COU204A Applied Counselling 3 Suicidal thoughts and crisis interventions Assessment Answer

Introduction

This report critically reviews a set of recent journals to evaluate different crisis intervention models for suicidal clients. It includes evaluation of six-steps model of crisis, LAPC (Listen-Assess-Plan-Commit) model and ASIST (Applied Suicide Intervention Skills Training) suicidal intervention model. It defines crisis and its association to suicidal thoughts. It also provides a brief case study to demonstrate the applications of three chosen models. It is discussed how each intervention model helps in assessment, understanding and support process for the clients. Using literature review, there is also comparison of personal findings along with example how the case could be addressed effectively.

Definition of crisis and crisis interventions and outline of chosen models

According to Murphy et al. (2015, p9(3)), crisis is a mental health situation in which individual’s feelings, actions and behaviours can prevent the person to function adequately or indicate that the person may harm themselves or others in group or community. Also, Faubert (2019, p1(2)) explained it as an overwhelming event causing psychological stress. In such situations, the usual coping mechanism of a person may be inadequate and symptoms are often reported during the crisis such as suicidal thoughts and attempts. As per Murphy et al. (2015, p9(4)), crisis intervention means to the technique used to offer short-term and immediate help to individual experiencing a situation causing mental, emotional, behavioural and/or physical distress. According to Kratcoski & Kratcoski (2017, p1(2)), the purpose of crisis intervention is to reduce potential permanent loss of ability of functioning to individual in crisis. An inadequate support to the patient can lead development of depressive disorders as discussed in this paper.

Instead of all, the report focuses on only three crisis intervention models. First, the six-stage model establish the foundation of intervening an individual to assist them to restore basic coping skills and a sense of control as explained by Ahmad & Ashri (2018, p1(6)). It focuses on problem definition, client safety assurance, provision of support, examination of alternatives, plan making and obtaining of commitment. Second, LAPC model helps to understand whether to use directive, collaborative or non-directive approach with the clients. It has advantages as it is easy to remember and apply as explained by Kanel (2019, p5(3)). Third, Shannonhouse et al (2017, p2(7)) explain that ASIST model focuses on establish of strong therapeutic relationship with clients and reduce the risk by preparing safety plan and arranging suitable support systems from community. It emphasizes on immediate help to clients and linking them to further help.

Case study

Sarah is a 25-years old aboriginal college student from remote areas in New South Wales. She is struggling with anxiety and depression for the past six months. She is feeling loneliness and hopelessness because she has recently experienced a significant loss of her long-term relationship. She is unable to focus on her studies and think that she might not be able to join the further courses for that she is selected. Over the past few weeks, she is not involving with friends and family members. She is unable to concentrate on studies and experiencing insomnia. Her roommate noticed a drastic change in her behaviour as several times, she found that Sarah is expressing thoughts of worthlessness, crying alone in room and admitting the thoughts of suicide. As academics are closed, Sarah’s roommate is seeking some professional help outside the university counselling centre.

With a communication to crisis supporter on lifeline to whim Sarah was used to communicate, she identified that she has developed suicidal thoughts ahead of her depression and she has lack of control on her thoughts as she is too much worried about the future.

Assessing the client

According to Polemikou (2021, p6(3)), the six-stage model of crisis intervention starts with identification of problem. During the identification of exact problem, there is also establishment of relationship between supporter and client. The active listening process is used in open-ended questions and core factors such as positive regard, genuineness and empathy. In second step, the client’s safety is ensured by assessing suicidal risks and homicide risks and access to all lethal means to suicide are removed.

Regarding LAPC model, Shannonhouse eta l. (2017, p2(7)) explains that listen and assessment are two importance stages. In crisis, it is vital to understand what is actually happening instead of pre-assuming the context which can lead inappropriate response. Open-ended questions, clarifying and summarizations are used as primary counselling skills to listen the client effectively. CPR (Connect-empower-revitalize) model is used for assessment of the client by making use of information shared by the client.

According to Dückers et al. (2017, p8(2)), assessment in ASIST model starts with invitation of help-seeker and then supporter explores past and current stressors, issues and experiences of the client. The core purpose of the assessment is to explore client’s perspective for the incident and determine suicidal intentions. The process includes exploration of risks connected to previous and current suicidal thoughts, actions and behaviours.

The six-stage model is presented in linear fashion but the client may move backward and forward in the stages and regresses as the situation changes as explained by Kanel (2019, p5(3)). The application of the model has lack of clarity regarding the current stage of the client while there are no standard mechanisms to assess the client’s current stage. Further, the model starts with definition of problem through several general open-ended questions and consideration of factors such as positive regard and empathy so that it is possible to have missing information from the clients as discussed by Eaton-Stull (2021, p242(2)). It is challenging to ask questions for trauma and incidents as they can rectify the symptoms and increase sensitization and stress. In ASIST model, there is focus on listening and responding on the client’s invitations. There are predefined instructions on what to explore with the client to assess suicidal risk as explored by Ahmad, & Ashri (2018, p988(2)). The six-stage model is not linear and heavily depends on problem identification for a nearly-perfect intervention whereas ASIST model is more about the therapeutic communication toward reduction in risk on immediate basis as evaluated by James (2016, p2(1)). LAPC is emphasized on perspective of the client and assess the behaviour and aspects of the clients instead of being directive for the situation as evaluated by Murphy et al. (2015, p5(2)).

In case study, Sarah is presented for counselling and after the discussion of contract and confidentiality limitation, I would begin to explore as suggested by Kratcoski & Kratcoski (2017, p5 (2)), like what has bought you here in counselling today? I would adopt AIST approach to listen the invitation that may indicate suicidal risks or putting her at higher risks and harms due to age, isolation level, gender and culture. According to Nsoesie (2022), p1(5), indigenous have almost double rate of suicidal incidents as compared to non-indigenous people. The percentage of male in death due to suicidal attempt is nearby 70% as reported in 2019. The risk of suicide is higher in remote areas due to poor accessibility to counselling. I would prefer to use SSQ-SR which is a simple but effective set of 25-items to assess the suicidal risk along with exploration of previous suicidal thoughts and feelings.

Understanding the Client

Faubert (2019, p2(4)) has demonstrated how to understand the client safety perspective and support requirements when using six-stage model. Once the problem is well-defined, there is focus to assess the suicidal risks and eliminate lethal means to suicide. The client is accepted as a person of values and they are communicated with care. The process to understand the client includes simple questions like what is going in their life and how they are taking care of their basic needs. The perspective of the client is point of attention to determine right support.

According to Eaton-Stull (2021, p2(5)), stage-3 of the LAPC model focuses on planning to address the crisis through understanding developed using CPR or DCIB suicide risk assessments. The understanding phase requires critical attention of helper as inadequate processing of the problem can put the client in new risks. There is active listening to the client’s perspective and any conflicting attitudes, and dysfunctional beliefs are identified to understand how the client has managed the situations in past and current time.

According to Kratcoski & Kratcoski (2017, p2(6)), The understanding phase of ASIST model includes exploration of the client thoughts indicating suicidal intentions. Supporting space is provided to the client to enable them for expression of thoughts and the reasons for living are highlighted to them when they are distracted to die. The conflicting attitudes are explored and addressed to encourage them for living.

In reflection, James (2016, p2(1)), got an understanding with emotional context of client and helpers get assistance to understand past coping skills and approaches of the client. According to Kanel (2019, p2(5)), ASIST model helps to develop understand the reasons of living or die as perspective of the client but six-stage model helps to determine their current perspective and examine alternatives to obtain their commitment for living. LAPC also emphasizes on their past stressors and coping mechanisms to develop suitable plan.

To assist Sarah effectively, I have to provide quality psychoeducation to reduce stress leading her toward the suicidal thoughts. Sarah can be assisted using ASIST model so that her reasons for living or die can be discussed. Further, the model can be combined with six-stage model to understand her previous approaches and coping skills and contribution of negative thoughts on her attitude and functioning as discussed by Shannonhouse et al. (2017, p2(2). It is examined that meaning making ability and core beliefs significantly impact individual’s reaction to events and it puts them in greater risk of depression and suicidal attempts.

Supporting the Client

Polemikou (2021, p545(2)) explain that the introduction of new coping and cognitive skills is effective once the previous coping mechanisms are identified accurately. It makes the recognition and overcoming of probable barriers easy through implantation of fresh perspectives. The six-stage model inform to arrange suitable support services to client in community and devise a recovery plan with identification of alternatives.

According to Dückers et al. (2017, p95(2)) the client gets significant support through the safe plan of the ASIST model. A safe plan includes disabling of suicidal thoughts and plans, minimizing exposure to risks such as substance use and encourage to manage emotional plan. It also helps to clarify the emergency support, use of available resources and linking to suitable care services to develop required coping skills.

Faubert (2019, p2(4)), explain that LAPC model plans safety for the client on priority to address the crisis. It focuses on employ of coping strategies to help ground themselves. Once the immediate dangers are taken care the planning phase includes referral to other organizations providing long-term support and care. In several cases, the first phase is again referred to restore equilibrium.

In summary, LAPC model and six-phase model focus on follow-up process while the clients in LAPC are volunteer to them opt out from the services. Faubert (2019, p2 (1) explains that it is important to design post-crisis evaluation and follow ups so that the client’s resolution in moving phase can be examined. I believe that ASIST model has benefits to train the clients for a short-period but guide them to develop emotional or cognitive support. Six-phase model and LAPC model are more emphasized to minimize the risk by addressing immediate factors in context.

In case of Sarah, she can be linked to a general practitioner. I will encourage her for regular check up and conversions, depends on risk level. If there is need of medication, she can be referred to psychologist, otherwise, psychotherapy can be preferred for her through her collaboration and consent. In case of severe depressive symptoms, cognitive behavioural therapy can be preferred for her to address immediate risk of the suicidal attempt.

Conclusion

This critical review indicates that six-phase model is most suitable and comprehensive for the client because it can address different kinds of crisis and eliminate the risk factors. It also focuses on follow-up and check-outs. I identified that each model has strengths and weaknesses and therefore, the other models also have their equal applicability. I would prefer to use ASIST model as it can help to train the client to regain control to coping mechanism and induce their contributions to improve the health situations. ASIST model is also simple and easy to apply while it determines the directions and future intervenes for the client on the basis of current stage of crisis management. There is comprehensive support and care management for the client through helper, community and others.

References

Ahmad, N. S., & Ashri, S. N. N. M. (2018). Comprehending Crisis Intervention among Helpers. International Journal of Engineering & Technology , 7 (4.38), 988-991. https://pdfs.semanticscholar.org/c070/a51d262cda2bccc8c0eaf30829f6bdd0010c.pdf

Dückers, M. L., Yzermans, C. J., Jong, W., & Boin, A. (2017). Psychosocial crisis management: The unexplored intersection of crisis leadership and psychosocial support. Risk, Hazards & Crisis in Public Policy , 8 (2), 94-112.

Eaton-Stull, Y. (2021). Crisis Intervention. Social Workers' Desk Reference , 242 .

Faubert, S. E. (2019). Crisis intervention: Building resilience in troubled times. https://econtent.hogrefe.com/doi/full/10.1027/0227-5910/a000607

James, R. K. (2016). Crisis intervention. https://www.academia.edu/download/33134071/Cap_2_Crisis_Intervention_Strategies_(CPSY_807)-4.pdf

Kanel, K. (2019). A guide to crisis intervention . Cengage Learning. http://students.aiu.edu/submissions/profiles/resources/onlineBook/r3c5A5_A_Guide_to_Crisis_Intervention-_4th_edition.pdf

Kratcoski, P. C., & Kratcoski, P. C. (2017). Brief Therapy and Crisis Intervention. Correctional Counseling and Treatment , 239-254.

Murphy, S. M., Irving, C. B., Adams, C. E., & Waqar, M. (2015). Crisis intervention for people with severe mental illnesses. Cochrane Database of Systematic Reviews , (12). https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001087.pub5/pdf/full

Nsoesie, E, 2022. The High Suicide Rates Among Indigenous Populations. https://www.publichealthpost.org/databyte/suicide-rates-indigenous.

Polemikou, A. (2021). Disaster-Induced Psychological Trauma: Supporting Survivors and Responders. In Emergency Medicine, Trauma and Disaster Management: From Prehospital to Hospital Care and Beyond (pp. 545-554). Cham: Springer International Publishing. https://www.researchgate.net/profile/Anna-Polemikou-2/publication/332963693_Disaster-induced_psychological_trauma_Supporting_survivors_and_responders/links/5cd4102592851c4eab8cbf41/Disaster-induced-psychological-trauma-Supporting-survivors-and-responders.pdf

Shannonhouse, L., Lin, Y. W. D., Shaw, K., & Porter, M. (2017). Suicide intervention training for K–12 schools: A quasi‐experimental study on ASIST. Journal of Counseling & Development , 95 (1), 3-13. https://doi.org/10.1002/jcad.12112

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