Counselling and Suicide Risk Assessment
“More people commit suicide each year than die in all the world’s combined conflicts” (WHO, 2006, p. 1). This statement by the World Health Organisation was made seven years ago and yet suicide remains a huge issue within the UK. Just last year, it was reported that suicide rates in the UK have risen to 6,045, which is 437 more than the previous year (BBC, 2013). I am going to explore my potential reactions to suicidal clients and discuss some strategies and tools for risk assessment and management.
The WHO counselling handbook for reducing suicidal risk highlights the importance of counsellors conducting a comprehensive suicidal risk assessment for prompt and effective preventive measures (WHO, 2006). This assessment should include reviewing (WHO, 2008):
Suicidal risk factors;
History of prior suicidal behaviour;
The presence of a mental disorder;
The extent of the client’s current suicidal manifestations;
The presence of any protective or mitigating factors, such as social support.
One of the questions to ask clients during their initial assessment is, “Have you considered harming yourself? If yes, have you considered suicide?” It is also important to collect data on their history, social support, and the methods they are currently using to cope, in order to gain a broad picture of their life. This helps to get into their frame of reference, which is particularly important for meeting the client at relational depth during any thoughts of suicide.
If a client expresses that they have considered harming themselves, the current danger to the client needs to be explored. For example, if they feel suicidal, is it a fleeting thought or have they devised a plan, such as when, where, and how? I will also explore previous suicide attempts as, statistically, someone who has attempted to take their life in the past is more likely to attempt it again (Stoney, 2014).
It is likely that many clients will express previous suicidal thoughts. My own personal view is that suicidal thoughts or expressions are ‘the language of despair’ and therefore I am to expect suicidal ideation within the counselling room. It is not something to fear, but the client’s way of communicating their distress, and therefore I need to respond in a way that helps a client feel heard. Panicking would not achieve this, but exploring the underlying feelings is more likely to do so.
There is a lot of judgment surrounding suicide. I would never want one of my clients to express the depths of their distress only to have my response make them feel judged. I would like my clients to know that suicidal ideation isn’t something to be ashamed of and that it is ok to talk about these feelings. I feel this approach will allow me to ‘hold’ some of the clients pain (while recognising that it is theirs and not mine), so that we can look at the pain together, which might ease it enough for the client to feel supported and able to go on.
BBC (2013). ‘UK suicide rate rises ‘significantly’ in 2011’ BBC News [online]. Available at: <http://www.bbc.co.uk/news/uk-21141815> [Accessed February 2, 2014].
WHO (2006). ‘Preventing suicide: A resource for counsellors’, Available at: <http://whqlibdoc.who.int/publications/2006/9241594314_eng.pdf> [Accessed February 2, 2014].
WHO (2008). ‘Preventing suicide: A resource for media professionals’, Available at: <http://www.who.int/mental_health/prevention/suicide/resource_media.pdf> [Accessed February 2, 2014].
Stoney, G. (2014). Suicide – frequently asked questions. Available at: <http://www.survivorsofsuicide.com/faq_suicide.shtml> [Accessed February 2, 2014].