Crisis intervention strategies chapter 8

Chapter - Crisis of Lethality FOCUS OF LETHALITY Instrumental - Acts of homicide that occur for some financial or other concrete gain 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, 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 in that you will come face to face with a suicide." EUTHANASIA * 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 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) 10 WARNING SIGNS IS PATH WARM: Ideation Substance Abuse Purposelessness Anxiety and agitation (Feeling) Trapped Hopelessness Withdrawal Anger Recklessness Mood fluctuations 19 AAS American Association of Suicidology 20 ASSESSMENT INSTRUMENTS "Are most helpful when backed up by a clinical interview and third-party collateral information." 21 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 22 ASSESSING LETHALITY When intervening client in acute crises * Never omit an assessment for suicide lethality * Do not hesitate to ask * Don't sugarcoat * Page 221: SIMPLE STEPS - step-by-step method to assess lethality and get a good read on the client 23 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 imminent or in the process of occurring" 24 CRISIS INTERVENTION STRATEGIES Two Categories Dealing with perturbations (using The Three I's) 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 explosive level 25 THE THREE I'S The major causes of perturbation have to 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 with deal with I's actively 26 OLDER ADULTS Highly neglected area in the entire field of suicidology 27 OLDER ADULTS ASSESSMENT Ego-Weakening Factors: * chronic and acute physical and mental illness * elder abuse * alcoholism * prolonged stress * failure to respond to medical treatment * complicated/prolonged grief 28 OLDER ADULTS ASSESSMENT Social Factors: * fewer friends * living alone * being excluded or living away from social and family events * getting separated from family 29 OLDER ADULTS ASSESSMENT Psychodynamic Factors: * Stress or strain of various losses (spouse, friends, work roles and income) * Thinking "I am just growing old" 30 HOMICIDE/SUICIDES OF ELDERLY Not "mutual, dying together pacts" Not Impulsive acts Often acts of desperation, anger, and depression Aggressive - (violence, marital problems, financial, health problems) Dependent-protective caregiver - (isolation, helplessness, fears of losing control) Symbiotic - (highly dependent, usually sick) 31 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 while in crisis mode 32 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 * Support Groups are very helpful 33 ... 23 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 imminent or in the process of occurring" 24 CRISIS INTERVENTION STRATEGIES Two Categories Dealing with perturbations (using The Three I's) Reducing lethality... 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