Clinical Interview

The first component of a comprehensive evaluation is a thorough clinical interview with the patient that covers the following domains: current mental status; sociodemographic factors; recent and chronic life stressors; coping style and resources; psychiatric, medical, and substance use history; family history of mental illness and suicide; past treatment history and compliance level; indi vidual strengths and vulnerabilities; and general presentation of suicidality (for a comprehensive review on suicide risk assessment, see American Psychiatric Association, 2003;Jacobs, 1999). If the patient provides written permission, corroborating data from family members, other mental health professionals, and medical records may be obtained. However, in cases where the immediate safety ofthe patient or others is threatened, clinicians are permitted and highly encouraged to seek such information regardless of patient consent.

During the clinical interview, clinicians should directly assess suicide ideation, intent, and planning by asking the following three questions:

1. Are you currently having any thoughts of killing yourself?

2. Do you currently have any desire to kill yourself?

3. Do you have a specific plan to kill yourself?

To learn more about the nature of the patient's suicidal thinking, the clinician poses further questions about the frequency, timing, persistence, and the current severity of suicide ideation. If a patient describes a specific plan for suicide, his/her expectation about the lethality of such a plan should be examined directly. Overall, patients who report a detailed plan involving violent and/or irreversible methods are likely to be at significantly higher risk (Rudd, Joiner, & Rajab, 2001).

Because the clinical interview is an essential element of a comprehensive suicide evaluation, clinicians may benefit from the following recommendations (Ellis & Newman, 1996). Be attentive, remain calm, and provide the patient with a private, nonthreatening, and supportive environment to discuss experienced difficulties. Do not express anger, exasperation, or hostile passivity. Be forthright and confident in manner and speech to provide the patient with a stable source of support at a time of crisis. Stress a team approach to the problem(s) presented; for instance, freely use the collaborative pronoun "we" when discussing suicidal behavior. Model hopefulness, but make sure to acknowledge the patient's distress and perspective on the problem. Do not avoid using the word "suicide," because this gives the impression that you stigmatize the concept. Most importantly, do not immediately suggest hospitalization. In our experience, patients are most agreeable if the therapist carefully explores various safety options, then plans for the most appropriate clinical response to an acute suicidal episode.

Letting Go, Moving On

Letting Go, Moving On

Learning About Letting Go, Moving On Can Have Amazing Benefits For Your Life And Success! Don't be held back by the past - face your guilt and fears and move on! Letting go is merely arriving at a decision, no more allowing something from the past tense to influence your life today or to cut down your inner sense of peace and welfare.

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