |
Unsuccessful attempts with a low likelihood of success |
|
Suicidal attempts |
Serious self-directed actions with the intent to end one’s life |
|
Completed suicide |
The successful ending of one’s life |
Box 27-3
Assessment the Potential for Suicide
“What has been the most difficult moment for you in the recent past?”
“Have things been so bad that you have thought about escaping? If so, how?”
“Are there times when death seems like an attractive option to you?”
“Have you thought of harming or killing yourself?”
“If you were to harm yourself, how would you do it?”
“Do you have access to the items you would need to carry out your plan? (This includes a gun, medications, a rope, an enclosed garage.)”
“Have you thought about or attempted to harm yourself in the past?”
“What has kept you from harming yourself thus far?”
“What might keep you from harming yourself in the future?”
“Do you think you can control your behavior and refrain from acting on your thoughts or impulses?” This is the
most important question to ask.
Table 27-3
Suicide Assessment
|
ASSESSMENT |
DESCRIPTION |
|
Suicide ideation (thoughts) |
Client talks about wanting to be dead, imagines AIDS or other serious illness, seems gloomy, brooding. |
|
History of suicide attempts |
Client has tried to end own life before; there may be family history of suicide. |
|
Present suicide plan |
The more detailed a suicide plan, the more likely it will be carried out. |
|
Availability of items to carry out plan |
What guns, rifles, knives, or other weapons are available? How difficult is it to obtain such items? |
|
Substance use or abuse |
Suicide rates are higher in people who abuse alcohol or other chemical substances. |
|
Level of despair |
Ask about the future; when despair is high, hope is low. |
|
Ability to control own behavior |
Inpatient hospitalization is indicated for individuals who are unable to control their suicidal impulses. |
*
Box 27-4
Problem Statements/Nursing Diagnoses Related to Suicide
Physical realm
Risk-taking
Behaviors
Disturbed
Body image
Noncompliance
Pain
Risk of
Self-mutilation
Rape-trauma syndrome
Risk of self-directed
Violence
Psychosocial realm
Anxiety
Ineffective
Coping
Ineffective
Denial
Complicated
Grieving
Hopelessness
Powerlessness
Chronic low
Self-esteem
Impaired
Social interactions
Spiritual distress
Box 27-5
Suicide Precautions
Protect client from harming himself or herself.
Determine whether client has specific suicide plan.
Determine history of suicide attempts.
Make a no-suicide contract.
Remove dangerous items from the environment.
Place client in least restrictive environment that allows for necessary level of observation.
Place client in room with protective window coverings, as appropriate.
Observe closely during suicidal crisis.
Escort client during off-ward activities, as appropriate.
Demonstrate concern about client’s welfare.
Refrain from criticizing.
Facilitate discussion of factors or events that precipitated the suicidal thoughts.
Facilitate support of client by family and friends.
Instruct client and significant others in signs, symptoms, and basic physiology of depression.
Instruct family that suicidal risk increases for severely depressed clients as they begin to feel better.
Instruct family on possible warning signs or pleas for help client may use.
Refer client to psychiatrist, as needed.
Reference
Morrison-Valfre, M. (2017).
Foundations of Mental Health Care (6th ed.).
St. Louis, MO. Elsevier
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