Assessing the risk of suicide is critical when treating individuals who exhibit suicidal tendencies. A comprehensive understanding of a client’s suicidal thoughts, non-suicidal self-injury, and related behaviors is essential, and there is a variety of tools that can help clinicians measure that.
Direct Inquiry
The first method involves direct questioning:
- Inquire about past and current suicidal thoughts.
- Assess any history of suicide attempts.
- Determine the presence of current planning and intent.
- Evaluate access to potential means for suicide.
Additionally, it’s crucial to work on strategies to restrict access to the means.
Using Standardized Measures
It’s beneficial to use available assessment tools:
- Free resources for clinicians are accessible through Marsha Linehan’s website at the University of Washington’s Behavioral Research and Therapy Clinics.
- Several instruments and accompanying articles detailing statistical validations are provided.
Suicide Behavior Questionnaire (SBQ)
The SBQ is a frequently used self-report tool:
- It is designed to gather insights into a client’s history of suicide attempts, self-harming behaviors, and current thoughts on suicide.
- Despite the usefulness of this questionnaire, clinicians must refrain from over-relying on it for predictions but use it to inform treatment and safety planning.
Linehan Risk Assessment and Management Protocol (LRAMP)
The Linehan Risk Assessment and Management Protocol, abbreviated LRAMP, is an invaluable tool frequently employed in clinical settings. This clinician-administered protocol serves multiple purposes:
- It reviews the risk factors linked to suicide and also addresses the protective factors.
- It facilitates the documentation of the clinician’s decision-making process. This aspect is particularly critical when choosing a course of action that diverges from standard procedures, such as opting not to hospitalize a client assessed as being at moderate risk of suicide.
The utility of the LRAMP lies in its ability to aid clinicians in:
- Making informed decisions about client care.
- Demonstrating the reasoning behind these decisions.
- Providing a documented rationale that substantiates the clinician’s professional judgment.
Thus, the LRAMP is not just a tool for evaluating risk but also acts as a safeguard for clinicians, affirming that they uphold a reasonable standard of care in their practice.
Diary Card
The diary card, a central component of DBT, is a self-reporting tool for clients to fill out daily and submit weekly. It is accessible via the Marsha Linehan website.
- It allows clients to record and track the intensity of their emotions and urges daily.
- Clients can note any engagement in suicidal or self-harming behaviors, providing a day-by-day account.
- It’s a critical tool for session preparation, helping clinicians prioritize issues to address.
Clinicians introduce the diary card early in therapy and begin each session by inquiring about its completion. This process is vital as it informs the clinician whether there is a need to address suicidal behaviors during the session based on the client’s tracked emotions, urges, and actions. Using the diary card regularly is crucial for the clinician to determine the required immediacy and type of intervention.
Addressing Compliance Issues
Should clients fail to complete diary cards, the clinician should:
- Provide a blank diary card for the client to fill out immediately in the session.
- Treat non-compliance as a therapy-interfering behavior, seeking to understand and overcome the barriers to compliance.
- Develop strategies to enhance adherence to the monitoring process.
Looking for practical everyday tools? This print-friendly handout is just what you need. Click on the following link to download the PDF:
Assessment Essentials: Tools for Evaluating Suicide Risk in Clinical Practice
This handout is designed to summarize the importance of conducting suicide risk assessments. It details the necessity of direct inquiries into a client’s suicidal thoughts and plans, including the exploration of past behaviors and current intentions. Emphasis is placed on standardized assessment tools, such as the Suicide Behavior Questionnaire (SBQ) and the Linehan Risk Assessment and Management Protocol (LRAMP), which assist in gathering comprehensive insights into a client’s risk factors and protective elements. Additionally, the handout highlights the importance of the diary card from dialectical behavior therapy, a crucial tool for clients to monitor and report daily emotional states and behaviors. This comprehensive approach aims to guide therapists in making informed decisions, ensuring client safety, and upholding a high standard of care in their practice.
Instructions
This handout serves as a summarized guide for therapists in conducting comprehensive suicide risk assessments. Begin with direct inquiries about the client’s history and current state regarding suicidal thoughts and planning. Use tools like the Suicide Behavior Questionnaire (SBQ) and the Linehan Risk Assessment and Management Protocol (LRAMP) to gather detailed insights and document decision-making processes. Implement the diary card from dialectical behavior therapy for clients to record daily emotions, urges, and behaviors, aiding in session planning and intervention determination. In cases of non-compliance with diary card completion, address this during sessions by providing a blank card and exploring barriers to adherence. These tools and strategies are instrumental in evaluating risk, guiding treatment, and ensuring clients’ safety while supporting the therapist’s professional judgment and standard of care.