How a professional therapist determines who's "at risk"!
So...we don’t start screening when you're sitting in our office. The truth is we start screening the minute you connect with us. Yep, that includes the “are you taking new clients” call - we’re tricky that way!
Here’s the inside scoop on what we are listening for – and the first one on the list is the reason I am writing this to you.
1. At a time when suicide rates are increasing and most are struggling – know that caring about or even knowing about someone who has died by suicide increases your risk.
If you’ve been slammed by this complicated, gut-wrenching loss – you are at risk so I’ve included some resources below. I’m inviting you to reach out to me or any professional and encouraging you to take some time for yourself to grieve what was and what could have been.
As a young therapist, suicide, was for me, the scariest risk of caring about patients. In fact, I often wondered if I could "do the job" knowing I could lose a patient. That I had no control really.
Time progressed and I regularly repeated to my patients at the start of every new client session: "everything is confidential except if I'm worried about your safety". Then one day it happened. My gut, my training, the hair on the back of my neck stood up, and the assessment risk added up. My first "at high risk" patient.
We had to have the talk. I told the patient: "I'm worried about your safety after the session" My patient responded: "me too". My gut dropped. I got goosebumps. Yet I felt calm. We were in it together. "Ok, I said, we have two choices - you call one of your emergency contacts to take you to emerg or I call an ambulance".
She called her mom. We developed a plan together. They went to emerg. She spent some time as an inpatient and was released back to my care. We kept working together. And as she completed counseling and left her last session she radiated strength, confidence, hope, and healing her trauma. She turned back, smiled, and said "thanks, Farah". The lump came back and I swallowed as I said "thank you". I didn't even try to start telling her what I was thanking her for her trust, taking my hand, her honesty, her brevity, her commitment to the process? For stepping back? Staring into the abyss with me?
Session over session, experience over experience, I began to realize how much patients relied on my promise - if I'm worried about you, our dance has to change to keep you safe. It's like an oath I make to patients - I won't keep it a secret.
Research from the center for suicide prevention and others teaches us that the following elements increase risk:
Knowing someone who has died by suicide
Being a male. 1,013 women died by suicide in Canada in 2013 compared to 3,041 men (Statistics Canada, 2017).
Diagnosis of depression
Experiences of abuse
Recent hospitalizations (hello Covid?)
Abuse of substances including alcohol, drugs, food, and exercise
History of mental health struggles
Access to the means by which the individual ideates about
This list isn’t exhaustive but they’re key factors. Factors that tend to reduce risk:
Having a healthy relationship
Women who have children
Having a faith
Having a therapist you feel connected with
Working with a physician to find the right type of medications* (more on this later)
If you or someone you love “sounds familiar” while you're reading this list please know that you are not alone and don’t try to “work” alone trying to “save” someone. The following are resources you may want to consider, especially if you're inviting people to talk to you - be prepared:
Canadian Resources to consider:
Psychology Today – a directory for therapists in your area
Your family physician – and if you can’t talk to him/her it’s time for a new one!
Canada Suicide Prevention Service Hours: 24/7/365. 1-833-456-4566
Farah Kurji BSW, MSW, RSW is an advanced level professional counselor specializing in CBT and EMDR. She provides treatment for various mental health conditions including anxiety, depression, and trauma. You can reach her and her associates at www.farahkurji.com
Alberta Centre for Injury Control and Research. (2012). Suicide/self-inflicted injuries in Alberta. Retrieved from http://suicideinfo.ca/LinkClick.aspx?fileticket=p9 tRgQ37n5s%3D&tabid=508
Beautrais, A. (2006). Women and suicidal behavior. Crisis, 27(4), 153-156.
Canadian Mental Health Association (British Columbia). (2013). Depression. Retrieved from https://www.cmha.bc.ca/documents/depression-2/
Center for Disease Control and Research. (2009). Suicide: Facts at a glance. Retrieved from www.cdc.gov/violenceprevention/pdf/Suicide-DataSheet-a.pdf
Center for Disease Control and Research. (2012). Sexual violence: Facts at a glance. Retrieved from https://www.cdc.gov/violenceprevention/pdf/sv-datasheet-a.pdf
Chaudron, L. and Caine, E. (2004). Suicide among women: A critical review. Women’s Health, 59(2):125-134.
Devries, K., Watts, C., Yoshihama, M., Kiss, L., et al. (2011). Violence against women is strongly associated with suicide attempts: Evidence from the WHO multi-country study on women’s health and domestic violence against women. Social Sciences & Medicine, 73(1), 79-86.
Grigoriadis, S., Wilton, A., Kurdyak, P., Rhodes, A., VonderPorten, E., Levitt, A., Cheung, A. & Vigod, S. (2017). Perinatal suicide in Ontarion, Canada: A 15-year population-based study. Canadian Medical Association Journal, 189(34). Retrieved from http://www.cmaj.ca/content/189/34/E1085.full
Joiner, T., Sachs-Ericsson, N., Wingate, L., Brown, J., Anestis, M. & Selby, E. (2007). Childhood physical and sexual abuse and lifetime number of suicide attempts: A persistent and theoretically important relationship. Behavior Research and Therapy, 45(3), 539-547.
Pearlstein, T., Howard, M., Salisbury, A. & Zlonsky, C. (2009). Postpartum depression. American Journal of Obstetrics & Gynecology, 200(4), 357-364.
Skinner, R. and McFaul, S. (2012). Suicide among children and adolescents in Canada: trends and sex differences, 1980–2008. Canadian Medical Association Journal, doi: 10.1503/ cmaj.111867. Retrieved from http:// www.cmaj.ca/content/early/2012/04/02/ cmaj.111867.full.pdf+html82-285
Statistics Canada. (2017). Suicides and suicide rate, by sex and by age group. Retrieved from http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/hlth66d-eng.htm
Wasserman, D. (2016). Eating disorders and suicide. In Wasserman, D. (ed), Suicide: An unnecessary death (pp.95-100). New York: Oxford University Press.