The client who is calling is seriously considering us as the last resort and hence it is important to be careful and helpful. A lot many suicides are impulsive while others are well planned. Impulsive clients are likely to decide on the spur of the moment. Hence it is important to buy time.
Common feelings in suicide
- A crisis that causes intense suffering and feeling of hopelessness and helplessness.
- Conflict between survival and unbearable stress.
- Narrowing of patient’s perceived options.
- A wish to escape (it is an escape rather than a going-towards).
- To punish self and/or to punish others with guilt.
Indicators for increased chance for suicide
- Withdrawal Behavior for few days
- Mention of suicide repeatedly.
- Suicide note
- Changes in eating and sleeping patterns
- A history of serious psychological problems.
- A history of impulsive, poorly controlled and destructive Behavior.
- A history of continuing academic problems and learning difficulties.
- Adjustment difficulties with family, school, peer.
HOW TO ASSESS THE RISK OF SUICIDE
When the counselor suspects that suicidal behavior is a possibility, the following factors need to be assessed:
- Current mental state and thoughts about death and suicide;
- Current suicide plan - how prepared the person is, and how soon the act is to be done;
- The person’s support system (family, friends, etc.).
- The best way to find out whether individuals have suicidal thoughts is to ask them.
- Contrary to popular belief, talking about suicide does not plant the idea in people’s heads.
- In fact, they are very grateful and relieved to be able to talk openly about the issues and questions they are struggling with
- Establish rapport
- Allow the client to narrate his/her own story
- Use age appropriate language
- Tactful questions. Avoid leading questions e.g. “you don’t want to kill yourself”
- Obtain detailed description of any suicidal plan ask about availability and lethality
- Smooth movement from one topic to another
- Communicate that people do get through this – there are other people who feel as badly as he/she feels now.
- Advise the client to give himself/herself some time e.g., “I will wait 24 hours before I do anything”. Or a week. Suggest that feelings and actions are two different things – just because you feel like harming / killing yourself, doesn’t mean that you have to actually do it right this minute.
- Periodically, keeping in touch over the phone will reduce the intent of ending their lives. Counseling needs to be practical and useful.
- Long lectures with a moralistic tone are not advised. These make the already depressed student guiltier and his intent stronger.
- The client should be advised to contact a professional counselor as soon as possible. If not efforts should be made to encourage him to meet his teachers or school counselors or talk to his parents. The more he talks about his problems to various people; he is likely to feel much better.
- A client who is severely depressed and expresses absolute helplessness about future is more at risk than a client who talks about casual things.
- No medicines should be prescribed over the phone