CONTENTS

About This Course

Table of Contents

1. The Nature and Scope of Suicide
2. Recognizing the Progressive Development of Suicide
3. Substance Abuse as a Major Contributor to Suicide
4. Suicide Across the Life Span
5. Special Populations and Suicide Risk
6. Prevention and Early Intervention for Suicide and Substance Abuse Problems

Supplements
References
Resources

Holding the Lifeline
A Guide to Suicide Prevention

Advice to the Counselor: Counseling a Client Who is Suicidal

• Screen for suicidal thoughts or plans with anyone who makes suicidal references, appears seriously depressed, or who has a history of suicide attempts. Treat all suicide threats with seriousness.
• Access the client's risk of self-harm by asking about what is wrong, why now, whether specific plans have been made to commit suicide, past attempts, current feelings, and protective factors.
• Develop a safety and risk management process with the client that involves a commitment on the client's part to follow advice, remove the means to commit suicide (e.g., a gun), and agree to seek help and treatment. Avoid sole reliance on "no suicide contracts."
• Assess the client's risk of harm to others.
• Provide availability of contact 24 hours per day until psychiatric referral can be realized. Refer those clients with a serious plan, previous attempt, or serious mental illness for psychiatric intervention or obtain the assistance of a psychiatric consultant for the management of these clients.
• Monitor and develop strategies to ensure medication adherence.
• Develop long-term recovery plans to treat substance abuse.
• Review all such situations with the supervisor and/or treatment team members.
• Document thoroughly all client reports and counselor suggestions.

Reprinted from U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. (2005). Treatment Improvement Protocol Series No. 42: Substance abuse treatment for persons with co-occurring disorders (DHHS Publication No. [SMA] 05-3992). Rockville, MD: Author, p. 215.