In our most recent social work blog post, we began discussing a core tenant of the social work profession: self-determination. Self-determination is our clients' right to make decisions regarding their treatment and their lives. While there will undoubtedly be times we do not agree with our clients, honoring their self-determination means that despite this disagreement, we support and trust their ability to make decisions for themselves. Self-determination is a topic we can just about guarantee will show up on your ASWB social work licensing exams (likely multiple times); so let's make sure you're ready to successfully tackle these questions!
Who remembers the specific instances when we cannot honor client self-determination? There are four key scenarios when we are legally and/or ethically unable to honor client self-determination and autonomy. These are when:
- a client is actively suicidal
- a client is actively homicidal
- your client lacks decision-making capacity and someone else has medical power of attorney for him/her
- your client has abused or neglected a child, elderly person, or dependent adult
Last month we presented a practice question around the topic of self-determination with the elderly. Let's see how you do with today's FREE practice question:
Self-Determination Practice Question
A 33-year-old woman has been seeing a therapist for 2 years for treatment of Major Depressive Disorder and Generalized Anxiety Disorder. The client has experienced passive suicidal ideation for her entire adult life. During the most recent session, the client calmly shares that after rationally thinking through the pros and cons, she has made the decision to end her life within the next 48 hours. What MUST the social worker do? A. Honor the client’s self-determination, because she is competent to make this decision
B. Begin the process of initiating an involuntary hospitalization
C. Complete a mental status exam
D. Explore voluntary hospitalization
(scroll down for answer and rationale)
The correct answer is D
Because the client is actively suicidal, we cannot honor her self-determination (A). There is no indication in the question stem that we need to conduct a mental status exam at this time (nor is it something we MUST do, as the question asks). Due to the severity of what she is saying, we need to pursue hospitalization regardless of her mental status. We always want to explore voluntary hospitalization (D) before pursuing involuntary hospitalization (B).
Did you answer this question correctly? How does this question and rationale fit into your understanding of self-determination with suicidal clients?
If you have any remaining thoughts or questions regarding self-determination, be sure to reach out to one of our social work coaches who can answer any questions you have.
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D. I only said that because I am unsure if we can involuntarily place someone in the hospital. Luckily I was right.
Because learned to always first try voluntary hospitalization before initiating involuntary hospitalization. Another reason because the keyword was "Explore". After acknowledging client feelings the social worker should explore, clarify, assess, then refer.
I chose the incorrect answer "B" as I immediately thought about safety and hospitalization weather the client wanted it or not. I never thought about voluntary hospitalization to see if the client would go to the hospital freely.
I said D because during the lecturers for the LCSW on the therapist development center this was thoroughly covered. You gain a simplifed understanding of the material, this is only my first week but it's great information. My confidence is building daily.
You always want to start with exploring voluntary hospitalization. If the client is not willing to go voluntarily, we must next initiate a 5150 (or find a qualified person that can write it). There’s enough risk to do either one of these.