Abstract
When engaging with persons at risk for suicide, healthcare professionals have an opportunity to make a real difference in the life of the patient. However, the situation can place a great deal of pressure on those trying to help. When dealing with a person struggling with suicidal thoughts, a variety of concerns might arise
A Introduction: The Challenge and Opportunity
Suicide concerns can present themselves in a wide range of healthcare situations, from routine screening to dealing with a person in the aftermath of a suicide attempt, and can even arise spontaneously when talking with a person struggling with suicidal thoughts.
When engaging with persons at risk for suicide, healthcare professionals have an opportunity to make a real difference in the life of the patient. However, the situation can place a great deal of pressure on those trying to help. When dealing with a person struggling with suicidal thoughts, a variety of concerns might arise:
The clinician cares about the person and worries about their safety.
They now feel personally responsible for the safety of the person.
There are time-consuming steps to take and documentation to fill out.
The clinician may be worried about being blamed or held legally liable if something goes wrong.
Settings: Acute Services
Acute services teams have a unique opportunity to support and care for individuals with mental illness who are often at a very vulnerable point in their lives. But time demands, patient volume, and the sheer number of different risks and problems that teams are responsible for addressing can make it hard to take the time for caring interactions that will promote honest disclosure.
These pressures can make it hard to remain focused and to maintain the kind of concerned but calm presence that will help patients through this difficult situation.
This chapter focuses on the core goal of Connecting. Forming a meaningful connection with the patient serves as the foundation for all other steps that need to be taken in a medical setting to support a person with suicide concerns.
B Principles
Forming a genuine connection with an at-risk person not only helps with understanding but is also a preventive measure in and of itself. Maintaining a concerned and calm presence is essential to achieving this goal.
Ask directly about suicide using a standard approach and with the goal of understanding the person’s experience and the purpose that suicidal thinking serves for them.
Involve family and other support people early and often.
Connecting with family members can cast light on the at-risk person’s experiences and can also show how family members can support them.
Approach conversations as a route toward finding common goals with the shared aim of working together to help the person feel better.
Recognize that while medical professionals see suicide as a problem, people with suicidal thoughts see it as a potential last resort solution to problems.
Validate the desire to be free from pain and offer hope that the person can get better.
Express a personal and institutional commitment not just to the person’s safety but to their full recovery.
C Rationale
Forming a meaningful connection is a vital part of suicide prevention. A lack of connection to others was one of the first common problems identified by early observers of suicide,1 and contemporary studies have repeatedly confirmed the link between suicide risk and a person feeling disconnected from those around them.2–5
The practical task of promoting a feeling of connection with professional helpers and with those in the person’s natural support network is a critical component of almost every effective psychosocial intervention.
This chapter will explain key aspects of how to form a connection using three keywords that can serve as a reminder of core skills and practices:
Ask, Collaborate, and Commit.
D Ask
Ask refers to:
1. Asking directly about suicide with a standard approach
and
2. Asking with the goal of understanding the person’s experience
Significant progress has been made in recent years toward the use of standardized tools and measures for assessing suicidal thoughts and behavior (see Chapter 6 for a review of these measures). However, sticking rigidly to the wording used in a validated measure does not guarantee an open and honest response, and can sometimes even be counterproductive. The goal of an assessment is to understand what the person is thinking and feeling. While asking valid questions on a scale is important,6 it is equally important to remember that the person with suicide concerns is an individual with unique experiences. Excessive focus on a standardized tool can sometimes obscure the personalized suffering that underlies and prompts yes/no responses.
In order to provide effective care to a person at risk of suicide, it is vital to form a connection on a human level. The best way to form such a connection is to ask questions that will help provide a personal understanding of how the individual feels.7
Example Questions
“Are you having thoughts about suicide?”
“Where are you when you’re having these thoughts?”
“What’s it like?”
How these questions are asked can have a significant impact on the connection that is formed with the person. In asking questions, it is important to honor the person’s experience of suicidal thoughts and behavior. The goal is to find out what it is like for them and what purpose the suicidal thinking serves for this particular individual.
If somebody says that they have had a specific thought about suicide or have a plan for ending their life, one line of questioning is to ask them what it is like to experience having such thoughts.
“Does that make you feel worried?”
“Does that ever scare you?”
“Have you been keeping that inside?”
Connecting with family members is also important. Engagement with the thoughts and experiences of family members can help the medical professional understand what they are going through. This will make it easier to communicate with them and to work together to take planning actions. Asking about the person’s experiences is the first step toward forming this connection.
“What was it like for you to hear that?”
“Does that feel overwhelming?”
“Does that scare you?”
Although these ways of asking may be unfamiliar, the concern behind them is consistent with what motivates much of our work as healthcare professionals: a direct concern for what the patient is experiencing. When dealing with suicide risk, it can help to refocus on the human dimension of medicine and to center approaches on the fundamental interaction of empathizing with the person who is being cared for.
E Collaborate
Collaborate refers to:
1. Finding shared goals and common ground with the suicidal person
and
2. Involving family and other support people early and often
