Adult Treatment Planner
41: Suicidal Ideation
SNOMED Terms
- Atypical depressive disorder
- Bipolar I disorder, single manic episode
- Bipolar II disorder, most recent episode major depressive
- Borderline personality disorder
- Chronic bipolar II disorder, most recent episode major depressive
- Depressive disorder
- Major depression single episode, in partial remission
- Major depression, single episode
- Mild bipolar I disorder, single manic episode
- Mild bipolar II disorder, most recent episode major depressive
- Mild major depression, single episode
- Mixed anxiety and depressive disorder
- Moderate bipolar I disorder, single manic episode
- Moderate bipolar II disorder, most recent episode major depressive
- Moderate major depression, single episode
- Reactive depressive psychosis, single episode
- Recurrent psychotic major depression in full remission, single episode
- Severe bipolar I disorder, single manic episode
- Severe bipolar II disorder, most recent episode major depressive with psychotic features
- Severe bipolar II disorder, most recent episode major depressive without psychotic features
- Severe bipolar II disorder, most recent episode major depressive, in partial remission
- Severe bipolar II disorder, most recent episode major depressive, in remission
- Severe major depression, single episode
- Single major depressive episode, severe, with psychosis
Goals
- Alleviate the suicidal impulses/ideation and return to the highest level of previous daily functioning.
- Stabilize the suicidal crisis.
- Placement in an appropriate level of care to safely address the suicidal crisis.
- Reestablish a sense of hope for self and the future.
- Cease the perilous lifestyle and resolve the emotional conflicts that underlie the suicidal pattern.
Behavioral Definitions
- Recurrent thoughts of or preoccupation with death.
- Recurrent or ongoing suicidal ideation without any plans.
- Ongoing suicidal ideation with a specific plan.
- Recent suicide attempt.
- History of suicide attempts that required professional or family/friend intervention on some level (e.g.,
inpatient, safe house, outpatient, supervision).
- Positive family history of depression and/or a preoccupation with suicidal thoughts.
- A bleak, hopeless attitude regarding life coupled with recent life events that support this (e.g., divorce,
death of a friend or family member, loss of job).
- Social withdrawal, lethargy, and apathy coupled with expressions of wanting to die.
- Sudden change from being depressed to upbeat and at peace, while actions indicate the client is "putting
his/her house in order" and there has been no genuine resolution of conflict issues.
- Engages in self-destructive or dangerous behavior (e.g., chronic drug or alcohol abuse; promiscuity,
unprotected sex; reckless driving) that appears to invite death.
Diagnoses
- Bipolar I Disorder
- Dysthymic Disorder
- Major Depressive Disorder, Single Episode
- Major Depressive Disorder, Recurrent
- Bipolar II Disorder
- Borderline Personality Disorder
Objectives and Interventions
- State the strength of the suicidal feelings, the frequency of the thoughts, and the detail of the plans.
- Assess the client's suicidal ideation, taking into account the extent of his/her ideation, the
presence of a primary and backup plan, past attempts, and family history.
- Assess and monitor the client's suicidal potential on an ongoing basis.
- Notify the client's family and significant others of his/her suicidal ideation; ask them to form a
24-hour suicide watch until the crisis subsides.
- Arrange for the client to take the Minnesota Multiphasic Personality Inventory (MMPI), Beck
Depression Inventory (BDI), or Modified Scale for Suicide Ideation (MSSI); evaluate the results for
the client's degree of depression and suicide risk.
- Verbalize a promise to contact the therapist or some other emergency helpline if a serious urge toward
self-harm arises.
- Elicit a promise from the client that he/she will initiate contact with the therapist or a helpline
if the suicidal urge becomes strong and before any self-injurious behavior.
- Provide the client with an emergency helpline telephone number that is available 24 hours a day.
- Make a contract with the client, identifying what he/she will and won't do when experiencing
suicidal thoughts or impulses.
- Offer to be available to the client through telephone contact if a life-threatening urge develops.
- Client and/or significant others increase the safety of the home by removing firearms or other lethal
weapons from easy access.
- Notify the client's family and significant others of his/her suicidal ideation; ask them to form a
24-hour suicide watch until the crisis subsides.
- Encourage significant others to remove firearms or other lethal weapons from the client's easy
access.
- Report suicidal impulses to a designated significant other or helping professional.
- Notify the client's family and significant others of his/her suicidal ideation; ask them to form a
24-hour suicide watch until the crisis subsides.
- Elicit a promise from the client that he/she will initiate contact with the therapist or a helpline
if the suicidal urge becomes strong and before any self-injurious behavior.
- Encourage the client to be open and honest regarding suicidal urges, reassuring him/her regularly of
caring concern by therapist and significant others.
- Cooperate with hospitalization if the suicidal urge becomes uncontrollable.
- Arrange for the client to take the Minnesota Multiphasic Personality Inventory (MMPI), Beck
Depression Inventory (BDI), or Modified Scale for Suicide Ideation (MSSI); evaluate the results for
the client's degree of depression and suicide risk.
- Arrange for hospitalization when the client is judged to be uncontrollably harmful to self.
- Identify life factors that preceded the suicidal ideation.
- Explore the client's sources of emotional pain and hopelessness.
- Encourage the client to express feelings related to his/her suicidal ideation in order to clarify
them and increase insight as to the causes for them.
- Assist the client in becoming aware of life factors that were significant precursors to the
beginning of his/her suicidal ideation.
- Increase communication with significant others, resulting in a feeling of understanding, empathy, and being
attended to.
- Probe the client's feelings of despair related to his/her family relationships.
- Hold family therapy sessions to promote communication of the client's feelings of sadness, hurt, and
anger.
- Meet with significant others to assess their understanding of the causes for the client's
distress.
- Significant others verbalize an understanding of the client's feelings of alienation and hopelessness.
- Hold family therapy sessions to promote communication of the client's feelings of sadness, hurt, and
anger.
- Meet with significant others to assess their understanding of the causes for the client's
distress.
- Cooperate with a referral to a physician for an evaluation for antidepressant medication.
- Assess the client's need for antidepressant medication and arrange for a prescription, if
necessary.
- Take medications as prescribed and report all side effects.
- Monitor the client for effectiveness and compliance with prescribed psychotropic medication; confer
with prescribing physician on a regular basis.
- Identify how previous attempts to solve interpersonal problems have failed, leading to feelings of abject
loneliness and rejection.
- Assist the client in becoming aware of life factors that were significant precursors to the
beginning of his/her suicidal ideation.
- Encourage the client to share feelings of grief related to broken close relationships.
- Review with the client previous problem-solving attempts and discuss new alternatives that are
available.
- Reestablish a consistent eating and sleeping pattern.
- Encourage normal eating and sleeping patterns by the client and monitor his/her compliance.
- Verbally report no longer feeling the impulse to take own life and demonstrate an increased sense of hope
for self.
- Assess and monitor the client's suicidal potential on an ongoing basis.
- Assist the client in developing coping strategies for suicidal ideation (e.g., more physical
exercise, less internal focus, increased social involvement, more expression of feelings).
- Assist the client in finding positive, hopeful things in his/her life at the present time.
- Identify the positive aspects, relationships, and achievements in his/her life.
- Assist the client in finding positive, hopeful things in his/her life at the present time.
- Review with the client the success he/she has had and the sources of love and concern that exist in
his/her life; ask him/her to write a list of positive aspects of his/her life.
- Identify and replace negative thinking patterns that mediate feelings of hopelessness and helplessness.
- Assist the client in developing an awareness of the cognitive messages that reinforce hopelessness
and helplessness.
- Identify and confront catastrophizing tendencies in the client's cognitive processing, allowing for
a more realistic perspective of hope in the face of pain.
- Train the client in revising core schemas using cognitive restructuring techniques.
- Require the client to keep a daily record of self-defeating thoughts (thoughts of hopelessness,
helplessness, worthlessness, catastrophizing, negatively predicting the future, etc.); challenge
each thought for accuracy, then replace each dysfunctional thought with one that is positive and
self-enhancing.
- Develop and implement a penitence ritual in which one expresses grief for victims and absolves self of guilt
for surviving an incident fatal to others.
- Develop a penitence ritual for the client with suicidal ideation connected with being a survivor and
implement it with him/her.
- Verbalize a feeling of support that results from spiritual faith.
- Explore the client's spiritual belief system as to it being a source of acceptance and peace.
- Arrange for the client's spiritual leader to meet with and support the client.
Index