Crisis Intervention (2)

situational cues of suicide

- death of a spouse or divorce - painful physical injury

structural family theory on developmental crises

- focuses on moving the family together through each of their individual stages - learning new roles when the previous ones were not working - addressing enmeshment and disengagement

developmental crisis

- proposed by Erikson wherein there is a specific crisis that a person can go through in each of his developmental stages; the crisis is expected in each stage and health is supposed to resolve the crisis 1. trust vs. mistrust - the crisis is needing someone to trust and the resolution is finding trust in a caregiver 2. autonomy vs shame 3. initiative vs guilt 4. industry vs inferiority 5. identity vs identity confusion 6. intimacy vs isolation 7. generativity vs self-absorption 8. integrity vs despair

what percentage of the population has a psychotic disorder or bipolar disorder

1% or less in each category, but 3% or less when combined

tasks of mourning

1. accept the reality of the loss 2. express the pain and grief - U.S. culture does not allow for open grief processing, most people are completely uncomfortable with someone opening processing grief 3. adjusting to the new environment 4. removing emotional energy from the lost

mental status exam categories

1. appearance - body odor - dirty - naked - poorly groomed 2. attitude - defensive 3. behavior 4. speech - could be substance abuse or a brain tumor - pressured speech often means hypomanic 5. mood and affect 6. tangential - a flowing narrative where the client talks but never returns to their original content 7. flight of ideas 8. disillusions - seeing things - believing that they have powers or other untrue things about themselves or others

crisis of loss

1. bereavement - the state one experiences that includes the feelings of sorrow after the loss of a significant other 2. grief - the feelings of sorrow, anger, guilt, and confusion that arise when one experiences a loss 3. mourning - the expression of grief and the usual response to bereavement influenced by culture and/or religion behavior

5 stages of grief (or of death and dying)

1. denial and isolation = is a healthy initial response because it helps cushion shock 2. anger = usually a sense of rage, bitterness, or injustice; sometimes "why me?" is asked; can mean that the client has accepted the loss as real for the first time 3. bargaining = usually a person will try and bargain their way out of loss with God, but sometimes they will bargain in other ways like "well if I start exercising every day then I can live longer" 4. depression = feelings of hopelessness often coupled with lethargy 5. acceptance = usually people will work through the depression and come to peace with the loss; sometimes this happens through disengagement with the world, others, or a loved one who is dying

myths about suicide

1. discussing suicide will cause the client to move toward it - no, it is helpful to ask and discuss it, it prevents it to intervene 2. clients who threaten suicide don't attempt it - people who threaten suicide are not always attempting manipulation and it is never safe to assume that they are manipulative; take every threat seriously and address behavioral issues later if that is the issue 3. suicide is an irrational act - suicide is rational to the individual; they have assessed their situation through their perspective and have decided that it is the best option 4. people who commit suicide are insane - suicidal people are generally just unable to effectively cope with their stress and are looking for a way out and to whom death seems like the only way 5. suicide runs in families - a suicidal situation is unique to every individual 6. once suicidal, always suicidal - again, it is unique, some people can experience suicidal thoughts once and never again and for some it is chronic 7. when a person has attempted suicide and pulls out of it, the danger is over - there are some times that a person is angry that their attempt did not work 8. a suicidal person who begins to show generosity and share personal possessions is showing signs of renewal and recovery - this can also be a side of suicidality because this is how some people prepare for death 9. suicide is always an impulsive act - most of the time it's not; people experience crisis and generally spiral as they can't cope to the point of suicide; it is rare for someone to impulsively choose to die

quarter life crisis

1. feeling trapped by life choices 2. rising feeling of "I have to get out" 3. quitting whatever is making you feel trapped 4. rebuilding a "new" life 5. developing and cementing new commitments that better reflect the self - relates to most negative smartphone and social media use - usually occurs if there is pre-existing stress

clues that someone may be suicidal

1. giving things away 2. writing a will 3. being preoccupied with death 4. showing psychotic behaviors 5. agitated depression

cultural humility for clinicians

1. lifelong learning and critical self-reflection 2. recognizing and challenging power imbalances for respectful partnerships 3. institutional accountability

three dimensions of cultural humility

1. lifelong learning and critical self-reflection 2. recognizing and challenging power imbalances for respectful partnerships 3. institutional accountability

how do you handle a client committing suicide as a clinician

1. look at it professionally first where you look at their case and see if you have missed anything as a staff 2. then check and see if you are handling it emotionally well

risk continuum of suicide

1. low risk - client has no history of attempted suicide - client has an adequate support system - client is concerned that they have suicidal thoughts (it bothers them a lot) 2. middle risk (most commonly seen by crisis workers) - client is functioning, but not well - client may have a history of threatening suicide - client may have feelings of hopelessness - client likely does not have a plan or at least a defined plan 3. high risk - client is generally depressed and angry - client has a history of suicide attempts - client has both a plan and the means

FOMO

1. making decisions between multiple options 2. perceived ability to exhaust 3. predictive imagination 4. fear of missing out

potential red flags of homicidal ideation

1. perception of humiliation or abandonment by others 2. presence or history of antisocial personality disorder 3. poor impulse control and the inability to delay gratification 4. feeling of being controlled by an outside force 5. being under the influence of substances 6. frontal lobe dysfunction or TBI

fomo

1. seeing all the attractive options 2. understanding you can't do it all 3. predicting what will happen if you do not participate 4. emotional distress - racing thoughts - inability to commit

Erikson's Eight Stages of Development

1. trust vs. mistrust 2. autonomy vs. shame and doubt 3. initiative vs. guilt 4. industry vs. inferiority 5. identity vs. role confusion 6. intimacy vs. isolation 7. generativity vs. stagnation 8. integrity vs. despair

Elisabeth Kubler-Ross

5 stages of greif- deny, anger, bargain, depressed, accept

what percentage of people who plan suicide attempt it

72

Psychotic decompensation

A state in which the client is out of touch with reality and shows symptoms such as delusions and hallucinations. This often happens when a schizophrenic patient stops taking medication or at the beginning of a person's first schizophrenic episode. The state can also be associated with bipolar disorder and paranoid disorders. This person usually requires involuntary hospitalization

High-risk suicidal clients

Clients who have a plan, the means, and the intent to complete suicide; they cannot be talked out of harming themselves. Hospitalization is often indicated for such clients. - if possible, the client should willingly admit themselves to the hospital because it empowers them and reduces the potential conflict of an involuntary hospitalization

Middle-risk suicidal clients

Clients who have been thinking about suicide and feel depressed. These clients probably still have some hope, but they might also have a suicide plan. Crisis intervention should be intense and frequent.

Low-risk suicidal clients

Clients who have pondered but never attempted suicide. These clients have adequate support systems and can usually be treated as outpatients. Therapy and educational interventions are encouraged. will say things like, "it scares me to feel this way" - elderly people who have lost a spouse are commonly low-risk suicidal

suicide watch

Observation by family or friends of those who are at middle risk of hurting themselves. Someone stays by the client's side 24 hours a day to ensure that the person does no harm to himself or herself. Suicide watches are also conducted in psychiatric facilities for high-risk clients.

gravely disabled

The inability of a person to meet his or her basic needs (like food or shelter) and to provide self-care

evolutional crises

The normal stages a family experiences as it evolves through the life span of its members. The crises result from having to adjust to the formation of the following subsystems: marital, parental, sibling, and grandparent

emergency psychiatry

When services are provided in an emergency setting such as a hospital to people with serious suicide attempts, life threatening substance abuse conditions, vegetative depression, psychosis, violence, or other rapid changes in behavior

no suicide contract

a contract made between a nurse or counselor and a patient, outlined in clear and simple language, in which the patient states that he or she will not attempt self-harm and in which specific alternatives are given for the person instead

quarter-life crisis

a crisis caused by a feeling of being locked in by life choices and a rising sense of "I have to get out" - quitting whatever is making the person feel trapped and embarking on a "time out" period to try out new experiences in order to figure out who the person wants to be - a period of rebuilding your life - treated by going back to identity vs. identity confusion to figure out who this person is and what the plan for their life could be

structural family therapy and developmental crises

a family can enter crisis if they hinder another member from passing through a critical developmental period

fear of missing out

a feeling of anxiety that an exciting or interesting event may currently be happening elsewhere

mental status exam

a set of interview questions and observations designed to reveal the degree and nature of a client's abnormal functioning

copycat suicide

a suicide that follows a highly publicized suicide of a public figure, idol, or peer in the community; often motivated by the pomp of the original suicide response, leading a person to want that for themselves

the frontal cortex is not fully developed until

age 25

in order to prevent something going undone or unsaid that will allow a person to reach suicide

always ask "what can we be doing to serve you better?"

how do you handle someone who is suicidal due to grave disability or psychosis

always hospitalize, no matter what

evolutional crisis

as a family develops and changes, crises that arise from the changes; also called normal passages in family development 1. crises arisen from getting married 2. crises arisen from having a child 3. crises arisen from having multiple children 4. crises arisen from becoming a grandparent

scales are not generally given to suicidal patients

because it is an emergency in nature and the person does not have the time

emic issues

behaviors and expectations that are unique to a specific culture

etic issues

behaviors or expectations that we see across cultures

catatonic

characterized by a marked lack of movement, activity, or expression

suicidality is most often rooted in

depression, so the clinician will likely try and treat the client's depression to see their suicidal thoughts decrease

non-suicidal self-injury

direct, deliberate destruction of body tissue in the absence of any intent to die - generally viewed as an impulsive disorder - often the result of abuse, trauma, poor self-esteem, mood swings, and fear of abandonment - seen in about 4% of general adult population, 21% of adult psychiatric inpatient populations, about 40-60% of adolescent in psychiatric inpatient settings - top five methods are cutting/carving one's skin, picking at a wound, hitting oneself, scraping one's skin to draw blood, and biting oneself - top five reasons are to stop bad feelings, feel something, self-punishment, to relieve feelings of numbness or emptiness, to feel relaxed, and to do something while one is alone

the most effective means of suicide prevention is

education

family systems theory on developmental crises

every family maintains a norm, and sometimes that is unhealthy or toxic, so, if a person tries to make a change the family will prevent the change from happening to maintain homeostasis - address new positive meaning to the change so that the family can accept it

no suicide contracts

having the client sign a contract to say that they will not hurt themselves - from a legal perspective, no suicide contracts do not stand up in a court of law because the client is not considered to be in their right mind, putting the clinician at risk of legal punishment

suicide is more common than

homicide

usually uncontrollable emotions do

not come immediately after a loss, but after a period of time; people usually become numb after a loss

codependency is fueled by

outside messages like "idk what your family would do if you weren't there"

SIS-MAP

scale for impact of suicidality management assessment

non-suicidal self-injury (NSSI) and self-mutilative behavior

self-inflicted bodily injury without suicidal intent diagnosis requires: 1. five or more days in past year of intentional self injury with the absence of suicidal intent 2. engaging in self injury to gain relief from a negative feeling or experience 3. the self injury is related to negative thoughts and feelings and thinking about hurting oneself preoccupies the client's thoughts 4. the behavior is not socially sanctioned or restricted to picking a scab or nail biting 5. behavior causes distress and inhibits proper functioning 6. the behavior does not occur exclusively during psychotic periods or drug-induced phases and is best described by another syndrome - the disorder is often a result of emotional instability, abandonment fear, and poor self image - represents about four percent of adults and about twenty one percent of the adult psychiatric in patient population

never never never make a list of

the pros and cons of suicide because the person who is seriously considering suicide, the pros will always far outweigh the cons

suicidal ideation

thinking about suicide, usually with some serious emotional and intellectual or cognitive overtones

disengaged families

those whose members are isolated from one another

homicidal ideation

thoughts of killing or harming another person

midlife crisis

triggered usually by feelings of a lack of purpose or that one's life is over - can be treated by working on practical ways to eliminate depression and in some cases, marriage counseling

enmeshment

when everyone in a family is overly involved in the others, feelings, decisions, wishes, and behaviors - a crisis may occur if someone attempts to break out from an enmeshed family because members are not often able to function on their own and other members do not like seeing independence in others

family systems theory and developmental crises

when one person in a family changes, the others will resist to try and maintain what is familiar

asking about a client's suicidal feelings

will often make them feel better

as a clinician

you should always be able to defend the decisions that you make