Working with Clients at Risk of Suicide
If at any time you feel your safety or your client’s safety is imminently threatened, call 911.
A printable copy of the following information is linked here: Citizens' Guidelines for Working with Suicide Risk
While it doesn’t happen often, we can, occasionally, have clients who present as at risk for suicide. These may include:
clients who rate themselves as high risk
clients who, either during a phone intake, a follow-up call, or in counselling, demonstrate warning signs and risk factors for suicide. Your informed judgement is important here. One client who rates themselves at a 7/10 may in fact be less suicidal than someone else at a 5/10.
Use the following tools:
IS PATH WARM to help you to consider a client’s warning signs and protective factors, and the Suicide Risk Assessment Matrix, to help you to assess a client’s current state. The categories of mild, moderate and high risk are guidelines only. Err on the side of caution to help your client stay safe. Copies are in each of the counselling rooms, and the filing cabinet by the copier.
Ask direct questions about suicidality. Based on your client’s responses to these questions and your awareness of warning signs, risks and protective factors, assess if your client is at low (or mild), moderate or high risk for suicide.
For example:
Have you been thinking of taking your life or harming yourself? Tell me more about those thoughts? How often do you have these thoughts?
Have you had these thoughts in the past? Did you try to end your life or hurt yourself before? Tell me more about that (when, how many times, what was your method, what stopped you).
Are you having thoughts of suicide now? If yes, on a scale of 1 to 10, with 1 being not at all and 10 being intention to die soon, where are you?
How would you do that? Do you have a plan?
Do you have the means available to carry this out?
What has been keeping you alive so far?
If you feel your client is at low(mild) to moderate risk, take the following actions:
Offer to write up either a Safety Plan [hard copy] or IntakeQ Safety Plan [hard copy] with your client. (The questions are the same.) Make copies for the client so they can have it on hand in multiple places. Keep a copy in your client’s IntakeQ file. (if you have created a hard copy, a staff member can scan and upload this). You can also “Create a New Note” and fill in a Safety Plan on the client’s IntakeQ file. This can be emailed directly to the client.
Work with your client to identify a friend or family member who they could tell about their suicidal thoughts and who could be a support.
Ask them to make their environment as safe as possible and make a plan to get rid of any lethal means they have access to.
If the risk is low (or mild), discuss the client with your supervisor at your next appointment. If the risk is moderate, connect with a supervisor the same day or next day.
If you feel your client is at high risk for suicide, do not leave the person alone or let them go home by themselves.
Take the following actions:
Ask if you can call a friend or family member to come pick them up and take them to Emergency at the Royal Jubilee Hospital. Their emergency contact information is on their Online Intake form which is found on their file.
If you cannot reach a friend or family member let them know you will call a cab. Call Bluebird Cabs at (250) 382-2222. Citizens’ has an account or you can pay for it and the Centre will reimburse you. Tell the driver this person is in distress and kindly ask them to walk the client into Emergency when they reach the hospital.
If the client is unwilling or unable to get to the hospital with a friend or family member and they are unwilling to go by cab let them know you are going to call 911 to arrange transportation to Emergency.
If you need to debrief and have no one to do this with call the Director or a Supervisor (see list below).
Complete a Critical Incident Report form (filing cabinet by photocopier) and submit it to Citizens’ as soon as possible.
Unsure of the risk level or unsure of what to do?
If your session is during office hours, consult with staff or a supervisor who is present on site.
If after hours, contact a supervisor at home.
Err on the side of caution and assist your client in accessing whatever care will help them feel safe.
CCC Staff and Supervisors to Call:
Holt Sivak 250-644-4448
Patricia Nasmyth: 250-360-7714
Jude Marleau: 250-889-4930
Michael Timney: 250-880-3690
Sue Farr: 778-700-0455
Marita Poll: 250- 858-1761
Crisis Lines
Vancouver Island Crisis Line (available 24 hours every day): Call 1 (888) 494-3888
Online crisis chat (available from 6 pm-10 pm every day): Visit www.vicrisis.ca
Crisis texting service (available from 6 pm-10 pm every day): Text (250) 800-3806
Mental Health Support Line (available 24 hours every day): Call 310-6789
CLCR Team: 250-818-2454 (Community-Led Crisis Response)