SCENE 15 Suicide risk assessment

Summary

In 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

00:00

😔 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.

05:00

💔 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.

10:01

🛌 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.

15:02

🚨 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.

Keywords

💡Depression

Depression is a mental health condition characterized by persistent feelings of sadness, hopelessness, and a lack of interest in daily activities. In the video, Ian expresses that his depression has impacted his work performance, concentration, and overall ability to cope with life’s challenges. It serves as the underlying issue contributing to his overwhelming feelings and thoughts of suicide.

💡Suicidal Ideation

Suicidal ideation refers to thoughts or plans about taking one’s own life. Ian admits to having constant thoughts about suicide, especially following his negative performance review at work. These thoughts are significant because they reflect his deep sense of hopelessness and inability to see an alternative way out of his problems.

💡Performance Review

A performance review is an evaluation of an employee's work performance, often used to provide feedback and discuss future goals. In the script, Ian describes how a recent performance review with his boss was negative, which exacerbated his feelings of failure and contributed to his worsening mental health.

💡Helplessness

Helplessness is the feeling of being unable to take control or influence the outcome of one’s situation. Ian repeatedly mentions feeling helpless, particularly in regard to his depression and inability to see how his life could improve. This feeling amplifies his suicidal ideation, as he believes there are no solutions to his problems.

💡Support Structures

Support structures refer to the people or systems in place to help someone during difficult times. Ian’s brother, John, is identified as a potential support, but Ian hesitates to reach out because he fears burdening his brother with his problems. The therapist encourages Ian to rely on this support as a protective factor against acting on his suicidal thoughts.

💡Protective Factors

Protective factors are elements in a person’s life that reduce the likelihood of them acting on suicidal thoughts. In the video, Ian identifies two protective factors: his daughter, who he doesn’t want to hurt, and his religious beliefs, which discourage suicide. These factors are important in the therapist's efforts to prevent Ian from attempting suicide.

💡Risk Assessment

Risk assessment is the process of evaluating the severity and immediacy of a person’s suicidal thoughts, including their intent and plan. The therapist conducts a risk assessment by asking Ian about his suicidal thoughts, whether he has a plan, and what might stop him from acting on these thoughts. This process is crucial for determining how to ensure Ian’s safety.

💡Means

In the context of suicide risk, 'means' refers to the method by which a person plans to take their own life. Ian mentions that he could use the medication prescribed by his general practitioner to overdose, showing that he has considered a specific means to end his life. The therapist focuses on this detail to better understand the severity of the risk.

💡Lethality

Lethality refers to the potential of a method to cause death. The therapist considers the lethality of Ian’s chosen means—overdosing on medication—by asking about the type of medication and how much Ian thinks would be enough to end his life. Understanding the lethality helps assess how imminent the danger is.

💡Imminence

Imminence is the likelihood that an individual will act on their suicidal thoughts in the near future. The therapist probes Ian about how soon he might act on his thoughts and whether he feels an immediate urge to do so. This is key to deciding whether Ian can be safely left alone or if more immediate interventions are necessary.

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