Suicidal Behavior Disorder describes a client who has attempted suicide in the past two years and includes unsuccessful attempts and completed suicides. Nonsuicidal self-injury is when a client inflicts self-injury without the intention to result in death and may also be considered as a precursor to suicidal behavior. While suicide is not a mental illness of itself, it usually stems from another, underlying condition such as depression, bipolar disorder, PTSD or schizophrenia. Studies indicate that clients who typically have completed suicides are primarily men, as men tend to choose more lethal forms of injury (gun, jumping from heights, etc.) and women use less lethal methods such as drug overdose. All suicide threats or attempts should be taken seriously for all people, regardless of age or gender.
Diagnostic Criteria:
Current disorder: the most recent suicide attempt has been within the past 24 months
Disorder in remission: the most recent suicide attempt was longer than 24 months ago
Client will not attempt suicide. Client will remain safe, without self-inflicted harm. Client will identify alternative activities or support systems to prevent future suicide attempts.
Perform neurological assessment
Determine baseline and if there are other neurological conditions present that may cause symptoms.
Initiate one-on-one monitoring at arm’s length per facility protocol. Avoid leaving client unattended for any reason (including and especially bathroom or shower time)
Ensure client safety and remove opportunity to harm self.
Follow your facility’s specific protocol regarding supervision, restraint, and documentation.
Create a safe environment by removing potential weapons or objects that may inflict harm (weapons, utensils, sharp objects, belts, ties, etc.)
Provide safety and remove items that may be used impulsively during actively suicidal phase.
When possible, remove monitor cables and electrical cables that are not being actively used.
Encourage client to discuss feelings, emotions, fears and anxieties and alternative ways to cope with those feelings
To determine the cause, if any, of client’s actions or thought processes.
Helps client gain a sense of control over actions and life in general
Emphasize resiliency with client to understand that
Help clients see that there are other ways of dealing with circumstances and give them perspective and hope
Assess for signs that the client has a plan to commit suicide
Ask specifically “do you have a plan?”. The client may even state “yes, I’m going to take that cable and hang myself with it” – this allows you to remove these objects from their reach.
Clients who have made the decision to follow-through with a planned suicide attempt may suddenly feel calm or relieved. This can be hard for caregivers or family members – they may perceive it as the client getting better.
Obtain history from client and family members
Determine if client has a personal or family history of suicide that would increase their risk, or any recent catastrophic events that may have prompted such behaviors (death of a loved one, loss of job, divorce, etc.)
Assist client in creating and sign a no-suicide contract
Demonstrates an alternative plan for coping when they feel suicidal instead of acting on impulses.
Allows client to feel more in-control of actions and promotes accountability
Identify situations or triggers and ineffective coping behaviors that may result in suicidal thoughts or actions
To determine most appropriate interventions and develop more positive coping techniques
Carefully and compassionately make client aware of unrealistic or destructive thinking and offer alternative or more realistic ideas and explanations
Constructive interaction helps client become more open to realistic and satisfying opportunities for the future
Discuss and identify things that are important to or have meaning for the client (religious beliefs, family, goals and dreams)
Helps refocus client’s thinking and priorities, and renews potential for attaining goals. Provides support and encouragement. Gives client something to hope for.
Teach positive problem-solving techniques
Helps client identify and learn more creative and positive avenues for coping with stress
Enlist client’s family members or friends to be available for client to call on in cases of crisis
Gives a sense of value to the client and reminds them that they are not alone. Provides a support system for the client. Helps family and friends understand the struggles that the client is facing.
Administer medications carefully and appropriately
Antidepressants and anti-anxiety medications may be given to improve client’s daily functioning ability and provide relief during crisis situations.
Provide resource information for support groups, hotlines and counselors that are available 24/7
Gives client support and more resources to help cope with emotions and underlying conditions such as substance abuse
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