Assessing support for clients at risk

Risk assessment and referral options for suicidal clients 

Risk assessments are critical in determining the level of suicidal intent, plans and availability of means of a suicidal client. While there aren't definite criteria to help a clinician choose between inpatient and outpatient care of a suicidal patient, the presence of a plan, access to lethal means and a timeframe generally indicates that the patient is at high risk. In these cases, hospitalisation should be considered.

Many of the methods used in the assessment of suicide risk tend to rely on patients providing information verbally. Despite this, the majority of interpersonal communication, including that between patient and client, tends to be of a non-verbal nature. A comprehensive risk assessment will include the evaluation of both verbal and non-verbal communication.

 

Examples of verbal cues

  • 'There's no point things aren't going to get better.'
  • 'They'd be better off without me around.'
  • 'Can't take this anymore.'

 

Examples of non-verbal cues

  • Slowed speech/movement
  • Less attention to appearance
  • Downcast eyes

 

You can begin to assess the risk of suicide by asking direct questions like: 

 

  • 'It sounds like you have a lot to deal with. Have you ever thought about hurting yourself?'
  • 'Sometimes people with a lot of problems and stress lose hope, have you?'

 

For a more comprehensive overview of the risk assessment process, see our tip sheet Tips for professionals: Suicide risk assessment

 

The next steps

Once the assessment is complete, you can then determine the next steps for helping your client. Some questions to consider may include:

 

  • How can I increase this person's safety?
  • Does this person need to be hospitalised?
  • Who else does this person see as being helpful and trustworthy?
  • Who can I involve in supporting this person?
  • What are the support options for when I am unavailable? 
  • What does this person think will be helpful for them?

 

Services available for referrals

In an emergency

If you judge your patient's safety to be at immediate risk, consider the following options: 

 

  • Call 000 and ask for an ambulance. Stay on the line and be ready to answer the operator's questions
  • Take the patient to the local hospital's emergency department
  • Phone your local Public Emergency Mental Health Service

 

Each of these emergency services teams are specially trained to support people in crisis, including people feeling suicidal, and will be able to keep your patient safe.

 

Police welfare check

If you are worried about the immediate safety of a client but they are not physically with you (for example, if you have spoken to them on the phone), you can contact the police to report your concerns and request a police welfare check. This will involve police officers visiting the person's residence in order to check on their safety. 

 

Individuals requiring urgent assessment or treatment

CATT Crisis Assessment and Treatment Team

The CAT Team provide 24/7 urgent assessment and short-term treatment services for people in serious mental health crisis where there are concerns about their safety. 

 

Doctors, mental health professionals and other community service workers can contact their local CAT Team, many are contactable 24 hours a day by telephone. The team can arrange an assessment and professional treatment for at-risk clients with a psychiatrist, psychologist, mental health nurse or social worker. 

The CATT service can also provide support and treatment for patients with acute mental illness who are able to be managed in the community.

 

Psychiatric triage

Psychiatric triage provides phone consultation, advice, assessment and referral for people experiencing mental health issues. The service is also provided to health professionals and carers who are concerned for somebody with mental health issues.

 

The service is staffed by a team of experienced senior mental health clinicians who provide advice, consultation, assessment and referral.

 

Individuals requiring immediate support

Suicide Call Back Service "1300 659 467"

The Suicide Call Back Service provides immediate telephone counselling and support to anyone affected by suicide, including clients at risk of suicide. They also offer a call back service, where clients may be able to receive up to six sessions of ongoing professional telephone counselling with the same counsellor, at a time that suits them. The Suicide Call Back Service is available 24/7, throughout Australia. 

 

Help them to help themselves

Educational and self-help materials can be helpful in empowering patients to help themselves when they are feeling suicidal. The Suicide Call Back Service website is a great place to start. 

 

General considerations when dealing with suicidal clients:

  • Identify, document and discuss suicidal behaviours using clear definitions
  • Recognise personal beliefs, stigma and myths about suicide
  • Involve the client's family, friends and support networks in their management
  • Be aware of the importance of the clinician-client relationship
  • Be clear to clients when explaining the exceptions to confidentiality, including circumstances where they may be at risk of harm.

 

Professional self-care

It is important when you are managing suicidal clients to take care of yourself to avoid burnout. Ensure you make use of professional supervision and debriefing after a session. Self-reflection and support from colleagues can also be invaluable. 

 

Personal self-care

It's critical to look after yourself while dealing with clients at risk. Try to continue to get ample and regular sleep and exercise, and maintain a good diet. Taking time out from your professional role with relaxation and hobbies can also be helpful.

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