SOS Suicide Prevention II

Being the Executive Director, Mrs Tan is very well-versed with the SOS Suicide Model.
As it was right after lunch, I noticed a couple of sleeping eyes. I was glad I did not take a full lunch and got interested in how to ‘ask suicide questions’. Posing the question will not make the situation worse if the ideation is already there. I was relieved to learn it may even be a relief for the client to know someone cares enough to want to know about it. Asking the question outright at the right timing with the right amount of empathy instead of skirting around it nervously will be perceived more professional and confident, I reckon. Open-ended questions invite the client to open up slowly as most times the latter is in a state of ambivalence.

Who do we pose the question to? Clients from any age group and the mentally ill included. Elderly persons fall under the high risk bracket of suicide cases. Even those aged 10 and below know what suicide is about basically although the depth of their knowledge varies. The young persons are impulsive and they fall under suicide copy-cats. Those who are mentally ill form 1/3 of completed suicide cases. I must not miss the opportunity to pose the question. It is safer to err on the side of caution.

In my risk assessment for suicide ideation, I examine client’s feelings, motives and expressions. Some empathetic statements I can use before popping the suicide question are:

1. I hear you say ‘life is not worth living’, I wonder if you have ever thought of ending it?

2. I sense you feel intense hopelessness, I wonder if you ever consider ending it all?

3. You seem devastated and overwhelmed by the challenges you are facing presently. You talked about ‘no way out’, I wonder if you have thought of ending it all?

The Los Angeles Suicide Prevention Centre identified 7 basic factors which can be used for judging a person-at-risk’s potential for completing suicide.

1. Age - Risk of suicide increases with age.
2. Sex - Men die by suicide more often than women. (Apparently the methods they used are more fatalistic.) Women attempt suicide more often than men.
3. Stress - A loss/change (current or anticipated) that is perceived as substantially diminishing the value of life.
4. Symptoms - Changes in behaviour, physical condition, thoughts or feelings (hopelessness/helplessness).
5. Current Suicide Plan - A specific, detailed plan consisting of method, venue and date and time of how to kill oneself and the means to carry it out.
6. Prior suicidal behaviour - Prior attempt or history of suicide in the family. Is it active and intense? (Happened recently? Frequency? Method?)
7. Resources - Supportive, preserving factors - Family, friends, career (external) and faith (internal).

In my assessment of risk, my focus will be on item 5, 6 and 7.

If there is no concrete suicide plan (+), no prior suicidal attempt record (+) and there is resource for client to fall back on (+), the risk is LOW.

If there is suicide plan (-), no prior suicidal attempt record (+) and there is resource for client to fall back on (+), the risk is LOW – MEDIUM

If there is suicide plan (-), there is prior suicidal attempt record (-) and there is resource for client to fall back on (+), the risk is MEDIUM

If there is suicide plan (-), there is prior suicidal attempt record (-) and there is no resource for client to fall back on (-), the risk is HIGH.

The protocol for SOS counsellor to do will then be:

1. Identify risks (using empathetic statements and suicide question)
2. Inquire plans
3. Assess risks (CPR)

Personally, I find clients’ ambivalence usually lies between wanting to die for someone and at the same time to live for another. By helping client to focus on the one(s) he would live for seems to help to a great extent.