Answer and Rationale for LCSW/LMSW Practice Question on Suicidal Clients

Yesterday we posted the following question about suicidal clients, and today we have the answer and rationale for you!

A 66-year-old man is referred to a social worker by his adult daughter. During the initial assessment, the man reports poor sleep, decreased appetite, and increased feelings of agitation and restlessness after being laid off from his job. He goes on to tell the social worker that “things just seem to keep going downhill since my wife died a year ago.” What action should the social worker take FIRST:

A. Refer the client to an MD to rule out any medical issues

B. Teach the client relaxation skills to help him sleep

C. Ask the client if he’s having any thoughts of suicide or self harm

D. Normalize the client’s feelings of grief and loss

After looking at the question and answer set yesterday, what did you think? This is a good example of an item that could show up on any of the ASWB exams, and one in which there are multiple answer options that look “right.” So, let’s go through the answer choices one at a time and think about them.

• • Answer A: does the client need a medical evaluation? Probably. He’s having symptoms (sleep disturbance, change in appetite, restlessness) that could indicate a medical problem, so we would want to rule that out. In many cases, this answer would take priority, but let’s see what else we have going on here.
  • Answer B: does the client need concrete coping skills to help address his stress and sleep issues? Probably. This would be something you would, in most cases, do with a client in this situation, but it wouldn’t be prioritized over an answer like A.
  • Answer C: should we ask this client if he’s having thoughts of suicide or self harm? ABSOLUTELY. He has a number of factors that put him at an extremely high risk: he’s an older male, he’s had multiple losses (spouse and job), he’s experiencing symptoms consistent with depression, and maybe most significantly, he’s expressing HOPELESSNESS (feeling like things are going downhill). This is the best answer, and would take priority over the medical referral because the suicidal risk is imminent (we want him to live to make it to the doctor’s office).
  • Answer D: should we respond to his feelings? Of course we would want to demonstrate empathy and compassion for this client. C is still a better answer to the question, though, as the social worker should feel comfortable directly addressing the potential for risk in this situation.

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Be sure to tune in next month for another practice question and discussion!