Suicide Intervention Plan Alexandra Jones Liberty University Primary Problem: Suicidal Client Client Name: Joanne Age: 45 Gender: Female Presenting Problem Joanne is a 45-year-old divorcee with a long history of depression. She has attempted suicide on three prior occasions, twice through overdose and once by attempting to slit her wrists. While she has monthly visits with a psychiatrist and is prescribed medication, she is not compliant with her medication. Joanne has stopped by unexpectedly to inform the clinician of how much she appreciates them and how important they are to her. She also admits to having a gun in her vehicle. She refuses to stay and talk, saying she just wants to go for a drive. Precipitating Events There are several precipitating events that are cause for concern regarding Joannes current mental status. First, Joanne works 60 to 70 hours a week in a high-stress job; she has no hobbies and finds all her satisfaction through work. Second, 15 years ago Joanne and her husband divorced after her husband came out as a homosexual; Joanne has not dated since then. However, the third precipitating event, which occurred seven years ago, is Joannes yearlong affair with her sisters husband. Though her sister never found out, Joanne broke off the affair due to guilt; her brother-in-law continues to pursue her. Finally, as mentioned above, Joanne has a long history of depression; while she is seeing a psychiatrist monthly, she is not compliant with her prescribed medication. Risk Factors There are several risk factors present which, put together, make Joanne a Very-High-Risk client. First are Joannes three prior suicide attempts. These indicate that she has previously decided that suicide is the best option on at least three occasions. Second, Joanne has a diagnosed psychiatric condition that she does not manage properly. She has a long history of depression and is non-compliant to her medication regimen. Third is Joannes age. Joanne is 45, which is right at the beginning of an age group at high risk for suicide. Fourth is the guilt Joanne feels over her previous affair with her brother-in-law. Fifth is her lack of involvement in life outside work, based on the fact that she has no hobbies and finds all her satisfaction in work. Sixth is her prior divorce from her husband and non-involvement in dating since that time, outside of her previous affair. Seventh is Joannes sudden visit to the clinicians office to tell them how much she appreciates them. Finally, the fact that Joanne currently has direct access to a firearm, and has it with her in her vehicle, is highly concerning. All of these factors combine into a picture of high stress, depression, and detachment paired with impulsivity and access to means to end a life. Resources Joanne has expressed that there are some resources upon which she can rely. First, Joanne is currently seeing a psychiatrist, who has prescribed medication. Therefore, Joanne has access to a mental health professional who is aware of her situation and has offered her a means to help improve that situation. Second, Joanne and her ex-husband have a 13-year-old daughter together. Joanne, therefore, has an emotional attachment and obligation to a minor child. Third, Joanne has developed a relationship with this clinician, as demonstrated by her desire to stop into the office and express her gratitude and affection towards them. She can, therefore, utilize that relationship to obtain support. Finally, there are resources outside Joannes existing relationships with her psychiatrist and counselor that she can use, specifically, the national suicide hotline or her local crisis center. Intervention Plan An intervention plan for Joannes current situation would include several factors. First, Joanne needs to be separated from her firearm. The fact that she has it with her in her vehicle is highly concerning, especially given her risk and current actions. Since Joanne refuses to stay in the office to speak to the clinician and the risk of suicidal action is imminent, it is necessary to involve authorities and place Joanne in temporary involuntary hospitalization. This will remove her from the immediate situation and give the clinician the opportunity to help Joanne in other ways. The second point of the intervention plan would be to reestablish trust with her, or to find her a new clinician. Clients can see forced hospitalization as a violation of trust. While it was necessary to hospitalize Joanne for her own safety, hospitalization is a traumatic experience. Re-establishing trust with Joanne will go a long way toward working with her to develop a long-term treatment plan. The third thing needed in Joannes intervention plan would be to convince Joanne to take her medication as prescribed. Once Joanne is taking her medication regularly her brain chemistry will level out, which will allow her clinician to work with her on developing support structures and coping skills. Fourth, the clinician will work with Joanne, her family, and friends to remove or monitor items from her home that can be easily used for suicide in the event Joanne experiences another crisis in the near future. For example, all firearms and unnecessary medications should be removed from the home. This will reduce Joannes immediate options if she becomes suicidal again. Fifth, once Joanne is stabilized, the clinician will need to work with her on developing support structures and healthy coping mechanisms. The clinician will need to establish an understanding of existing coping skills and support structures, good and bad. They will then work with Joanne to establish healthy ones, such as contact with family, developing hobbies, or contacting the clinician when Joanne feels it is necessary. They will need to meet on a frequent basis, especially in the beginning, to develop and maintain these structures and skills Sixth, the clinician will work with Joanne to reduce the hours she spends at work. Once Joanne has begun to get involved in activities outside work she will be able to find satisfaction and meaning in something other than work. In order to do so, however, Joanne needs to reduce the time she spends at work, especially because it causes her stress. Seventh, and finally, the clinician will work with Joanne to reestablish hopefulness. While this stage will be difficult, especially given Joannes current crisis, it will be necessary to help prevent such crises from reoccurring. Spiritual Aspects Joanne has not mentioned any specific inclination toward a faith or spirituality. Before proceeding with her treatment it would be prudent to ask Joanne if she has a belief system she would like included in her treatment. Jackson-Cherry and Erford (2018) point out that spirituality can be an important coping mechanism for facing any mental health struggle. Alcoholics Anonymous, for example, is centered around the belief that people need the intervention of a higher power to help them overcome their struggles (Capuzzi & Stauffer, 2016). In Joannes case, if she is interested, it would do well to have her engage in the support and community religion can offer. The clinician must be careful, however, and make sure that the inclusion of religion or spirituality will not cause more harm than help (Jackson-Cherry & Erford, 2018). If Joanne is interested, incorporating faith within client/counselor sessions might be warranted, or referral to a pastor for spiritual guidance might be more appropriate. Treatment Plan Problem 1: Joanne is engaging in behavior indicative of current suicidal ideation as evidenced by her sudden proclamations of gratitude and affection accompanied by her possession of a firearm and refusal to talk about it to her counselor. Goal 1: Joanne will reside in a safe environment to address her current suicidal crisis. Objective 1: Joanne will relinquish her firearm. Intervention: The counselor will convince Joanne to relinquish her firearm to family or authorities. Objective 2: Joanne will cooperate with hospitalization. Intervention: The counselor will contact the proper authorities for committing Joanne for temporary hospitalization. Goal 2: Joanne will resolve her emotional conflicts and recognize what behavior prompts her suicidal crises. Objective 1: Joanne will participate in therapy to identify what life factors have led to her current suicidal crisis. Intervention: The counselor will implement psychotherapy sessions to allow Joanne to explore what has prompted her numerous suicide attempts. Objective 2: Joanne will identify positive aspects of her life, including relationships and accomplishments. Intervention: The counselor will ask Joanne to compile a list of only the positive aspects of her life. Problem 2: Joanne has a history of depression and suicidal actions and is engaging in risky behavior that may exacerbate her depression and suicidal ideation, as evidenced by her non-compliance with her medication and her lack of involvement in life outside of work. Goal 1: Joanne will maintain hopefulness and positive daily function. Objective 1: Joanne will take all medications as prescribed and keep a daily journal regarding medication intake. Intervention: The counselor will examine Joannes medication journal at weekly counseling sessions. Objective 2: Joanne will participate in therapy to learn to identify negative thinking and hopelessness and replace them with positive thinking and hopefulness. Intervention: The counselor will educate Joanne on how to be aware of and challenge negative thinking and hopelessness. Goal 2: Joanne will establish strong support structures and coping mechanisms. Objective 1: Joanne will establish hobbies and/or interests outside of work. Intervention: The counselor will ask Joanne to inform them of one activity in which she has participated outside of work every week. Objective 2: Joanne will promise to contact the counselor or an emergency helpline if the urge to harm herself becomes strong. Intervention: The counselor will inform Joanne of the resources available to her when she is experiencing suicidal or self-harming urges. References Capuzzi, D., & Stauffer, M. D. (2016). Foundations of addictions counseling (3rd ed.). New York, NY: Pearson. Jackson-Cherry, L. R., & Erford, B. T. (2018). Crisis assessment, intervention, and prevention (3rd ed.). Upper Saddle River, NJ: Pearson.
Joanne is a 45-year-old divorcee with
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