Suicide Assessment and Treatment for Children and Adolescents

1700 UPS Dr.Suite 107

Louisville, KY 40223Phone: 502-327-

8045Fax: 502-327-7272

Email: email@pembertoncoun

seling.comwww.pembertoncounse

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PEMBERTON COUNSELING

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Suicide Assessment and Treatment for

Children and Adolescents



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Introduction• Charles Pemberton

– Ed.D. in Educational Counseling– 16 years in Counseling and Mental Health– Presented in England, South Africa, Central

America, and US.– Adjunct Professor – Graduate University of

Louisville• Undergraduate – IvyTech and KCTCS

– Private Practice – 80% children and families• ADHD• Depression• Aggression• Anxiety



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Today’s Schedule• Current Statistics

• Treatment and Assessment Methods

• Legal Concerns

• Questions



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Quick Quiz• There is a correlation between winter

holidays and suicide rates – T/F• Men attempt suicide more often than

women – T/F• Suicide rates are higher in the western

states than in the eastern states – T/F• American Indian males have the

highest suicide rate – T/F



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Quick Quiz• There is a correlation between holidays and

suicide rates – F– Rates in the US are lowest in winter/highest in

spring• Men attempt suicide more often than women

– F– Women report attempting 3x that of men

• Suicide rates are higher in the western states than in the eastern states – T– Higher than national average/lower in eastern and

midwestern• American Indian males have the highest

suicide rate – F– Caucasians have highest/American Indians are

2nd



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Current Statistics



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Current Statistics



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Current Statistics



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Adolescent Suicide

• Suicidal Ideation– thinking about suicide common among

adolescents



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Adolescent Suicide, cont.• Five reasons for erroneous belief that suicide

is common in adolescent– rate is triple the rate of 40 years ago– adolescents lumped together with young

adults as one statistical category- adolescent suicide is shocking and grabs

attention- social prejudice considers teenagers as

problems- suicide attempts are more common in

adolescence



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• Parasuicide—deliberate act of self-destruction that does not end in death

• Parasuicide and suicide depend on five factors– availability of lethal means, especially

guns– lack of parental supervision– alcohol and other drugs– gender– cultural attitudes

Parasuicide



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• Worldwide, parasuicide is higher for females; completed suicide is higher for males – except in China, where females complete

suicide more than males• Cluster suicides occur when several suicides

are committed within the same group in a short time

Gender, Ethnic and National Differences in Suicide



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AssessmentFirst, remember to do three things:

1) consult - this allows for another opinion, better care, and protects you 2) document, document, document! Everything you do, everyone you talk to, every question you ask the client should be documented 3) evaluate the client's risk



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Risk Factors• mental diagnosis, especially

depression and substance abuse, or Borderline Personality Disorder which increase risk

• over 45 years old are higher risk

• sex (men try more lethal means, women try more often)



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Risk Factors cont’• marital status (unmarried are

lowest risk, never married, divorced, widowed, recently separated are highest risk)

• recent job loss increases risk

• chronic illness is higher risk



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Risk Factors cont’• recent loss of loved one increases risk,

as does the anniversary of the loss and fantasies of reuniting with the deceased

• hospitalized and discharged with improvement; this may seem counterintuitive, but many suicidal people feel better once they have made the decision to kill themselves, and have the energy to wrap up loose ends, see others and say goodbye...



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Risk Factors cont’• Caucasian - ethnic minorities

have a lower suicide risk

• previous attempts - this is one of the best predictors

• gay/lesbian youth - may be at 3 to 5 times the risk for suicide as heterosexual Caucasian youth



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Risk Factors• extensive and detailed plans, or

plans using a highly lethal means

• history of suicide in their family

• history of impulsive or reckless behavior



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Questions to ask• Do you have thoughts of suicide?• Are they related to current

stressors going on in your life, or have you had such thoughts before?

• Do you have a plan? Tell me.• Ask if they have access to the

components of their plan, like a gun, pills, etc...



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Signs of Depression• sleep, energy, weight, or appetite

changes

• decreased interest in sex and other pleasurable activities

• feelings of helplessness and hopelessness

• social isolation and withdrawal from others



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Other thoughts• Empathize with the client

They are experiencing crises and stress, hopelessness, and helplessness. Offer that there is a part of them that wants to live, since they were cooperative with you. Offer too that services and referrals, as well as social support could be helpful to use now too.

• Make a No-Suicide Contract This is best when the client has support, is low risk, and can give clear reasons why they would not kill themselves; the client agrees they won't hurt themselves, and if they feel they can't stop themselves, they will call 911, an ER, a crises line, a therapist, or another designated special person, and will return for help on next appointment. Make the patient sign it and get a witness.

• Family InterventionThis is best is there is high support and low impulsiveness in the client. The clients agree with you to contact their family. They stay with the family member until the suicidal thoughts have been addressed in treatment, and the family is briefed on who to contact for help in an emergency. The family also takes an active role to remove drugs, guns, or other means of suicide from the home, and promises 24 hour supervision.

• HospitalizationThis is best if there is little family support, or mental illness, substance use or impulsiveness. Try voluntary admission, but use involuntary if needed.



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Inventories• Beck

• CDI

• Hamilton



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Medical vs. Collaborative• Depression

• Lack of sleep• Poor appetite• Anhedonia• Suicidality???

• Suicidality• Pain• Stress• Agitation• Hopelessness• Self-hate• Reasons for

living vs. reasons for dying



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Treatment Options-standard• Individual

• Psychopharmacological

• Group/Family

• EMDR

• ECT

• CDI

• Hamilton



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Treatment Options-CBT• Journaling

• Interactive journaling/email

• Bibliotherapy

• Physical activity

• Self-soothing



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Stages of Treatment• Stage 1 – Acute

• Stage 2 – Short Term CBT and Stabilization

• Stage 3 – Longer Term Psychodynamic/Interpersonal Treatment



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Three Pillars of Liability• Forseeability

• Treatment Planning

• Follow-up/Follow-through



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Legal Concerns• Screen all clients for suicidal risks

during initial assessment and remain alert to issue throughout

• Arrange an environment that will not offer easy access to instruments

• Create actively supportive environment



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Legal Concerns• Make every effort to communicate

and justify realistic hope

• Consider use of contracts

• Explore client’s fantasies

• Be clear and communicate impact to interventions

• Conform to State Laws



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Web links• http://www.psychpage.com/learning/library/counseling/suicid

e.html• http://aacap.org/page.ww?name=Teen+Suicide&section=Fac

ts+for+Families• http://www.athealth.com/practitioner/Newsletter/FPN_7_3.ht

ml• http://archfami.ama-assn.org/cgi/content/full/9/10/1119• http://www.cdc.gov/nchs/fastats/suicide.htm• http://suicideandmentalhealthassociationinternational.org/

intervadol.html• http://www.save.org/cdcstat1.html• http://www.suicidepreventtriangle.org/Suichap6.htm• http://www1.endingsuicide.com/PageReq?id=3048:7576• http://www.cdc.gov/ncipc/dvp/suianno.htm• http://www.nimh.nih.gov/suicideprevention/suifact.cfm• http://www.aafp.org/afp/20020501/tips/15.html• http://www.who.int/mental_health/prevention/suicide/

suicideprevent/en/

Documents

Suicide Assessment and Treatment for Children and Adolescents