Standard approaches to suicide prevention implement face-valid screening measures across systems of care. The approaches encourage providers to “ask the question” about suicide risk to avoid missing those who are at risk.
Yet, in practice, the approach misses many of the people who are actually at risk. Why is this?
Part of the reason is because this approach does not integrate a nuanced understanding of human psychology.
In my work as a psychologist who often treats those at risk, I see four profiles of those at risk. I have created the following risk typology based on my observation.
To understand it, let’s look at it through the lens of the intersection between substance use and suicidality.
PROFILE 1: Someone has intent to die—with self-awareness—and a substance is part of or the primary method using to carry out a suicide attempt.
How they show up clinically: The individual has self-awareness of their suicidal thinking and would likely share it if a highly trusted person asked them, they wanted to address it, and they were confident that help and healing were possible for them.
PROFILE 2: Not suicidal (no intent, either in self-aware or latent way). This person may nonetheless die by overdose and their death happens either after prolonged struggle with addiction or as the result of accidentally taking an overdose in the first few times they take a drug. This person is not suicidal.
How they show up clinically: No endorsement of suicide risk on standard screeners. They would spike on assessments of substance abuse, though, if asked by a trusted source and if they wanted to address it and felt help was possible.
PROFILE 3: Slow-burn intent. This person might die by overdose as part of a bigger campaign of self-neglect. The substance wasn’t the means of an intentional suicide attempt, but, rather, their physical and mental defenses have become so fragile after a long campaign of self-neglect in which they have been fundamentally unprotective of their basic physical and safety needs.
How they show up clinically: Individuals in this category would likely not endorse being suicidal. They might be in very poor health, with unmanaged diabetes, for instance, or other chronic health concerns that are undertreated or unaddressed. They might be homeless. They might be a celebrated police officer who is taking reckless risks out of a slow-burn intent. The opposite of death by cop is death by violent criminal. I see this quite a bit in my work with first responders, since they can get benefits for their family if they die in the line of duty and they will be hailed as having a hero’s death.
PROFILE 4: Veiled intent. The person is suicidal but that risk sits in their blind spot. When they get high or intoxicated, that kind of altered state operates like a diathesis-stress model, revealing the underlying intent they were not aware of and creating a level of disinhibition that greatly elevates acute risk. The suicidal mode is an altered state as well, so the combination of substance use and suicide mode are very dangerous together for many individuals.
How they show up clinically: They would not endorse suicide risk on an assessment. Suicide risk is sitting in their blind spot, revealed only when their defenses are breached by the substance.
What is critical to see is this: Conventional thinking on suicide screening misses many of the people who are at risk. Most people who receive a screening measure would never endorse items that show them to be at risk. This is true in three out of the four categories in the typology I’ve described.
If we want to prevent suicide, we must think deeper. We must stop thinking in basic algorithms and using simplistic approaches. We must stop leading with technology solutions that can’t discern the unique psychological landscape of those we serve. Technology can support suicide prevention but only when it serves a solution that is based on human connection, trust, and interpersonal courage.
Source link : https://www.psychologytoday.com/za/blog/free-range-psychology/202410/suicide-risk-assessment-a-critique
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Publish date : 2024-10-07 21:20:15
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