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Guidelines for Suicide Intervention
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In the last section, we discussed four techniques available to parents to help foster independence in a teen undergoing a depressive or suicidal crisis. These four techniques are providing choices, problem solving, listening techniques, and active interest.
In this section, we will discuss guidelines for parents regarding intervention during a teen’s suicidal crisis in four situations. These four situations are, an emergency life threatening attempt, a non-emergency life-threatening attempt, possible suicide, and a low-risk situation.
4 Guidelines regading Intervention
♦ Guideline #1 - Emergency Life Threatening Attempt
A first set of guidelines for parents regarding intervention during a teen’s suicidal crisis involves crisis intervention during an emergency life threatening event. Clearly, the guidelines for parents during an emergency event, such as an active suicide attempt, are very specific. The central issue is the physical survival and safety not only of the teen client, but of others as well. I state to parents, "If the situation has become dangerous, do not attempt to handle a volatile situation by yourself; get outside help as soon as possible."
Depending on the severity of the teen’s action, the parent may need to call 911, take the child to a doctor, or contact me or my emergency line. Hospitalization may need to be discussed. Once the teen’s immediate physical safety has been provided for, I encourage parents to try to determine the method the teen client used in their attempt. If the teen has attempted suicide by drug overdose, I encourage parents to Write Down the Following:
-- 1. The drug or type of drug
-- 2. The amount taken
-- 3. The approximate time of ingestion
-- 4. The teen client’s weight.
♦ Guideline #2 - Non Emergency Life-Threatening Event
A second set of guidelines for parents regarding intervention during a teen’s suicidal crisis involve crisis intervention during a non emergency life-threatening event. Louise, 17, had entered a crisis after a breakup with her boyfriend. Louise’s mother came home to find that Louise had carved her boyfriend initials into her arm, scratched her face, and pulled out chunks of her hair. When Louise’s mother confronted her, Louise indicated that she had a clear plan to kill herself, including a time and method.
Safe Place Technique
When I consulted with Louise’s family, we decided hospitalization was the best option. Unfortunately, no bed was immediately available in an inpatient unit, so in this situation it was necessary for Louise to be cared for at home. In order to maintain Louise’s safety, I introduced the "Safe Place" technique to Louise’s parents. As you know, the safe place technique involves immediate risk reduction and monitoring in order to protect a teen client unable to control her or his actions until inpatient care is available.
-- 1. Remove all possible means of suicide from the house including pills, guns, knives, razors, and scissors.
-- 2. If the teen has keys to a vehicle, take the keys away. Make sure other car keys are not accessible.
-- 3. Take turns monitoring the teen around the clock. In the case of a teen like Louise who is at a high risk of suicide, it is very important that she or he not be left alone.
♦ Guideline #3 - Lowe-Risk Situation of Possible Suicide
In addition to guidelines for an emergency and a non-emergency life-threatening event, a third set of guidelines for parents regarding intervention during a teen’s suicidal crisis involves crisis intervention during the lower-risk situation of possible suicide. Toby, 18, was an honor roll student who was well liked at school. He had expected to go to an ivy-league school following graduation, but a recent financial setback in family finances had made that unlikely unless Toby won a major scholarship.
In addition, Toby’s girlfriend of three years had recently requested that they become "just friends" so that she could date other people. Toby’s favorite teacher became concerned that Toby’s behavior was becoming unusual, and spoke with Toby. The teacher discovered that Toby had been thinking of killing himself, but was concerned how this would affect his mother’s health. Toby did not have a specific plan, but he did have a time picked out. His mother would be going out of state to visit her sister the following week.
Toby stated that this would be an ideal time, since "at least his mother would have someone with her" when she got the news. Toby’s teacher also discovered that Toby had been giving away possessions. When Toby’s teacher notified his parents, they brought Toby in for therapy. In this moderate risk situation, crisis intervention focused on creating a supportive family situation to help Toby during therapy. I also suggested family counseling to reinforce family support. As with family intervention during a non emergency life threatening situation, I also reviewed risk reduction home procedures with Toby’s family.
These interventions are also appropriate in the case of a suicidal gesture, such as superficial scratching or cutting of the wrists.
♦ Guideline #4 - Low-Risk Situation
A fourth set of guidelines for parents regarding intervention during a teen’s suicidal crisis involves crisis intervention in a low-risk situation. By low risk, I refer to a teen client who has vague feelings of not wanting to go on. Although a sense of helplessness or hopelessness may be present, but plans or threats of suicide have not been made. I encourage parents of low risk teen clients to focus family crisis intervention on assuring the teen that the parents are concerned about his or her well-being, and that they are listening, willing to understand, and accepting.
By working with parents to help them encourage the teen to talk at home, the family environment increases in its ability to provide support and compliment the work the teen is doing with me in therapy. One caution I give to parents of teen clients in a lower risk situation is that while they should offer potential solutions to the teen’s daily life problems, they should not be surprised if the solution is rejected. I encourage parents to recognize that this rejection only means that the teen needs to continue talking, and is not yet ready for problem solving because the negative emotion they are experiencing is too strong.
Think of a teen client you are currently treating as the result of a risk of suicide. To which risk group does the teen belong? Would playing this section in your next session with your teen client’s parents be helpful to them?
In this section, we have discussed guidelines for parents regarding intervention during a teen’s suicidal crisis in four situations. These four situations are, an emergency life threatening attempt, a non-emergency life-threatening attempt, possible suicide, and a low-risk situation.
In the next section we will discuss two focus areas for family change following a teen client’s suicide attempt. These two focus areas are what to say about the attempt and realistic expectations.
Peer-Reviewed Journal Article References:
Braun, M., Till, B., Pirkis, J., & Niederkrotenthaler, T. (2020). Suicide prevention videos developed by and for adolescents: A qualitative study. Crisis: The Journal of Crisis Intervention and Suicide Prevention. Advance online publication.
Finan, L. J., Ohannessian, C. M., & Gordon, M. S. (2018). Trajectories of depressive symptoms from adolescence to emerging adulthood: The influence of parents, peers, and siblings. Developmental Psychology, 54(8), 1555–1567.
Fox, K. R., Harris, J. A., Wang, S. B., Millner, A. J., Deming, C. A., & Nock, M. K. (2020). Self-Injurious Thoughts and Behaviors Interview—Revised: Development, reliability, and validity. Psychological Assessment, 32(7), 677–689.
Mackelprang, J. L., Karle, J., Reihl, K. M., & Cash, R. E. (G.). (2014). Suicide intervention skills: Graduate training and exposure to suicide among psychology trainees. Training and Education in Professional Psychology, 8(2), 136–142.
Schapir, L., Zalsman, G., Hasson-Ohayon, I., Gaziel, M., Morag-Yaffe, M., Sever, J., Weizman, A., & Shoval, G. (2016). Suicide, satisfaction with life, and insight capacity among adolescents with mental disorders: A preliminary study. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 37(5), 347–352.
What are the three steps in the safe place technique?
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