How to Answer There Three Risk Questions (Complete Guide)

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Original Question

There are three risk levels involving those who express thoughts of suicide; low, middle, and high. Those who are in the level considered are described as who have thought about suicide but have not followed through with an attempt, they have a strong support system (Kanel, 2018) and have a demeanor which is very much like “I have had thoughts of suicide but my will to live supercedes my want to die”. A description I learned in Crisis Intervention Training was low risk level would be someone who has suicidal ideation who may not have a plan or intent, they just sometimes feel like they would be better off “not here”. According to an article provided by the National Action Alliance for Suicide Prevention (2018) there are evidence based practices which can reduce the risk of a low risk client from escalating including focusing on coping mechanisms, ensuring support systems are in place, and providing access to helpful resources. This article further suggests some other methods to assist in navigating this level. Safety planning intervention is a method, this course of action helps to identify warning signs, use coping strategies, compiling a list of contacts and activities to distract, phone numbers for mental health professionals and emergency contacts, and reducing access to lethal means. There are many forms which a safety plan can be recorded and placed somewhere it can be accessed. Another method is least restrictive care and stepped care models. This model supports providing a level of care for a low risk client in which avoids hospitalization if possible. When using this model, the goal is to start with the less invasive intervention and increasing intensity if necessary. Middle level risk clients are similar in that they are still high functioning and depending on the situation the initial goal is the least invasive means of intervention. Kanel states that middle level risk clients may are concerning as they are often still able to function but they are not feeling well and challenging to evaluation. Middle level clients may express verbally thoughts of wanting to kill themselves and may be ignored. A method of intervention used is a no-suicide contract in which the client “gives up the right” to kill themselves for a few days while they seek help by working with a crisis worker (Kanel, 2018). This contract should not be used with a client who does not have support or lives alone. High-risk clients are different from low and medium clients in which less invasive interventions such as safety plans and suicide contracts are not generally appropriate. These clients are similar to middle risk clients as there may be statements of “I am going to kill myself”. Unlike low and middle risk clients, high risk clients often struggle to function and are generally very depressed and or angry (Kanel, 2018). High risk clients have often tried suicide before, have a clear plan or determination to follow through, and may not have as much support according to our weekly reading. This may not be the case for all high risk clients; while they may not feel they have support the actually could have a solid support system available. High risk clients differ from low and middle in that the initial course of intervention is attempting to get the client to admit themselves voluntarily to a hospital (Kanel, 2018). If a client is not willing to do so and they have a viable plan, means, and intention to kill themselves, there are laws in place by each state to have a person committed involuntarily by court order. In the state of Missouri this is called a 96 hour hold. Missouri revised statute 632.305 indicates a person can be detained and delivered to a psychiatric hospital for evaluation by law enforcement upon court order of a Judge. The subject must be evaluated within 96 hours (not including holidays or weekends) by a licensed professional. If it is deemed the subject is in need of inpatient care to exceed the 96 hours, motions may be filed with the court for a longer commitment if necessary. In most cases two people must sign and file an affidavit who witnessed an attempt or threat of self harm. Exclusions to this are law enforcement, first responders, and medical personal in which only one affidavit is necessary (632.305, n.d.). An ongoing problem I have witnessed on a professional level is a person who has made valid attempts, threats, or legitimate cause for concern for affidavits to be filed and judges to issue these orders, then the person is admitted for the 96 hour hold and tells the provider they did not mean it and they are ok. The facility then releases them. A client I supervise on probation had a valid attempt, he cut his throat in front of a police officer. He needed medical treatment and was taken to the hospital; a 96 hour commitment order was taken to the hospital (which is where the psychiatric unit is located). After he was stitched up and medically clear, he was released. On another occasion a judge issued a commit order, the person was transported to the psychiatric center, they told the doctor they were just made when they made the threats and grabbed the gun. The person was discharged, went home, and shot himself. Although all of the events that lead up to the order were well documented and enough for a judge to issue a hold, that person was still released. We cannot control what people do, as much as we want to help, and as much as we have saved many many lives, sometimes it is a reality that it may still happen. Gravely disabled is a term referring to a person who is unable to take care of their basic needs due to a mental health disorder (Kanel, 2018). People who are gravel disabled are unable to take care of personal needs such as food, shelter, and overall health due to a MH diagnosis. Example of clients who are gravely disabled include clients who have been diagnosed as schizophrenic, in a paranoid state, or someone who has dementia or Alzheimer’s disease (Kanel, 2018). References 632.305. (n.d.). https://revisor.mo.gov/main/OneSection.aspx?section=632.305 Kanel, K. (2018). A Guide to Crisis Intervention (6th ed.). Cengage Learning US. https://ambassadored.vitalsource.com/books/9798214344850 National Action Alliance for Suicide Prevention. (2018). Best Practices in Care Transitions for Individuals with Suicide Risk: Inpatient to Outpatient Care.— this a discussion needing a response to a peer and it needs citations in the answer and also needs references at the end

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