Academic journal article Journal of Counseling and Development : JCD

The Process of Suicide Risk Assessment: Twelve Core Principles

Academic journal article Journal of Counseling and Development : JCD

The Process of Suicide Risk Assessment: Twelve Core Principles

Article excerpt

Assessing an individual to determine level of suicide risk is one of the most difficult and challenging experiences a counselor can face. Almost all practicing counselors will encounter a suicidal client during their careers, and most, as many as 71%, according to one study (Rogers, Gueulette, Abbey-Hines, Carney, & Werth, 2001), will work with an individual who has made a suicide attempt. Nearly one fourth (23%) of professional counselors have experienced a client suicide (McAdams & Foster, 2000). In general, mental health professionals who experience a client suicide describe it as "the most profoundly disturbing event of their professional careers" (Hendin, Lipschitz, Maltsberger, Haas, & Wynecoop, 2000, p. 2022).

Accurate suicide risk assessment is essential to identify acute, modifiable, and treatable risk factors and to help counselors recognize when clients need more specific interventions to help them manage their lives (Simon, 2002). Bonner (1990) stated that client suicide may be a counselor's "worst fear, often paralyzing the clinician emotionally and interfering with sound clinical judgment and effective crisis resolution" (p. 232). Given the high prevalence of suicidal behavior, the difficulty that clinicians face in conducting suicide assessment, and the impact of suicidal behavior on the mental health treatment community, it is vital that counselors have access to state-of-the-art information regarding assessment of suicide risk (Rogers, 2001).

Suicide risk assessment is a complex set of skills that requires knowledge, training, and experience. In general, the determination of suicide risk is based on a comprehensive assessment of individual risk factors and warning signs as well as a careful appraisal of protective factors that can work to mitigate the risk. Counselors who engage in suicide assessment often rely on formal (structured) and/or informal (unstructured) tests and interview protocols. There are dozens of commercially available assessments for children, adolescents, and adults, as well as specialized assessments for a variety of special populations. In addition, countless informal checklists and interview protocols are readily available. The content and methods used for suicide assessment has been the subject of many books, articles, and websites.

The purpose of this article, however, is to focus discussion away from the content of suicide risk assessment and instead focus on the principles that guide the process of assessment. Most of what appears in the literature regarding suicide assessment articulates risk factors and warning signs (e.g., Westefeld et al., 2000) or specific methods for intervention (e.g., Jacobs & Brewer, 2006). Although this information is essential for suicide assessment, what has been missing is a more global perspective to help situate the process. A careful review of the research and literature, as well as clinical experience and discussions with practicing counselors in a variety of settings, reveals at least a dozen overarching principles that guide the implementation of suicide assessment, regardless of setting, population, or specific type or method of assessment used (Granello & Granello, 2007). These clinical aphorisms guide the work of individuals who engage in suicide assessment, becoming a part of the expert thinking that directs the process. Taken together, the principles can form a foundation for the process of suicide risk assessment and add a significant contribution to the risk assessment literature.

Suicide assessment, by its nature, encourages counselors to focus on details and minutia, to become extraordinarily concrete in decision making, and to develop a sort of therapeutic tunnel vision. These principles are intended to draw attention back to the bigger picture, to provide the context for assessment, and to remind counselors of the foundational principles that will best serve their clients during suicidal crises. …

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