MCO Suicide Assessment & Management Guide

Introduction:

The following is a guide for MCO therapists in assessing clients who are expressing self-harm or suicidal ideation.  It is not a form to be filled out.  Instead, refer to the items used from this guide in writing your Routine Progress Note.

1st Assessment Item:

On a scale from 1-10 how much do you want to harm yourself, with 10 being the strongest desire.

• What number would you have to be at to take action in actually harming yourself?

Option 1: Client is at a number high enough to harm themselves.

1. Ask the client“Are you planning on ending your life?” & “Do you have a plan of how to end your life?”  In many cases, the client may express having been hopeless or thinking about no longer being alive, but this does not include them seriously considering suicide or having a plan.a

a. If the client does not have a plan, take time to process their feelings of hopelessness.  This can be documented in the Routine Progress Note.  Example: 

i. The client expressed feeling hopeless and considering what things would be like if she was no longer alive.  Therapist verified with the client this was an expression of sadness and that she had no suicidal/self-harm intent or plan.  Consulted with supervisor/colleague (include name of supervisor/colleague)

b. If the client does have a plan, move immediately to step #2.

2. Determine people who are resources for them currently they can reach out to (parents, spouse, friends, etc).  Verify the client has contact information and their intent to contact these persons if needed.

a. Plan with the client how they can be with someone until their number decreases (ie: they are not going to self-harm).

b.  Offer a therapy session within 24-48 hours as follow-up.  Verify if the client is willing to keep themselves safe until their next scheduled counseling appointment with you or another therapist, if you are not available.  Best practice, in the event you are unable to see the client for a follow-up session, is to make a phone call to check on them.

c. Let the client know, if they do not come to their follow-up appointment, and we are unable to reach them, we will need to call in a wellness check to local authorities for them.

3. If the client is not able to commit to staying safe with supports until their next session, they have both a desire and a plan, therapist will direct the client to go to their local emergency room. 

a. ALTERNATIVE #1: If the client cannot verify they will keep themselves safe, advise them to go to their local emergency room and contact you via the MCO switchboard 1-855-755-3797 & your phone extension (last 4 digits of your cell number) once they have arrived & checked-in with medical personnel.  

b. ALTERNATIVE #2: If the client is not willing to go to their local emergency room, advise them due to your role to warn and protect, you will be calling their local emergency services to perform a well check and assess the client.  

i. *International Clients: We can advise international clients to pursue medical help, but they may not be willing or have access.  In this case, we can offer a follow-up counseling session within 24-48 hours with ourselves or another clinician, if we have no availability.  However, we are unable to contact emergency services for them.  

Option 2: Client is at a number lower than actually taking action to harm themselves.

1. If the client does not have a plan, take time to process their feelings of hopelessness.  This can be documented in the Routine Progress Note.  Example: 
   1. The client expressed feeling hopeless and considering what things would be like if she was no longer alive.  Therapist verified with the client this was an expression of sadness and that she had no suicidal/self-harm intent or plan.  Consulted with supervisor/colleague (include name of supervisor/colleague)
2. Encourage the client to identify support people (parents, spouse, friends, etc).  Verify the client has contact information and their intent to contact these persons if needed.
   1. Ask if the client needs to be with someone or have regular check-ins with safe people.
   2. Verify if the client is willing to keep themselves safe until their next scheduled counseling appointment.  If clinician sees a need, they can offer a follow-up appointment sooner than previously planned or a phone call.

Minors:

In the event your client is a minor, you do not need to involve the parents unless the client shares having suicidal intent, per Step #1.  At this point, remind them of the limitations of confidentiality and let them know you will need to bring their parent into session to discuss keeping them safe.  Please be advised that if a parent can verify their ability to have an adequate level of supervision for the child, you do not need to insist they take the child to the hospital.  However, if the child is high risk (see risk factors) or parents cannot supervise, advise them to take the child to the hospital.