Keep in mind that we do not rescue people from threats of suicide or depression, nor do we send an ambulance out of our own anxiety. Police, ambulance and hospitalization, sometimes the only appropriate interventions, are not panaceas and create hardships that may increase a caller's vulnerability. Moreover, each rescue involves a violation of client confidentiality. Although we would far rather preserve lives than confidences, initiating emergency procedures is a serious undertaking and must be carefully thought out. Make sure you are doing it for the caller's well-being and not in response to your own anxiety and desire to do something.
Thus, your first task will be to assess the lethality of the situation. This will help you to decide whether to keep the call on a counseling level or take a more directive stance. Refer to Chapter 5 in the operation’s manual for a discussion of lethality assessment and how to counsel suicidal callers. Here we discuss some things to think about before enacting emergency procedures.
Imminent Risk
A caller is determined to be at imminent risk for suicide or homicide when the crisis counselor believes, based on information gathered during the exchange from the caller, that there is a close connection in time between the person's current risk status and actions that could lead to suicide or a homicide. A thorough assessment of a person’s risk must be made. Has the caller already hurt himself? What is the caller’s plan for suicide/homicide? Is the caller hurting himself with the intent to die? How easily accessible are the means? What is the time frame for the suicide/homicide plan?
Imminent risk is determined when the crisis counselor believes that the caller is likely to seriously harm himself if no action is taken.
Imminent Risk may be determined if an individual states both a desire and intent to die or harm others and has the capability of carrying through his intent with a definite plan and access to the lethal means.
Active Engagement
Active Engagement refers to the crisis counseling skills used to effectively build an alliance with callers at Imminent Risk towards mutual understanding and agreement. Crisis counselors must have a willingness to connect with callers. Crisis counselors work collaboratively with callers to successfully reduce imminent risk and to increase callers’ safety. Sometimes, the safe plan is for the caller to accept medical or emergency interventions when the person is in the process of a suicide attempt or harms another.
Active engagement is typically necessary for both a comprehensive, accurate assessment of a caller's suicide risk as well as for collaborating on a plan to maintain the caller's safety. Crisis counselors must actively engage with callers to try to understand and reflect the caller’s situation and emotional state. Through Active Engagement, the crisis counselor is more likely to help callers feel understood, and to come to a mutual agreement towards actions necessary to reduce the caller’s imminent risk.
Active Engagement is what crisis counselors do to collaborate with and empower the caller towards securing his own safety, or the safety of the person he is calling about.
Least Invasive Intervention
Confidentiality and callers self-efficacy are important concepts with working on the crisis lines. Any involuntary action taken should always be a last resort and initiated in circumstances where the person at risk is unable to participate in a plan to keep safe. Make sure to explore other options before utilizing emergency procedures. Some options include the Mobile Crisis Unit, Sausal Creek, have a friend come over, or to call the caller’s therapist or physician.
Act in Progress
It is important to always keep in mind the concepts for active engagement and least invasive interventions. A rescue must be initiated, with or without consent, if a suicide attempt is believed to be in progress. Sometimes, there is not enough time to explore different options for safety. You should continue to build rapport with the caller and utilize your shift partners help to enact a rescue.
Shift Supervisor
There is a shift supervisor on every shift. This person’s main duty is to support you as a crisis counselor. Notify the shift supervisor if you are on a call with someone who have medium or high risk for suicide so the supervisor and monitor the call and provide support. The shift supervisor may communicate with you over Message Pal. If the Shift Supervisor is not available, the phone number for the Crisis Line Coordinator, Training Coordinator, and Clinical Director is posted in front of the Crisis Line Coordinators Office.
In Summary these are the questions to ask yourself before Emergency Procedures
• Am I acting in the caller’s best interest? (or out of my own anxiety)
• What is the suicide risk of the caller?
• Have I actively engaged with the caller?
• Am I choosing the least invasive intervention to keep the caller safe?
• Who can I consult with?
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