As you all know, September is Suicide Prevention Month, and here at TDC, we are using the month as a platform to begin conversations around this often-taboo topic. If you’re studying for your licensure exam, whether a social work exam OR a MFT exam, you’ve probably found that this topic is front and center. There’s a good reason for that: at some point in our professional lives we will almost certainly work with at least one client who wants to end his or her life. Our state boards and licensing organizations want to ensure that as competent professionals we can recognize the signs and symptoms of potential suicide, assess for it accurately, and take the necessary steps to help our client’s stay safe.
Our study systems help prepare you for this topic in a number of ways: we provide concrete information on danger to self and others, risk factors, signs, behaviors, how to evaluate the level of risk, and a spectrum of interventions that will be reflected on the exam. We also provide numerous practice questions with rationales that help you think about this topic from all angles.
Let’s get into a practice question that looks at this topic:
SAMPLE QUESTION:
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
So, what would we do here? Try to help him with concrete issues? Address the potential for medical problems? Leave your answer in the comments below and be sure to tune in tomorrow for the answer and a discussion of the rationale.
Comments
C. Always assess for suicidal or self harming thoughts first
C. He is describing symptoms of depression and he has experienced loss. Loss of employment and his wife.
I choose "C" as my first intervention given he lost his wife and has encountered other down falls.
It's asking which action should be taken first - I'd think a medical referral (A) could be made while also asking if pt was having thoughts of SI.
I really want to say A because you always have to rule out anything medical. However, he's sitting in front of you so you ask if he's suicidal. Then refer. Then normalize during next session
C- assess for suicide. I don't feel like there is enough physical symptoms to make a medical referral as the first step. I pick up hopelessness- which csn indicate depression which in turn can start a person to think of suicide.
C makes sense to me because of multiple stressors. Looks like he and his wife had a very good and beautiful relationship and to loose his job on top of that is killing.
Since his wife recently died and he was recently laid off from his job (two major stressors), along with poor sleep, decreased appetite, and increased feelings of agitation and restlessness. I would say he has major depression. Also stating everything is just going downhill indicates hopelessness. I would definitely assess for suicide.
My answer is C. The other three answers are things I would do, but like Shannon said the key word is first. I would be assessing him to see if he is at risk of harm to himself or others.
My first instinct was D; however, if he is experiencing multiple risk factors and feeling as if he has lost everything that is important to him, C would make much more sense.
Due to his multiple stressors and feelings of hopelessness, I would choose C.
C is where I would start to make sure that he is safe, especially when he says, "things just seem to keep going downhill.." that makes me think if there are other things that he is feeling but perhaps has not stated.
C. Key word here being 'first'. Is he a danger to himself or at risk for self harm ?
Since the client seems to be down on his luck, my answer would be "C." Given the age of the client. He lost his wife a year ago and was also laid off from his job. It's always best to be direct and ask if they are feeling suicidal.
These are the type of questions I struggle with and then second guess myself. I chose A because of his sleep issues and appetite issues. My first instinct is d.
I hear you too, it's really very clinical in some legal and ethical situations, we are forced to think 10 steps ahead of ourselves, just in case....
The first thing would be to address the grief and loss. One his wife die a year ago, and therefore this is a loss. Second he lost his job and therefore this is another loss. Overall, client is suffering 2 loss and as a result he is grieving.
C. Due to his last response. Always best to err on the side of caution.