A client …
Who among us have not had our lives influenced by an encounter with death by suicide. When you serve those who journey with a mood disorder, explorations of suicidal thoughts and fantasies come with the territory. When the news is full of information about this kind of death, our antennas go up, making sure we are looking out for those in our care.
Most of us learn to explore this territory with some ease if not confidence, none of us want to lose someone to suicide. We soldier into the conversation with some clear objectives:
- Is there a plan?
- How serious and immediate is that plan?
- Do they have access to the resources to carry out that plan?
We AND our clients have access to information but not always ample and equal access to resources. The recent celebrity deaths can and are having an influence with clients journeying through the darker environs of grief and / or mood disorders.
Back in the eighties, I worked at the Western Institute of Neuropsychiatry (WIN) on the mood disorders unit. We had the luxury of working with all patients individually for hours at a time. This was in addition to groups, medication stabilization, etc. Our team consisted of a psychiatrist, psychologist, a couple of social workers and nurses, with ancillary service providers on staff. We met regularly, exchanging information and collaborating on care.
Most inpatient facilities these days afford no such luxuries. Nonetheless, hospitalization to protect clients from immediate danger is the standard of care, as it should be. But what about those clients who are not presenting with a clear and present danger and are at risk nonetheless?
One thing I learned from my early and very satisfying experiences at WIN is the importance of having a care team. Having a care team enables practitioners to "put the hospital around the patient," as a brilliant colleague would say.
- increasing the number of visits to two, three, four or more times a week
- with the clients' permission, including family or friends in the care plan as needed
- communicating at regular times between visits
- helping the client map out a somewhat structured day plan – this is extremely valuable to those suffering with the brain fog and heaviness that can accompany mood disorders
- supporting them in using the small, easy practices they have learned. Loving kindness meditations via apps can be useful for clients during this time. Unless they have already been practicing mindfulness, it is not the best time to learn mindfulness.
- collaborating with the client's care team. For me that generally means my client and the prescribing practitioner.
This final point, collaborating with the prescribing practitioner is one that I see is often neglected by practitioners in private practice. As my mentor, Dick Olney would say, "Don't wait until you are in the middle of a fire to practice a fire drill."
When someone is shut down by the heaviness of depression AND they are considering suicide – there's a firestorm. We are able to provide better care when we have a good collaborative relationship with our clients' prescribing practitioner. If you have clients on medication and you are not in touch with the person prescribing medication for them, I hope you will get a release if you don't already have one, reach out to consult and collaborate about your shared client. Developing this kind of collaborative relationship puts you in the position to help access valuable resources for your client when they may not be able to do so.
AND, take care of yourself. Seriously. Reach out to your friends, take some time to be in the woods and put your feet on the grass. If you've lost someone to death by suicide, you are likely carrying some tension. How is the news about death by suicide affecting you and your practice?