Warnings and Acts...
There may be suicidal
warnings or suicidal
acts.
You should see also
Self Injurious Behaviour when there are episodes of actual damage/harm or suicidal actions are ocurring.
A suicidal warning may be:
(a) An attempt to warn people that a Suicidal Act is about to take place - so it should
always be taken seriously.
(b) An attempt to influence people's behaviour - which can have a negative effect on those around the young person:
"This person is trying to manipulate me! this is just attention-seeking!"
- The RISK in this situation is that a genuine "cry of pain" can get overlooked.
- The REAL ISSUE if someone is seen as "attention-seeking" is:
- WHAT PROBLEM REALLY NEEDS ATTENDING TO?
(c) An attempt to communicate about an overwhelming emotional experience.
Effects on the worker:
Hearing a young person say
"I'm going to kill myself" will often leave the worker feeling:
- Helpless
- Hopeless
- Frightened
- Infuriated
- Panicky
This is likely to reduce the worker's ability to mentalize accurately, but if this can be overcome it is an experience that (through
Mentalizing the Affect) can be a helpful opportunity to develop more accurate understandings of the client, and to deepen the authenticity of the therapeutic relationship.
If left un-processed, there is a risk that such feelings could de-stabilise the
KeyWorker's own
Mentalization,
What to do
The key in these situations is to use the available
SupervisoryStructures to help you do some
Thinking Together about this.
- The feelings that the worker is overwhelmed with may be just the same feelings that the young person himself is struggling to cope with. (Psychodynamic theory would describe this as an example of 'Projective Identification'.)
- Being able to distinguish and work with experiences like this is an example of how Mentalizing the Affect can help the KeyWorker better work with the young person.
"I don't know quite what it must be like going through all the things that you are going through, but I am wondering if it seems important for me - to have a kind of taste of how it feels - to be kind of frightened and furious at the same time? I find myself thinking that I need to be really careful to make sure I have understood what you need right now for this to be helpful. Can you help me make sure I have understood things properly, as I may have got this wrong?"
Interventions
1. Make a proper assessment - including a good understanding of what happened, as well as covering:
(a) What is the risk of:
See and update your RiskAssessment, and ensure that any risks are addressed in your updated Care Plan
(b) Why now?
Are there
recent changes in the young person's
SocialEcology or personal history (relationship issues? abuse? impending criminal proceedings? etc) that might be acting as precipitants to this?
(c) How does the young person understand this behaviour?
The young person may have a very clear idea in his or her head as to why they are making these utterances, and what they want, or they may be very confused.
Either way, if the the
KeyWorker is to
Mentalize the problem accurately, these are questions that need to be approached.
Ask calmly, respectfully - mindful of the
General features of a "Mentalizing Stance".
Interventions to reduce Suicidal Warnings?
This depends largely on how the young person and family understands the "behaviour" (i.e. making utterances that falsely give other people the impression that there is a risk they will kill themselves is different from giving a warning because I am worried that I might indeed kill myself)...
Of course we WANT a young person to give suicidal warnings, not to hide suicidal ideas and plans until it is too late. What we want to avoid is the kind of mixed signals whereby the young person wants one thing (care, relief from pain or fear, etc) but asks for another thing ("I want to die".)
If the worker can begin to
Mentalize the young person's position accurately, then root causes can be addressed, and alternative ways for the young person to achieve their ends (i.e.
"I don't want to feel this pain any more" or
"I want to know that there are people about there who do really care about me" or
"I am frightened that I am about to get sent to prison.", etc) sought.
Techniques that may be applicable:
MentalizationBasedWorkPsychoEducationFamilyWorkCognitive Behavioural work