Tomorrow is the first day of the MUS Statewide Summit on Suicide Prevention in Bozeman, Montana. From 2:30-3:45pm I’ll be participating on a panel: “Screening and Intervention Options with the Imminently Suicidal.” During my 10-12 minutes, I’ll be offering my version of what I view as essential strategies and skills for face-to-face suicide assessment interviewing. Below is the handout for the Summit. I think it’s a great thing that we’re meeting in an effort to address this important problem in Montana. Thanks to Lynne Weltzien of UM-Western in Dillon and Mike Frost of UM-Missoula for the invitation. Here’s the handout . . .
Three Strategies for Conducting
State-of-the-Art Suicide Assessment Interviews
John Sommers-Flanagan, Ph.D.
University of Montana
I. To conduct efficient and valid suicide assessment interviews, clinicians need to hold an attitude of acceptance (not judgment) and use several state-of-the-art assessment strategies.
II. If clinicians believe suicide ideation is a sign of psychopathology or deviance, students or clients will sense this and be less open.
III. Asking directly about suicide is essential, but experienced clinicians use more nuanced assessment strategies.
a. Normalizing statements
- I’ve read that up to 50% of teenagers have thought about suicide. Is that true for you?
- When people are depressed or feeling miserable, it’s not unusual to have thoughts of suicide pass through their mind. Have you had any thoughts of suicide?
b. Gentle assumption (Shea, 2002, 2004, 2015)
- When was the last time you had thoughts about suicide?
c. A solution-focused mood evaluation with a suicide floor
1. “Is it okay if I ask some questions about your mood?” (This is an invitation for collaboration; clients can say “no,” but rarely do.)
2. “Please rate your mood right now, using a zero to 10 scale. Zero is the worst mood possible. In fact, zero would mean you’re totally depressed and so you’re just going to kill yourself. At the top, 10 is your best possible mood. A 10 would mean you’re as happy as you could possibly be. Maybe you would be dancing or singing or doing whatever you do when you’re extremely happy. Using that zero to 10 scale, what rating would you give your mood right now?” (Each end of the scale must be anchored for mutual understanding.)
3. “What’s happening now that makes you give your mood that rating?” (This links the mood rating to the external situation.)
4. “What’s the worst or lowest mood rating you’ve ever had?” (This informs the interviewer about the lowest lows.)
5. “What was happening back then to make you feel so down?” (This links the lowest rating to the external situation and may lead to discussing previous attempts.)
6. “For you, what would be a normal mood rating on a normal day?” (Clients define their normal.)
7. “Now tell me, what’s the best mood rating you think you’ve ever had?” (The process ends with a positive mood rating.)
8. “What was happening that helped you have such a high mood rating?” (The positive rating is linked to an external situation.)
This protocol assumes cooperation. More advanced interviewing procedures can be added if clients are resistant. The goal is a deeper understanding of life events linked to negative moods and suicide ideation and a possible direct transition to counseling or safety planning.
IV. When students or clients disclose suicide ideation clinicians should:
a. Stay calm
b. Express empathy
c. Normalize ideation
d. Move to conducting a full suicide assessment interview (i.e., R-I-P-SC-I-P*) or refer the student/client to someone who will do a full assessment along with safety planning
e. Use suicide interventions as appropriate
V. Using Shneidman’s “Alternatives to Suicide” approach is a parsimonious way to simultaneously assess and intervene to reduce danger to self
VI. IMHO: All health and mental health providers should be trained to use these clinical skills and strategies when working with potentially suicidal students/clients.
Adapted from: Clinical Interviewing (6th ed., 2016), Wiley. Feel free to share this handout as long as authorship is included. For more information or to ask about professional workshops for your organization, contact John Sommers-Flanagan: firstname.lastname@example.org or 406-721-6367.