CHCCS501A Assess and respond to individuals at risk of self-harm or suicide Version 1 Learner Resource Training and Education Support Industry Skills Unit Meadowbank Product Code: 2557
Community Services, Health, Tourism and Recreation Curriculum Centre CHCCS501A Assess and respond to individuals at risk of selfharm and suicide Version 1 Community Services Learner Resource Product Code CHCCS501A/LLP/1
i Acknowledgments TAFE NSW - would like to acknowledge the support and assistance of the following people in the production of this resource package: Writer/Complier: Keith Bourke Community Services Teacher TAFE NSW Editor: Helen Oxley Community Services Teacher TAFE NSW Project Manager: Karin Rule Program Manager Community Services Enquiries: Enquiries about this and other publications can be made to: TAFE NSW Locked Bag No. 6 MEADOWBANK NSW 2114 Tel: 02-9942 3200 Fax: 02-9942 3257 T:\aaResources and Promotions\Resources for sale\community Services\from May 2007\Final Resources\Learner Guides FINAL 07\CHCCS501A_LLP_V1\CHCCS501A_LLP_1 The State of New South Wales, Department of Education and Training, TAFE NSW,, 2007. Copyright of this material is reserved to Community Services, Health, Tourism and Recreation Curriculum Centre, TAFE NSW. Reproduction or transmittal in whole or in part, other than for the purposes of private study or research, and subject to the provisions of the Copyright Act, is prohibited without the written authority of Community Services, Health, Tourism and Recreation Curriculum Centre, TAFE NSW. This product is for use in TAFE NSW ONLY. It is not to be published or on-sold. ISBN 978-0-7348-9008-5 ISO 9001
iii TABLE OF CONTENTS SECTION 1 INTRODUCTION... 1 1 GENERAL INTRODUCTION... 1 2 USING THIS LEARNING RESOURCE... 1 3 UNIT DESCRIPTION... 2 4 LEARNING TOPICS... 3 5 UNIT ELEMENTS AND PERFORMANCE CRITERIA... 5 6 LEARNING OUTCOMES... 6 SECTION 2 ASSESSMENT REQUIREMENTS... 7 SECTION 3 RESOURCE LIST... 9 SECTION 4 GLOSSARY...13 SECTION 5 LEARNING TOPICS...15 TOPIC 1 IDENTIFY AND ESTIMATE THE RISK OF SELF HARM/SUICIDE...15 1.1 Recognise and respond to indicators of possible self-harm/suicide...15 1.2 Risk and protective factors...17 1.3 Verbal and behavioural indicators...21 1.4 Mental health issues...23 1.5 Asking directly about thoughts of suicide and self-harm...25 1.6 Determining the current level of risk and the level of threat...27 Topic overview...32 TOPIC 2 UNDERTAKE THE NECESSARY ACTION TO PROMOTE SAFETY...33 2.1 Remove any items that may be used to carry out self-harm or suicide...33 2.2 Remove other people who may be at risk in the situation...33 2.3 Attend to the validity of the person's feelings and possible pain...34 2.4 Work with the person, where possible, to generate a safety plan...35 2.5 Facilitate the intervention of emergency medical help...36 2.6 Seek and act on feedback from your workplace supervisor...37 2.7 Occupational Health and Safety (OHS)...39 2.8 Possible options for dealing with aggressive or threatening people...40 2.9 Referral procedures...44 Topic overview...45 TOPIC 3 FACILITATE AND STRENGTHEN THE INDIVIDUAL S LINKS TO FURTHER CARE...47 3.1 Explore the person s openness towards accepting help...47 3.2 Provide information to enhance capacity for further assistance...48 3.3 Develop plans for accessing/ utilising informal supports and professional help...50 3.4 Encourage and facilitate the use of supports when required...50 Topic overview...51 TOPIC 4 PROVIDE ONGOING SUPPORT WHEN ASSESSED THERE IS NO IMMINENT RISK...53 4.1 Maintain an open rapport with the individual...53 4.2 Support the individual to develop coping strategies...53 4.3 Determine with the person possible underlying issues...55 4.4 Assist in seeking out additional resources...55 4.5 Documenting and communicating supports and coping strategies...56 4.6 Comply with relevant ethical guidelines and policy requirements...57 Topic overview...58 FEEDBACK FORM FOR CHCCS501A... 1 ISO 9001
15 SECTION 5 LEARNING TOPICS Acknowledgement Much of the section Learning Topic 1 has been adapted from Department of Education and training (2006) Certificate IV Mental Health Work Non Clinical V1.0 Hybrid CD Produced by the centre for Learning Innovation State of New South Wales, Department of Education and Training. Published by: Centre for Learning Innovation (CLI) Written by David McKenzie, Additional Writer: Marilyn Farrell, Other contributors: Maree Morgan& Anne Finnane,, TAFE NSW, Aidan Conway, Richmond Fellowship. Topic 1 Identify and estimate the risk of self harm/suicide 1.1 Recognise and respond to indicators of possible self-harm/suicide Social and legal perspective of suicide What could be some of the impacts from either a client or legal perspective of community service workers other than specialist mental health workers, not understanding suicide? Suicide and self-harm myths Complete the suicide and self-harm myths quiz. 1) Between the 1960 s and the 1990 s male youth suicide has increased by 50% 100% 200% 300% 2007, TAFE NSW
16 CHCCS501A Assess and respond to individuals at risk of self harm or suicide V 1 2) Most people who kill themselves suffer from mental Illness True False Unsure 3) Talking to a depressed person about suicide increases their risk of suicide. True False Unsure 4) A person who talks about suicide or threatens to kill him/herself is just after attention and is not likely to do it. True False Unsure (Correct answers- 1-300%, 2 F, 3 F, 4 F) 1.1.1 Statistics and trends The Australian Bureau of Statistics provides periodic reports on suicide in Australia. These may be found at http://abs.gov.au/ausstats/abs@.nsf/productsbycatalogue/a61b65ae88ebf976ca25 6DEF00724CDE?OpenDocument The most recent review was conducted in 2003. There were 2213 deaths from suicide registered in 2003. This number was a slight decrease from 2320 registered in the previous year. For males, in many age groups, there was a decline in age-specific suicide rates following peaks in the years 1997 and 1998. The age-standardised suicide rate for total males (17.7 per 100,000) in 2003 was lower than in any year in the previous decade (1993-2002). Similarly for females, there were declines in rates for some age groups over this period and the age-standardised suicide rate for total females (4.7 per 100,000) in 2003 was the lowest since 1994. Throughout the period 1993 to 2003 the male age-standardised suicide death rate was approximately four times higher than the corresponding female rate. In 2003 the most common method of suicide was hanging, which was used in almost half (45%) of all suicide deaths. The next most used methods were poisoning by 'other' (including motor vehicle exhaust) (19%), other (15%), poisoning by drugs (13%), and methods using firearms (9%). This distribution was consistent with that of the previous few years. However, over the decade strong trends were apparent such as the increase in the use of hanging, and a decrease in methods using firearms. 2007, TAFE NSW
17 1.1.2 Vulnerable groups Often adverse environmental factors and the lack of coping abilities influence a person s thinking about the viability of suicide. Specific population groups can have individual characteristics which affect the development of suicidal and self-harming behaviours. These groups include: young people refugees prisoners older people Indigenous Australians 1.2 Risk and protective factors A risk factor is affected by: the way a person has learnt to cope with problems in their lives the way the person sees him or herself the ability and opportunity for the person to cope the availability of support assessments if required. For further statistics on mental health and suicide go to National Health and Medical Research Council www.nhmrc.gov.au Risk and protective factors refer to the vulnerability and resilience a person has when looking at suicide. These are not lists to be checked when working with clients. Risk factors help you determine who is at high risk of suicide. You then need to work with that person to assess the risk further and plan support. Risk factors can be personal and affect people in different ways. It is not a community worker s role to conduct suicide risk assessments. This is a clinical role and should be undertaken by a case manager, psychologist or other clinical professional. Although you, as a community worker, would not conduct a suicide risk assessment, it is important for you to be aware of risk and protective factors in relation to risk of suicide and self-harm to be able to refer clients to clinicians for more specific 2007, TAFE NSW
18 CHCCS501A Assess and respond to individuals at risk of self harm or suicide V 1 1.2.1 A history of suicide or self-harm attempts Previous attempts at self-harm or suicide can indicate that a person has used these as coping methods in the past. Knowing how and when a person has previously attempted suicide can give an indication as to the type of issue or crisis they think will be solved with suicide; communication strategies that they use (remember, suicide and self-harm are forms of communication); and possible methods they could use (although methods can change - an attempted suicide by taking pills may not indicate this will be the method of future suicide attempts). Knowing a person s suicide history can also provide information on what interventions worked or didn t work before, and what has changed to make suicide a solution again. It is also important to be aware that someone who has attempted suicide in the past is more likely to succeed if they attempt suicide again. Self-harming behaviours can be quite different from suicidal behaviours. Self-harming behaviours can continue for years without interruption or intervention. Once a person (more often a girl or woman) finds a method of self-harming that relieves pain and stress, that is not visible and that is easy to inflict, the person can stick with that method for a long time. Knowing when self-harming started, what type of self-harming was inflicted and what interventions worked or didn t work previously can go a long way to supporting a person through a period of crisis without resorting to previous coping methods that can be self-destructive. 1.2.2 The presence of a suicide or self-harm plan If a person you know has a suicide plan, this can indicate that they are more committed to the idea of killing themselves. Exploring the suicide plan with the person can assist with developing strategies to ensure the safety of the person in the short term and identify issues that could be addressed in the medium to long term. When you know what the suicide plan is, you can begin dismantling it. The first step in dismantling the plan is to ensure the immediate safety of the person. This can be achieved to some degree by removing the means of suicide they have planned to use e.g.: pills, a gun or knives. Knowing when the person plans to commit suicide also allows you to put in place external supports that the person can use or that can respond to a suicide attempt (e.g.: an area mental health team). When notifying a third party such as the area mental health team you will have to clearly identify how long they need to be alerted to the risk of the person attempting suicide. It is important to remember that responding to a suicide plan in this manner does not remove the threat of the person harming themselves. They may decide on another means and another time. You cannot control people and should not attempt to in this situation as overcrowding can exacerbate the feelings the person is experiencing. A holistic approach to suicide intervention is required. 2007, TAFE NSW