20 Sep Working with a suicidal client is often an anxiety-provoking experience for counselors.

Safety-related clinical issues and treatment planning

Counseling suicidal patients

1. In 2010, suicide was the 10th leading cause of death in the United States, accounting for more than 42,000 fatalities.  Studies also show that an average of 22 military veterans commit suicide a day.

2.  Clients who are seen in counseling settings and those who have a mental disorder are at a greater risk for suicide attempts and completed suicides.

3. Working with a suicidal client is often an anxiety-provoking experience for counselors.  Counselors must have the following core competencies in dealing with suicidal clients. a)  managing one’s own reactions to suicide b)  maintaining a sense of collaboration in treatment, c) understanding the constructs of suicide, d) possessing appropriate risk assessment and intervention skills, e) developing an effective crisis plan, f) keeping appropriate documentation, and g) understanding potential legal and ethical issues in the treatment of suicidality. 

4.  Related to ethical and legal issues, it is important that counselors document the steps  taken to enhance client safety.

5.  Safety contracts are used and signed by the client to attempt to enhance client safety.  These basically are a contract that the client will sign that they will not kill themselves.  It identifies triggers and resources the client can use instead of lethal action.

6.  Limitations to safety contracts are:  makes the client believe that the counselor is only concerned with protecting himself/herself against legal action; the contract may serve to inadvertently silence the client by making them feel embarrassed, discouraged, or ashamed for their ideations.  The word “contract” may scare the client.

7.  It is often difficult to predict whether an individual will attempt suicide.  Here are some factors that could indicate suicidality:  a) past suicidal behaviors b) substance abuse c) impulsivity d) aggressiveness, e) thoughts of suicide, f) hopelessness, g) loss of control, h) presences of a mental health disorder and i)  extreme chronic physical pain.

8.  Restricting clients’ access to weapons can be an important cornerstone of effective intervention.

Counseling Homicidal patients

9. Nearly 16,000 people in the United States were victims of homicide in 2014. 

10.  Homicides initiated by person unknown to the victim account for under a quarter of all homicides.  The majority are done by someone known to the victim.

11. Homicide is the most serious consequence of intimate partner violence.  IPV accounts for about 40% of all female homicides.

12. In 2009, homicide was the official cause of death in 57% of child fatalities due to maltreatment.

13.  Counselors must consider the following when working with potentially homicidal clients:  must monitor the client for any homicidal risk; must put some physical distance between client and therapist to prevent physical harm; do not startle the client, walk behind them, take notes the entire time.  Counselors must explore their own emotions about working with this population.

14.  Clients who pose a risk to others may display a lack of empathy and understanding of others’ emotions.  Predictors of violence are:  youth, male, low socioeconomic status, substance use, and a history of violence.

15.  These clients may display behaviors such as jealousy, need for control, aggression, as well as noncompliance in treatment.  Intimidating behavior toward and stalking of the potential victim may also be seen.

16.  Assessing violence is a challenge and clients typically minimize  their intent to harm others, or their violent behaviors.

17.  No comprehensive interventions exist for treating homicidal ideation.  Issues such as mental health problems, and substance abuse must be treated first and there may be a reduction in homicidal ideations.

Your question:  Answer in essay form, (2 pages)  With all the work put into suicide prevention, why is it still such a problem, especially with military veterans? Do not use any sources or references.