How to Respond to a Suicidal Client

According to Michelle E. Toth and colleagues in an article in the Annals of the American Psychotherapy Association, approximately 71 percent of psychotherapists have had at least one client who has attempted suicide. However, a clinician can help reduce risk by knowing what questions to ask and what actions to take when a client begins talking about suicide.

Instructions

• 1

  Make sure the client is safe. This will depend on the setting. If you are in an emergency room, medical or psychiatric hospital, the client can be put under observation to ensure immediate safety. If the client is not in an inpatient setting but is actively suicidal, where they can't stop thinking about hurting themselves, then they need to go to an emergency room or inpatient psychiatric setting. You may need to call an ambulance. If the client is passively suicidal, having had thoughts of hurting themselves but no current plan or intent, then you may want to continue to discuss these thoughts, but emergency hospitalization may not be required.

• 2

  Assess the client's risk. This involves talking to the client and possibly collateral contacts such as family members, friends and other health care providers. Ask about risk factors for suicide. These include current thoughts or ideation, substance abuse, feeling hopeless or helpless, anxiety, social isolation, an underlying mental illness, past suicide attempts, family history of suicide, family history of abuse and history of aggressive behaviors. Other factors that may increase risk of suicide include age and gender; people between the ages of 15 and 24 are more likely to commit suicide and men are more likely to commit suicide successfully. Another important risk factor is access to lethal methods -- whether the client has a plan and the ability to put that plan into action. The number of risk factors and their severity will lead to both an immediate safety plan as well as a long-term treatment plan.

• 3

  Assess the client's protective factors. Although these factors will not necessarily negate risk factors, they can be helpful in creating a treatment plan as they allow you to work with the strengths and supports that the client already has in place. Protective factors to look for include effective support for mental, physical and substance abuse disorders, family, community and social support, ability to solve problems in a non-violent way and cultural beliefs that discourage suicide.