Assessing suicide risk in the adult patient

Assessing the Suicide Risk in Adult Patients
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Chapter 3
The article starts by saying that suicide and suicidal patients are a pervasive part of the mental health practice. According to a survey, a typical psychologist sees up to five patients for whom suicide is a problem. 36% of the professionals surveyed indicated they had lost a patient during their practice. In the same way, 97% of the practitioners, have treated at least a patient sporting suicidal tendencies. This indicates that most professionals offer suboptimal care in the issues related to suicide. In the same way, most of them lacked a formal assessment of suicide risk among their patients. Also, for most psychology or medical trainees, asking questions about suicide to their patients is a delicate issue, and most of them do not do it. We can say that this happens because there is not an authority that defines the standard of care for suicide risk assessment. Although the APA has a series of guidelines that could constitute an assessment, they do not constitute a standard.
Among the factors that contribute to the rates of suicide are Access to firearms; medical illnesses; prior suicide attempts; suicidal communications; social isolation; Biological-Gene tic-Dispositional, and Lack of Protective Factors. In the same way, there are methods to determine those risks such as psychological testing. For instance, the use of the MMPI-2, or the DSM-5 to determine the illness the patient suffers and if said patient has suicide risk.

To assess those risks the psychologist can use a series of methods such as the Beck Depression Inventory and Beck Hopelessness Scale, a scale with a range of items designed to assess the severity of depression in adolescents and adults. Also, the Linehan Reasons for Living Inventory, which assesses a person’s commitment to not to die. That is why the importance of categorizing patients according the suicide risk is that important. Regularly checking on a suicidal patient can make the difference, and keep the patient alive. However, there is also the doubt of “Is this patient going to kill himself?” Despite the care, if a patient wants to end its life, it will.
Chapter 6
To correctly assess suicide, and suicidal patients, the psychologist has to manage the risk of violence to protect themselves; the patient, and any interested third-party for any violent outburst the patient might experience. By correctly assessing the likelihood of violence in their patients, the therapist can determine which interventions will be correct to treat patients safely. This chapter comments the methods of analysis that can be useful to plan risk management.
For instance, situations such as: history of violence; violent threats and fantasies; gender history of victimization culture; socioeconomic status, and intelligence are associated with violence, and patients subject to said conditions are more likely to react violent to treatment than those who are not. Besides the patients’ situation, the clinical diagnosis plays a key role in the assessment. Although the proportion of mental health-related violence is small, it still plays a primary role in this evaluation. Illnesses such as acute schizophrenia; mania and cognitive disorders; substance use disorders, and personality disorders are a few of the main causes of violence in patients. That is way therapists have to tread carefully in the presence of that kind of patients. Among the symptoms of a violent outbreak, we find anger; aggressive attributional style, and command hallucinations.
It is important to note that there are a series of situations that might trigger a violent outburst, such as the relationship with potential victims; the availability of potential victims; social support, and the availability of firearms. All those items are of fundamental importance when confronting and treating an aggressive patient. There are a series of decision tools that the therapist can use such as the HCR-20; the VSC; BVC; START, and DYAS. All those tools offer a quick diagnosis that could make the difference in treating a violent patient. After diagnosis the patient, a series of precautions must be taken, and prepare a series of rapid interventions to limit the patient’s behavior. Either a verbal, or pharmacological intervention could work, depending on the acute of the setting.
Upon knowing all those variables, and offering the patient support, and the help it needs could make the difference in having to confront an aggressive outburst, or treating a docile patient.