Assessing/intervening with suicidal ideations

[KyleC]

Hello again everyone

First off thank you for being such a great community! I perform oversight at my workplace and usually have to answer my questions by doing my own research, and your replies to my posts have been invaluable in helping to guide my study.

I am getting ready to perform an in-service on individuals who report suicidal ideations.

I want to equip staff to help guide an individual who makes statements such as, "I feel depressed," or "I feel suicidal." This is a group home setting, and individuals with a history of suicidal ideations often express these thoughts. Currently, the homes in which these particular individuals live are staffed by unlicensed personnel, so I want to give them some concrete teaching for handling these situations on a daily basis.

So, here are my questions:

1. What classifications exist to categorize suicidal statements? I.e., "I feel suicidal," vs "I am going to commit suicide," vs "I plan to lay down in the street at night and let someone run me over." I know these statements can have very different meanings, but I would like to learn more about how to categorize them, and what actions to take in each scenario.

2. In each situation, what can a staff member say to the individual in order to determine the risk level, and find out whether the crisis prevention team should be called? Despite having past legitimate episodes, these individuals do crave attention, and I feel it is important to determine whether it is a genuine emergency. I realize that every statement of suicidal thoughts should be taken 100% seriously, but I am concerned about false alarms wearing down the vigilance of staff and emergency responders.

Links to articles / sources are greatly appreciated!

Thank you

[redmielita]

I don't know how helpful this will be to your situation, but when we've had consumers with suicidal ideation at our facility, policy has been to contact guardian/family and get their input, preferably also have them speak with the consumer. We then take guardian/family's input into account when determining risk level and whether or not we need crisis intervention. I recall one particular incident where staff didn't think that the consumer was necessarily in particular danger, but upon speaking with guardian their response was "Call the crisis team NOW!!!" Come to find out that sure enough, consumer had a plan to carry it out. So we've found that input can be invaluable.

[bear14]

Depending on the age I would ask what they mean by wanting to kill themselves. I have found with some of my clients they use that as a general term but not really wanting to do it. Some have said they wanted to kill themselves or die but when you really sit and talk with them they want to get away (take a break) but not really die. Obviously you take all statements seriously but when you can sit and talk you find out they are not always suicidal.

[NutmeggeRN, BSN]

Specifically asking them if they have a plan? what is it? how do they think they will execute it? Do they have access to a means? A weapon, a prescription etc. If they cannot articulate a clear thought process on this, they MAY be less likely to really be looking to kill themselves.

BUT! It is important to make sure someone else is advised (preferably with training) and they can make the decision as to how intense the intervention may need to be. Sometimes it is making an agreement not to harm all the way to admission to a hospital for evaluation. Gatekeeper training by NAMI may be a good place to start. Or contact your local mental health agency to see if they will do some training. Good luck!