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Attitudes and approach

Exploring attitudes and beliefs

Before performing a suicide risk assessment, it is important that clinicians recognize and understand how their attitudes, beliefs and emotions affect the suicide risk assessment and management process. Reflecting on the questions below can help you work toward reconciling the potential conflict and adversarial position sometimes inherent to suicide risk assessment (Rudd, 2006). Ask yourself each question and then read on to find out what your answers can teach you.

Why do people die by suicide?

By asking this question, you articulate your personal theory of suicide. You may ask patients questions that reinforce your theory and may neglect other important issues. It is important that your theory of suicidality be grounded in empirical science. If you discover that much of what you ask is driven by anecdotal evidence, it may be a sign that personal beliefs are playing a prominent role in your suicide risk assessment.

Is it ever acceptable to die by suicide?

Regardless of your personal opinion, it is crucial that you identify and explore it. Clinicians must be able to separate personal belief from professional obligation.

Can suicide be prevented?

This question hints at your hopefulness, something that is often evident to patients. This question also helps to identify your sense of responsibility in terms of intervention and management of suicide risk.

Do people who access care want to die?      

Accessing care is, in and of itself, an act of hope, even when the person is experiencing the most desperate of circumstances. It is important for the clinician to recognize the significance of the simple act of accessing care and reflect this back to the patient. Even in cases of persistent and chronic suicidality, continuing to access care is evidence of hope.

What are your individual professional responsibilities with a patient who is suicidal?

Knowing your professional responsibilities will help you determine the steps you will take in suicide intervention and management following the risk assessment. It is important to understand that your responsibilities are not endless; rather they should be driven by clearly articulated policies and procedures. If you cannot answer this question in a straightforward way, it may mean that you are unclear about policies and procedures around working with patients at risk of suicide.

Maintaining a collaborative stance

Working with patients at risk for suicide requires a collaborative stance, which helps to establish and maintain a good working alliance with the patient (Rudd et al., 2008). Here are ways to demonstrate a collaborative stance:

  • Acknowledge the patient´s ambivalence about living.
  • Contextualize feelings of hopelessness within the patient's psychiatric illness or diagnosis, or their current life circumstances. Normalizing these feelings provides an understandable model of suicidality. For example, tell the patient:
    • It´s not unusual to feel hopeless when a person is seriously depressed.
    • Suicide is an effort to eliminate psychological suffering.
  • Identify a common goal for treatment, such as the reduction of emotional suffering and psychological pain.
  • Understand the time and resources required to care for high-risk patients and the need to articulate clear expectations and boundaries.
  • Make a realistic assessment of your ability and the time needed to assess and care for a patient who is suidical, as well as of what role you are best suited for.
  • Recognize the time and resource demands of high-risk patients.
  • Articulate and establish appropriate boundaries with high-risk patients.

References

Rudd, M.D. (2006). The Assessment and Management of Suicidality. Sarasota, FL: Professional Resource Press.

Rudd, M.D., Cukrowicz, K.C. & Bryan, C.J. (2008). Core competencies in suicide risk assessment and management: Implications for supervision. Training and Education in Professional Psychology, 2, 219-228.