SCENE 15 Suicide risk assessment
Summary
TLDRIn this video script, Yan discusses his struggles with depression, work performance issues, and overwhelming feelings of helplessness. He reveals suicidal thoughts, driven by the desire to escape his problems. Yan acknowledges protective factors, such as his daughter and religious beliefs, but feels these are weak motivators. The conversation focuses on assessing his immediate risk, identifying protective factors, and exploring potential support options, such as contacting his brother. The therapist emphasizes the importance of a thorough risk assessment, ensuring client safety, and finding solutions to encourage hope and well-being.
Takeaways
- 😔 Ian is feeling overwhelmed due to a poor work performance review, which he attributes to his ongoing depression.
- 😞 He feels that life is becoming too much to handle, with one problem piling on top of another.
- 💭 Ian is experiencing frequent suicidal thoughts, particularly since the review, and finds it hard to escape these thoughts.
- 💊 He has thought about using his medication as a means to end his life but hasn't acted on it yet.
- 👨👧 His daughter and religious beliefs are factors that have prevented him from taking action on these thoughts so far.
- 📸 Ian spends a lot of time at home, looking at photographs, which makes him feel worse, compounding his sense of isolation and hopelessness.
- 👪 While Ian considers contacting his brother for support, he hesitates due to concerns about burdening him with his problems.
- 📞 Despite agreeing to call his brother after the session, there is uncertainty about whether Ian will follow through, necessitating follow-up support.
- 🔍 The therapist emphasizes the need for a thorough risk assessment, including understanding the likelihood and imminence of Ian acting on his suicidal thoughts.
- 🛡 Protective factors like Ian’s daughter and religious beliefs need to be reinforced, and his support network, especially his brother, should be actively engaged to provide support during this critical time.
Q & A
What was the main issue Ian discussed during the session?
-Ian discussed feeling overwhelmed after receiving a poor performance review at work, which he attributes to his depression. This review has contributed to his sense of helplessness and worsened his mental state.
How does Ian feel about his current situation?
-Ian feels overwhelmed and hopeless, describing his situation as one problem piling on top of another. He expresses difficulty in seeing how things could improve.
How frequently has Ian been experiencing suicidal thoughts?
-Ian admitted that his suicidal thoughts have been frequent, especially after the performance review over the past few days.
What reasons does Ian give for not acting on his suicidal thoughts?
-Ian mentions two reasons: his daughter, as he doesn't want her to think he lacked the courage to continue living, and his religious beliefs, which discourage suicide.
What method does Ian mention for potentially acting on his suicidal thoughts?
-Ian mentions that he has considered using his prescribed medication to end his life, though he is not entirely sure about the outcome.
What stops Ian from engaging more with strategies to feel better?
-Ian admits that he hasn't been able to focus on strategies for improving his situation because he's been feeling too overwhelmed and stuck in a negative mindset.
What coping strategy does Ian consider during the session?
-Ian considers visiting his brother John and his family as a potential source of support, though he hesitates because he worries about burdening his brother with his problems.
What does Ian spend his time doing since his performance review?
-Ian has been spending most of his time in bed or sitting around the house, often looking at photographs of his deceased wife, which he acknowledges makes him feel worse.
How does the therapist assess Ian's risk level during the session?
-The therapist is concerned about Ian's safety, especially since Ian indicates that the part of him wanting to end his life is stronger than the part resisting it. The therapist also asks about Ian’s plan to call his brother for support and considers checking in later to ensure he does.
What are some protective factors identified during the session?
-The therapist identifies two protective factors: Ian’s concern for his daughter and his religious background, both of which play a role in preventing him from acting on his suicidal thoughts.
Outlines
😔 Feeling Overwhelmed with Work and Depression
Yan shares that his depression is affecting his work, resulting in a poor performance review from his boss. This negative feedback has added to his stress, leaving him feeling overwhelmed and questioning his ability to cope. He describes a mounting sense of helplessness, as challenges in his personal life and work keep piling up without improvement. Yan admits he feels like things will never get better, contributing to his sense of despair.
💔 Suicidal Thoughts and Inner Conflict
Yan expresses that he has been having frequent suicidal thoughts since his bad performance review, feeling that ending his life may be the only solution to stop his overwhelming problems. He reveals that these thoughts are persistent and details his consideration of using his medication to end his life. However, the thought of his daughter and his religious beliefs serve as barriers to acting on these thoughts, though they don't completely eliminate his sense of hopelessness.
🛌 Struggling with Isolation and Support
Yan admits to spending a lot of time in bed and isolating himself, particularly looking at photographs that make him feel worse. Despite feeling that taking his life may be a solution, he also acknowledges not wanting to burden his brother, John, with his problems. However, he considers contacting his brother for support. The therapist encourages Yan to reach out to John, suggesting that being with family might help him feel less alone.
🚨 Assessing the Risk and Protective Factors
The therapist reflects on the session, emphasizing the importance of conducting a thorough risk assessment for clients like Yan who are contemplating suicide. They note that Yan's protective factors, such as his daughter and religious beliefs, are significant but not strong enough to fully counteract his desire to end his life. The therapist stresses the need to assess the lethality of the means Yan is considering and whether he has a support system in place, like his brother, to keep him safe.
Mindmap
Keywords
💡Depression
💡Suicidal Ideation
💡Performance Review
💡Helplessness
💡Support Structures
💡Protective Factors
💡Risk Assessment
💡Means
💡Lethality
💡Imminence
Highlights
Yan feels overwhelmed after receiving negative feedback on his work performance due to his depression.
Yan struggles with concentration at work, which exacerbates his feelings of helplessness.
He admits to feeling as though things won't improve, contributing to his sense of despair.
The conversation reveals Yan has been contemplating ending his life as a way to stop the overwhelming feelings.
Yan frequently has suicidal thoughts, especially after the negative performance review, which increases his distress.
He shares that the idea of suicide involves taking all the medication prescribed to him by his doctor.
Despite these thoughts, he mentions his daughter and religious beliefs as factors that have stopped him from acting on his suicidal impulses.
The therapist explores how Yan feels about his thoughts of wanting to stop his suffering versus wanting to die.
Yan has been spending time in isolation, looking at photographs, which he admits makes him feel worse.
The therapist expresses concern for Yan's immediate safety and the possibility of him acting on his suicidal thoughts.
The suggestion of calling his brother John for support is discussed, but Yan worries about burdening him with his problems.
Yan acknowledges that his brother likely wouldn’t view him as a burden, but he still hesitates to reach out.
The therapist emphasizes the importance of support during such a vulnerable time and suggests Yan contact his brother after the session.
The therapist discusses the difficulty of focusing on strategies to feel better amidst overwhelming feelings.
The therapist plans to follow up with Yan to ensure he contacts his brother for support, showing concern for his well-being.
Transcripts
okay Yan so you've been telling me that
you've actually had quite a a rough week
this week can you tell me a bit more
about what's been going on for
you um things were things were bad as
you know last time I saw you but I had a
a meeting with my boss right this week
and
um it was about my work
performance um and I I think that my
depression's been getting in the way of
you working properly at work as well
haven't been able to concentrate and so
on
so he um didn't really think that I'd
been performing too well um so my review
was quite bad in a number of areas and I
don't know I
just I just feel as though it's just
another thing that I don't really need
to deal with at the moment on top of
everything else okay so it's leaving you
feeling quite overwhelmed yeah
overwhelmed and
just just don't know if I can handle it
anymore okay when you say that you don't
feel that you can handle it what kind of
goes through your mind thinking about
that
it's it's just one thing on top of
another on top of another and no matter
what I do I just just you know I can't
seem to see how things are ever going to
get any better
mhm MH so it's very very hard with all
of this happening with your financial
problems within having the the you know
having difficulty at work because you're
feeling so depressed with your
concentration to ever even think that
things might get
better okay does that kind of make you
feel that it's kind of not worth it at
the
moment yeah I just I don't think that
anything I can do is going to help me
get out of this okay
rut so feeling quite
helpless
okay does that make you think at all
about wanting to end your
life it does how often is that coming up
for
you quite yeah a lot in the last since
the review last few days last few days
okay so you you having those kind of
thoughts going through your
mind do you have anytime when they're
not going through your
mind not much not much okay so so tell
me a bit more about what actually goes
through your mind when you think about
this just I think
it just be a lot
easier just to
bow out
M so that that seems like kind of an
option that that would
work okay have you thought about how you
might do it if you were to bow
out
yeah
okay sorry it's a little bit hard to
talk about mhm take your
time
probably you know with the medication
that my GPS put me on right and I don't
know much about it but i' imagine if I
took enough it would be enough okay so
when you think about it you think well
if I took all the medication that I have
then then maybe that would be enough to
to end my life I think so
okay and um you know you you're
obviously here
today so what is stop you so far from
actually acting on those
thoughts not much
um I don't know I I don't like the idea
of my daughter thinking MH
that I didn't have the guts to stick
with my life
mhm okay so so that's something that
kind of stops you when you think think
about her a bit Yeah a bit any other
things I'm from a fairly religious
background I suppose and does that feel
for you that kind of are stopping you
from so far from having kind of done it
okay and are you aware Ian of kind of
what you're hoping will
happen cuz sometimes I know when we
feeling this desperate and we feeling
very very overwhelmed we can get a sense
of we just want things to
stop versus maybe wanting to kind of to
die so I'm just trying to understand
what it feels like for you I just want
it to stop you want it to stop okay so
it seems that saying taking all the
pills that you have would be one way of
having a solution to your
problems okay but when you think about
that what's stops you from actually
doing anything is the feeling of you
know what your daughter would feel like
if you did it and also that it kind of
goes against your
beliefs okay but it must seem quite
quite overwhelming to have those
thoughts then
yeah just seems like the
only the only way the only way okay so
has it been quite hard for you in the
last while as well the last week since
you had the performance you to focus on
the things that we've been talking about
in terms of the things looking at
strategies that may help you to start to
feel
better yeah I'm sorry I haven't really
given that much thought okay so that's
been really really hard to hold on
to okay so I just want to kind of check
what have you have you still been going
to work since the performance review
what have you been doing
spending a lot of time in bed right just
sitting around the house
mhm looking at
photographs this is off
your my Bo
yeah and the more you do
that does it make you feel
worse okay
so it would seem that we're in a a kind
of a dilemma here there's one hand you
have this one option that would seem to
solve all your problems in that it would
stop it would make everything stop but
on the other hand there's a part of you
that doesn't want to do
that yeah okay how strong do you think
that part of you is at the
moment not very not very
no no okay saying a percentage wise
which which part feels stronger the one
that says okay well let's just go home
and take all the
pills it's much stronger that's much
stronger okay do you have you been
collecting the pills for that only the
ones that I've only the ones the do so
those are the anti-depressants in the
sleeping tablet okay right
so I'm wondering what you know CU this
is quite concerning in a way and I'm
quite worried about you in terms of
going home and feeling like this and
having to deal with the struggle um do
you have any ideas of what you think
might be helpful for support for you at
this point in time
it's hard to even think about anything
else rather than think this this point
okay do you have cuz I'm wondering how
helpful it is for you to to sit at home
kind of looking at
photographs kind of thinking constantly
about your wife and that she's not there
and and those kind of things how almost
that makes you feel
worse so I'm wondering maybe during the
time while you're feeling like this
whether we can think of anything that
may help you to to kind of feel more
supported to feel less
alone I could give John a ring I suppose
is my brother
right going and visit him and his family
mhm do you feel that you'd be able to do
that
MH I don't want to kind of Burden him
with all of this though and just cuz my
relationship's in the toilet doesn't
mean he has to kind of suffer all of my
misery as well okay so you worry about
being a burden to him or putting your
problems on him okay would would he see
it that way
probably not probably not because you've
described him as being quite supportive
and that's great and and and that you
normally have quite a good
relationship okay okay so so do you feel
that you could contact him say after the
session or would you prefer to do it
maybe
together I can give him a call mhm yeah
I going do it after the session when I
get home when you get home home
okay
um you know as you would was saying a
bit earlier sitting at home and looking
at photographs and I'm assuming probably
your sleep is still quite affected as
well from what you were telling me in
the last session and and how how are you
eating at the
moment not much over the last couple of
days I haven't really felt you haven't
felt like eating at all so so it's it's
really been hard to kind of look at
anything else than I just want it to
stop and this is my kind of way out of
stopping but it kind of goes
against kind of a religious beliefs and
feeling that this wouldn't be very good
for your daughter as
well okay so maybe there's a time where
you
could be with someone with your brother
and just to help you through this really
kind of tough time until we can start to
work on looking at other things that
might be more helpful for you how does
that sound to
you something I
suppose yeah
okay would it be helpful for me to maybe
give you a call later on to see whether
you have kind of contacted your brother
and manage to talk to him and I can call
him yeah I can do that
if you sound like you feel quite
confident that that you'll do that I can
do that
okay all
right as we can see from that scenario
Ian was quite depressed and feeling
quite helpless and hopeless and was
admitting to um having constant suicidal
liation or thinking about that he wanted
his problems to stop although he wasn't
saying that he was actually wanting to
die now what would would be important is
to take enough time to actually do a
thorough RIS assessment and it was clear
that I hadn't been able to get all the
information that I would like to in in
the brief 10 minutes that you saw some
of the things that will be important to
to get from Ian would be whether he he
would actually make an attempt in that
How likely did he feel that he would
actually act on his thoughts so asking
things like you know how likely do you
feel that you would act on the thought
that you're
having so if you were to go home now How
likely do you feel that you might
actually take the anti-depressants and
how many do you think you would take the
other thing to ask him would be whether
he'd actually done a trial run whether
he'd taken any extra antidepressant and
how that had gone and hopefully this is
something that I would have done in an
assessment interview with him was to
find out whether he'd had any previous
attempts of suicide and how what those
attempts in
tailed now Ian had said that he would
phone his brother however it was unclear
as to when he might do that or or how
safe he was at that point in time so the
other thing I'd want to find out is um
the imminence of the risk so How likely
he felt he was going to act on these
thoughts in addition to then maybe
making sure that he actually founded his
brother whilst I was in the room with
him um because sometimes clients will
say yes they'll do this but they may
then leave the room and actually not do
this so the the really important thing
to think about is how safe is this
client to leave your office on their
own um he mentioned a couple of
protective factors in that he didn't
want to hurt himself because of his
children or his family and these are
always important things to find out um
and his support structure in who was
around that could help him over the time
where he was feeling at is most
vulnerable the other thing that you may
have noticed when you watched the video
was that I tried to engage him in trying
to think of solutions and to get
involved with what might help him to
feel better and what might help him at
that point in time CU often clients who
are feeling suicidal or feeling that
there's no hope kind of lose their
ability to feel that they can make
decisions or actually take action within
their Liv so trying to engender that is
is a really helpful thing to do and
engenders
hope um the other thing to think about
when you're doing risk assessment is
that it usually takes longer and you
could see with Y is he was quite
depressed and it took him quite a while
to open up and to talk about what was
going on for him so if you're having
another client booked in right after
you've got to think about that this is
going to upset your timetable you can't
just say well it's the the hour is ended
and okay off you go because again you've
got to ask yourself is this client safe
to leave so it it just takes as long as
it needs to take for you to get all the
information that you need
need thinking about the means is another
thing that's important he mentioned that
he was taking anti-depressants and
having knowledge about how lethal um the
means are that a client is thinking
about is important so for instance if
they're saying they're going to shoot
themselves finding out whether they
actually have access to a gun or whether
they know how a gun works or whe they
have access to bullets or things that
are important to ask so knowing The
lethality um of the means is another
important thing to think about and to
find
out so there's quite a number of things
that you need to find out when you're
doing a risk assessment it's the intent
how serious are they and how soon do
they think they might act on these
thoughts that they having the means that
they're going to use how they're going
to do it and how s how lethal the means
are whether they they've had any
previous attempts what support
structures they've got and whether there
any protective factors that might
prevent them from actually acting on
their thoughts
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