Crisis intervention strategies chapter 8

SCOPE OF SUICIDE CASES"If you are planning to become a mental health professional, the odds are about 1 in 4 that you will come face to face with a suicide."... * Assisted suicide - som

Chapter 8 - Crisis of Lethality

FOCUS OF LETHALITY

1. Instrumental - Acts of homicide that occur for some

financial or other concrete gain

2. Expressive - Acts designed to reduce psychological

pain (emotionally distraught, helpless, etc.)

SCOPE OF SUICIDE CASES

In the U.S.:

* 30,000 to 35,000 every year

* May be underreported (many may be reported as accidental)

* May be as high as 60,000 per year

* 300,000-600,000 Attempts per year (19,000 survivors

permanently disabled)

* 10th -11th leading cause of death

SCOPE OF SUICIDE CASES

In the U.S.:

* Age 15-24, largest increase in past 30 years

* Men, 4 times the rate than women

* Elderly (10% of US population) - 25% of all suicides occur in the over 65 group, and much higher after 70

SCOPE OF SUICIDE CASES

"If you are planning to become a mental health professional, the odds are about 1

in 4 that you will come face to face with a suicide."

* Assisted suicide - someone else provide the means

(lethal agent) but the person who is dying administers it

* Euthanasia - Someone else administers it.

"The appropriate role of the crisis worker

is to intervene and attempt to prevent all suicides and homicides that he or she

possibly can."

PSYCHOLOGICAL THEORIES OF SUICIDE

* Freudian Inward Aggression (Intrapsychic conflict when dealing with psychological stress) Depressions becomes self-destructive

* Developmental ( one does not navigate life stages and are unable to cope)

* Deficiencies (mental deficiency caused risk factors)

* Escape (Flight from situation that is intolerable)

* Hopelessness (there is nothing one can do to change a situation)

*Psychache (psych-ache) - (one has intolerable psychological pain)

SOCIOLOGICAL THEORIES OF SUICIDE

* Durkheim's Social Integration

Societal integration - degree to which people are bound together in social networks

Social regulation - degree to which the individual's

desires and emotions are regulated by societal norms and customs

SOCIOLOGICAL THEORIES OF SUICIDE

Durkheim's Social Integration

* Egoistic suicide - ones lack of integration or identification with a group

* Anomic suicide - a perceived or real breakdown in the norms of society (such as financial and economic ruin)

* Altruistic suicide - perceived or real social solidarity, (such as 'hara-kiri'

or mid eastern extremist groups)

* Fatalistic suicide - when a person sees no way out of an intolerable or oppressive situation (such as confined n a concentration camp)

SOCIOLOGICAL THEORIES OF SUICIDE

Suicide Trajectory Model - considers multiple factors,

* biological (substance abuse, being male , genetic predisposition

to depression)

* psychological (low self-concept, hopelessness, borderline

personality disorder)

* cognitive (rigid, dogmatic, irrational, all-or-none thinking)

* environmental (access to firearms, stressful occupations, loss,

family)

SOCIOLOGICAL THEORIES OF SUICIDE

Interpersonal Theory (three

SOCIOLOGICAL THEORIES OF SUICIDE

Existential-Constructivist Framework

-Trigger events that come from suicide trajectory risk

factors

- combine to form the critical mass that allows the

individual to construct a worldview that it

- is a better choice to no longer view the world at all

OTHER EXPLANATIONS

1 Accident (pushing their luck

2 Biochemical or neurochemical malfunction

3 Chaos (unpredictable behavior can occur within predictable systems)

4 Dying with Dignity/rational suicide

5 Ecological/integrative (painful intrapsychic factors interact with negative interpersonal/societal issues

6 Interactional - suicide because of external rage toward

another

OTHER EXPLANATIONS

7 Ludic suicides - having the desire to experience an ordeal or a way to

prove oneself in gamesmanship (Russian roulette, tribal rite of passage)

8 Oblative suicides - Those that are sacrificial in nature and seen to put one

in a 'higher' place (LSD user who 'wants to meet God, or Buddhist monks

who set themselves on fire)

9 Overlap Model - Lack of social support, biological propensity to suicide, and presence of psychiatric disorders (the more of these areas over-lap the greater the potential for suicide

10 Parasuicide - (acts that closely resemble suicide, self injurious behavior, risky behavior that could cause death)

6 COMMON CHARACTERISTICS OF PEOPLE WHO

COMMIT SUICIDE

1 Situational Characteristics (unendurable psychological pain)

2 Motivational characteristics (The purpose is to see solution)

3 Affective characteristics (emotions of hopelessness and helplessness)

4 Cognitive characteristics (1 ambivalence between doing it and wanting

to be saved, (2 and perception of limited options

5 Relational characteristics 1) Communication of intention, 2) have the right to get out of 'pain'

6 Serial characteristic - lifelong patterns of coping with pain

SIMILARITIES BETWEEN SUICIDE AND HOMICIDE

* Often, the person who is suicidal is also homicidal

* 30% of violent individuals have a history of

self-destructive behavior

*10-20% of percent of suicidal persons have a history of violent behavior

MYTHS ABOUT SUICIDE

Read pages 216-217

ASSESSMENT USING SUICIDE CLUES

1 Verbal clues - spoken or written, (I'm of no use to

anyone anymore)

2 Behavioral clues - purchasing a grave marker, slashing wrist

3 Situational clues - bankruptcy, death of a spouse,

divorce, terminal illness

4 Syndromatic clues - severe depression, loneliness,

hopelessness, dependence, dissatisfaction with life

AAS

American Association of Suicidology

ASSESSMENT INSTRUMENTS

"Are most helpful when backed up by a clinical interview and third-party

collateral information."

CLINICAL INTERVIEW

Page 219-220: When a person

manifests four or five of these risk

factors, it should be an immediate signal for the crisis worker to treat the person

as high risk in terms of suicide potential.

* Some have more weight than others (previous attempts

or having a concrete plan)

* As these risk factors add up, the potential increases

* Page 221: SIMPLE STEPS - step-by-step method

to assess lethality and get a good read on the client

INTERVENTION STRATEGIES

Perturbations - Anxiety: mental

uneasiness

* A cause of such anxiety or uneasiness

* Synonyms: disturbance, trouble,

agitation, unrest, anxiety

Suicide Intervention strategies involve

"interrupting a suicide attempt that is

CRISIS INTERVENTION STRATEGIES

Two Categories

1 Dealing with perturbations (using The Three I's)

2 Reducing lethality levels

When perturbation level is lowered and

some control and hope is restored in the person's life, lethality will drop below the

THE THREE I'S

The major causes of perturbation have to do

with the three I's.

The person confronts a situation he or she

believes to be

* Inescapable (can' t get away from it)

* Intolerable (can't stand it any longer)

* Interminable (it won't end)

After establishing rapport and trust, crisis work

OLDER ADULTS

Highly neglected area in the entire field

of suicidology.

OLDER ADULTS ASSESSMENT

OLDER ADULTS ASSESSMENT

OLDER ADULTS ASSESSMENT

Psychodynamic Factors:

* Stress or strain of various losses

(spouse, friends, work roles and income)

* Thinking "I am just growing old"

HOMICIDE/SUICIDES OF ELDERLY

Not "mutual, dying together pacts"

Not Impulsive acts

Often acts of desperation, anger, and depression

1 Aggressive - (violence, marital problems,

financial, health problems)

2 Dependent-protective caregiver - (isolation,

helplessness, fears of losing control)

3 Symbiotic - (highly dependent, usually sick)

FAMILY, FRIENDS, AND ASSOCIATES

Best help is educational.

Help them learn about risk factors, cues, and cries for help

Can be a part of treatment.

Help them become aware of the suicidal persons feelings and actions that

reciprocally influence each other.

Do not deal with the past issues, at least

POSTVENTION (SURVIVORS OF SUICIDE)

Vulnerable to physical and mental health problems Faced with guilt, shock, trauma, police

interrogation, legal issues, shame sleep difficulties, concentration problems, denial, family relationship problems, complicated long-term grief.

Anger that they 'skipped out' on responsibilities.

Especially serious for child survivors and parent

survivors.