Suicide/Homicidal Tendency Assessment: Duty to Warn

By: Mara ZuschlagApril 4, 2010PSY483: M5A2Professor John ColyarArgosy University

Suicidal and homicidal tendencies have a strong relationship with alcohol and drug use, therefore a counselor needs to be insightful on signs of both and assess continuously (Miller, 2005). All suicide and homicide tendencies need to be carefully examined, taken seriously and handled in a careful ethical manner (Miller, 2005). There are suicide completers, attempters, threateners, and parasuicidals., of which all are treated in the same way.

A trustful client-counselor relationship with in-depth communication allows

the counselor to be attuned with the client, alerting to potential crisis in the near future (Kulewicz, 2010). An alert counselor can pick up on the client’s changing demeanor to assess the developing disturbance, such as suicidal and homicidal tendencies. Preventative planning is a form of intervention.

Considering that both impulsive behavior together with feelings of hopelessness can be lethal for a substance abuser , a counselor continuously assesses to increase alertness and awareness of their clients (Argosy University, 2010)

Assessment for suicidal and homicidal tendencies is part of the counseling process as to the frequency of their occurrences. Chemical substance abuse was a coping mechanism, thus as a crisis arises so to the challenges to both the client and counselor to learn to overcome them. One method to assess suicidal/homicidal tendency is to memorize the following three questions: Are you thinking of hurting yourself? Or others? How would you hurt yourself? Or others? What stops you from hurting yourself? Or others? (Miller, 2005)

A counselor learns to watch for signals of possible suicidal ideations. Another way of assessing for this is the administering the SAD PERSONS scale (Argosy University, 2010; Miller, 2005). 10 Factors correlated to suicide

Age, Sex, depression, previous attempts, ethanol, rational thinking loss, social supports lacking, organized plan, no spouse and serious sickness.

Interventions can be carried several ways, however choose the least restrictive alternative (Miller, 2005). Develop support and explore alternatives that are helpful. Provide local or the national hotline resource numbers for

“back up”, as one never knows that may be all that is available at a time of need.

Increase counseling sessions Involve family or friends, if consent is made available.(Miller,

2005) Provided supporting data for the usefulness of these

interventions knowledge of these categories might help the counselor

identify the issues that need to be addressed in the intervention and counseling.

Address concerns and assess with questionsKnow the limits of working with suicidal patients

(Miller, 2005). Risks low to moderate, have patient sign contract to

promise to not attempt suicide for a specific amount of time and agree to take action that has been agreed upon should the thought arise (Miller, 2005).

For moderate to high risk patients, hospitalization or medication may be necessary (Miller, 2005).

Counselors need to practice self-care, by taking small breaks, reach out to others for support, positive self talk and know own stress warning signs (Miller, 2005).

Confidentiality Limitations Substance Abuse Counselors need to be trained as to their limitations of “duty

to warn” to remain in compliant with federal law Code of Regulations (CFR), 42.

According to SAMSHA, “conflict between the "duty to warn" imposed by the many States that have adopted the principles of the Tarasoff case and the Federal confidentiality requirements.”, CFR 42 (1992, p. 5).

Three questions to ask regarding duty to warn, protect or report: (1) Does State law require the program to make a report? (2) Does State law permit the program to make a report? (3) How can a report be made without violating the Federal law and regulations governing confidentiality of patients' records (42 U.S.C. §§290dd-2 and 42 C.F.R. Part 2)? (SAMSHA, 1992) CFR 42 – Prohibits disclosure in situations in substance abuse treatment

(Miller, 2005) Substance Abuse Counselor additional confidential restrictions

"yes" if child abuse is involved and generally "no" if battering of a spouse is involved.

CFR42 law does not permit disclosure of information to a third party to prevent imminent danger to a third party, transmission of communicable diseases or reporting elder abuse or domestic violence (Stevens & Smith, 2009). The following allows disclosure of those in substance abuse treatment: Consent to disclose must be in writing Court Orders Medical personnel in a medical emergency or to a qualified personnel for

research, audit, or program evaluation. Ethical codes and state laws stipulate responsibilities of counselors duty to warn

Legal Duty to warn onto therapists when the tendency becomes a “threat” (Miller, 2005) Tarasoff v. The Regents of the University of California (1974) does not over

ride the federal law, which prohibits the duty to warn from patients of substance abuse (SAMSHA, 1992).

SAMHSA(1992) Checklist for monitoring alcohol and other drug confidentiality compliance: Technical Assistance Publication (TAP) Series 18. The Confidentiality Law (42 U.S.C. § 290dd-2). Retrieved from http://www.kap.samhsa.gov/products/manuals/taps/18d.htm

Argosy University. (2010). PSY483: Substance Abuse Treatment II: Module Five: Retrieved from http://myeclassonline.com

Kulewicz, S. (2004). The twelve core functions of a counselor. (5th ed.). Marlborough, CT: Counselor Publications.

Miller, G. (2005). Learning language of addiction counseling (2nd ed.). Hoboken, NJ: Wiley & Sons, Inc. Retrieved from http://online.vitalsource.com/#/books/978-0-471-69612-4/pages/2699970