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Risk assessment

Discuss about the Social Work Assessment and Interventions in Self Harm and Suicide.

Acts that are fatal in nature, underlying intension behind which is ending one’s life which is self-harm initiated. From a generic perspective, such acts are considered to be an impulsive act. However, in reality such incidents associated with self-harm and suicidal tendency are associated with years if suicidal behavior which includes suicidal acts or ideation associated with, deliberate self-harm.  In this context, self-harm can be considered as any kind of act of harm that may result in causing self harm which is associated with an increased suicidal risk. The severity of the issue is well established with the help of the statistics that reflects that as of 2016 the suicide rate in Australia was 11.7 deaths per 100,000 people which increased from 10.6 per 100,000 individuals as of 2007.

Considering the above made discussion the present Needs-for- service-assessment would focus on risk assessment, mental state exam and needs assessment in regards to the provided case of Steven.    

In case of individuals who demonstrate suicidal tendencies, as observed in case of Steven, in majority of these incidents they display warning signs and clues. In case of these individuals who tend to commit suicide, in most of the cases do not want to die, all they want is to stop the pain they are going through (Lindsay, 2017).  Most of these cases of suicide are preventable, with the help of effective risk assessment.

In case of Steven, with the help of effective risk assessment, the risks which promoted him towards committing such an act of self-harm followed by getting drunk can be effectively analyzed (YouTube, 2018). This would help in preventing him in the future from further committing such an act. Hence, for the purpose of performing effective risk assessment in case of Steven there is certain aspects which are needed to be taken into considered which are as follows:

The first factor which is needed to be taken into consideration in context to risk assessment is Who is at risk?

There are three factors which are needed to be considered in this context which are biological factor, psychological factor and social factor. In biological factors it has been observed that substance abusers, individuals suffering from depression, suffering from mental illness, physical illness, high risk behaviors, family history of suicide, individuals who are disfigured or disabled, fatigued, individuals at the life stage of being elderly or adolescence are aspects the presence of which if observed in any individual increases the risk of self-harm and suicidal tendencies (rcpsych, 2018). In regards of these biological factors, if the case of Steven is analyzed it may be observed that he was using alcohol in an excessive amount in the recent time. It reflects that in regards to biological factors, the factor of substance abuse was present in his case (Rajwal & Gash, 2006). Other associated biological factor like high risk behavior, fatigue because of work load, and symptoms of depression because of turmoil he is going through due to broken marriage and not being able to meet his children was also observable in his case. Basing on the analysis of the biological factors establishes the fact that he is at increased risk of self-harm and suicidal tendency.

Who is at risk?

In context to psychological factors aspects like depression or any other mental illness, individual suffering from addiction, low self-esteem, poor coping skills, individuals who gets easily angered or frustrated, feeling of hopelessness, despair or fear, increased level of anxiousness and individuals who are impulsive in nature are at increased risk of self-harm and suicide. The fact that the issues, Steven was having with, work life along with the despair of broken marriage and the inability to meet his son and daughter was the major reason for hopelessness in his case. Conversation with Steven provided with the clear reflection of his feelings of hopeless or despairs due to broken marriage and not being able to meet his children.  With the help of the conversation with Steven, his depression due to the situation he was undergoing in his life is also evident. The fact that he previously thought of self harm also establishes that he was suffering from depression (Ceuschool, 2018). Excessive consumption of alcohol on the part of Steven also reflects that he was suffering from depression. His lack of ability to cope up with work load and issues with his personal life also establishes poor coping skills. Thus his psychological factors reflect also puts forward the fact that he is at increased risk of self harm.      

In order to determine individuals who are at increased risk of self harm and suicide considering the social factors are also needed. Social factors include isolation, non-existent or unstable support system, trauma survivor, changed/diminished socio-economic situation and experience of relational loss. In case of Steven the issues of experiencing relational loss due to broken marriage and not being able to meet his children could be clearly observed. Lack of any stable support systems was also evident from his conversation in which he stated that followed by his work days he has noting much to do that also reflects isolation which he was undergoing. Thus the analysis of the social factors of Steven reflects the fact that he is under increased risks of self-harm.

In the process of performing risk assessment in case of self-harm and suicidal tendencies, protective factors of the client are also needed to be considered. Protective factors in case of these clients include, strong connections with family members, religious and cultural believes which discourage such acts, effective coping mechanisms, effective clinical care for physical (Randall et al., 2013). In case of Steven the protective factors can be seen to be his attachment for his family members particularly his children.

Protective factors

Risk assessment of these clients also needs to consider any trauma which the clients have experienced. Trauma may be considered any objective incident or event which results in adversely impacting or damaging the sense of belonging of an individual along with result in creating anxiety among them. There are primarily 4 types of trauma that results in occurrence of crises among clients which includes development traumas, situational traumas, intra-psychic traumas and existential traumas (rcpsych, 2018). In case of Steven situational trauma is observable. This kind of trauma is the result of any kind of situation or circumstance which includes death of closed ones, broken down relationship, major illness, arrest, financial issues, family violence etc. Intra-psychic trauma is associated with feeling and thoughts which result in making an individual upset. Existential trauma is the result of lack of purpose in life and feeling of emptiness. It is mainly associated when an individual identifies the fact that the daily activities which are being performed on the part of the individual. In case of these traumas, different individuals demonstrate different reactions which vary from anxiety, shock, anger, depression, intellectualization and anger (Cross & Ashley, 2007). In case of Steven, the broken marriage can be seen to lead to situational trauma, intra psychic trauma can be seen to be associated with not being able to meet his children and existential trauma may be seen to be associated with his lack of satisfaction with his job life. Thus the presence of three forms of trauma can be seen to be present in case of Steven.

In case of risk assessment of clients associate with self-harm and suicidal tendencies analysis the sings of crisis which are being disseminated on the part of an individual are also needed to be taken into consideration. It is due to the fact that certain signs of crisis are more obvious in case of these clients. In case of certain clients associated with self harm is also noticed that they tend to verbalize distress (Kapur et al., 2007). On the part of some clients it is noticed that that exhibit acting out behavior. In this regard, on analyzing the case of Steven it is noticed that his distress associated with broken marriage, pressure for paying mortgage, not being able to meet his children is clearly seen to be verbalized.

Knowing the history of the client is who is being assessed is also important it is particularly significant in case of clients associated with risk of self harm. On analyzing the history of Steven it can be observed that he was not the same as he is in the present. His history reveals that, as per his wife his behavior has changed significantly, turned out to be irritable and more involved in consumption of alcohol (patient, 2014). Static factors are also needed to be taken into considered in this context which includes substance abuse, mental health condition, driving in an intoxicated stated, involvement in criminal justice. In case of Steven the static factor of alcohol use is noticeable. It is worth mentioning that behaviors are the most effective means of predicting behavior which is needed to be focused in the process of assessing clients with risk of self harm. The aspects which are needed to be considered in this context are use of drugs or alcohol, anxiousness, depression, despondent, remorseful, anger, agitated, appetite change and experiencing sleeplessness (health, 2018). In regards of behavioral pattern of Steven as well, use of drug, depression, to certain extent sleepless is noticeable.   Thus, basing on the risk assessment of Steven it can be clearly stated that he is at increased risk of self harm and suicide.

Types of trauma

This is a systematic way of appraising the behavior, appearance, mental functioning and the total behavior of an individual. It is a way in which the overview regarding the psychological functioning of an individual may be gathered at a specific point of time. There are certain domains under which this appraisal is done. The first domain in this examination is appearance and behavior (almostadoctor, 2017). This domain provides with an idea regarding the quality of life style and emotional state of an individual. On analyzing appearance of Steven his clothing is observable which reflects that presence of mismatch. To certain extent it reflects the lack of ability on the part of Steven in coordinating his thoughts. Other than that, the choice of gloomy shades being predominant in his clothing also reflects the state of his mind to certain extent. Similarly the behavior of Steven reflected agitation (YouTube, 2018). This body movement and gestures reflects the use of large hand gestures in the process of communicating with the interviewer which is a clear demonstration of the fact that he is in a chaotic state of mind and is out of control. His level of arousal also reflects the presence of agitation.

In regards to speech, it can be seen to usual in regards to the variation in his tone. Spontaneity in his tone was present with pause in part of the communication particularly when discussing if he has been thinking of such self-harm actions previous or in a repetitive manner.

In the domain of mood and affect, his mood reflected depression. In regards to affect it seemed to be expansive. In context to his cognition, the analysis of his memory functioning reflected the fact that he was not having the short term memory associated with the detailing of the previous night when the incident occurred (Potter, 2018). He was only able to provide with certain details of the incident. It is an integral aspect which is needed to be analyzed as it provided with the present ability of the individual to provide with information.

The analysis of thoughts also plays an integral role in this examination. It is evaluated in accordance to content and process (rch, 2018). The content analysis of his thoughts reflects that he had depressive thoughts and thoughts associated with self harm for some time. The major underlying reason being his broken relationship and not being able to meet his children . The process of his thoughts to certain extent demonstrated circumstantial thinking. No issues with his perceptions could be noticed.

Signs of crisis

In regards to the domain of insight and judgment, the domain of insight reflects that though he believes that the way he has been acting is not usual but it can be noticed that he is not much willing to seek professional help. Insight analysis of Steven reflects that he is of the opinion that such depressive phases are part of life. Though he was aware of his behavior but he can be seen to be of the opinion that it is not something for which he needed treatment or was not considering it as mental disorder. In terms of his judgment, it could be seen to be effective which can be noticed from the fact that he had clarity regarding his responsibility towards his children and about the fact that death was not an option.       

Followed by risk assessment and mental state exam, needs assessment are also needed to be conduct. It is due to the fact that, only with the help of needs assessment, the kind of requirement of the client can be effectively analyzed on the basis of which he may be provided with the needed support (Hume & Platt, 2007). There are certain aspects which are needed to be considered followed by the incident of self-harm on the basis of which need assessment can be effectively conducted.  One of the major aspect in this context is personal relations which includes recent broken down major relations. From this perspective is the needs of Steven is analyzed one of major need is that of a social support.

Social situation is also needed to be taken into consideration for need assessment. This mainly includes present arrangement of living, debt and work (Kendall et al., 2011).. In case of Steven, his lack of any individual family and residing within his parents is a considerable aspect in terms of his social situation. His social situation also reflects his lack of satisfaction with job but need to pay for his mortgages preventing him from leaving the job.

Present difficulties of the client along with recent life events are also needed to be taken into consideration. Not being able to meet his children and the sense of not doing good at his job was some of the major challenges he was experiencing.

The psychiatric history of the client which also includes any history of alcohol use and previous harm is needed to be considered. The psychiatric history of Steven reflects that he has been binge drinking lately. Enduring psychological characters which are associated with self harm are also needed to be noted (drugsandalcohol, 2010). In Steven’s case, the persistent depressive thoughts are one of such psychological characteristics.

Motivation for the act is another major component which is worth considering. In his case, it was the willingness to be free from the thoughts which has been disturbing him.

In case of formulation of needs of such clients there are certain other aspects as well which are needed to be taken into consideration. One of this aspect is long term vulnerability factor. In case of Steven the long term vulnerability factor was his broken marriage. Short term vulnerability is also required to be noted. The absence of any kind of social support and over consumption of alcohol can be seen to be aspects of short term vulnerability. Precipitating factor in this case was the comment on the part of his mate that he is 42 years and still living with his parents.

Thus, on the basis of the analysis of the risks and needs of Steven interventions are needed to be implemented for the purpose avoiding further occurrences if such instance.

One of the applicable interventions in this case is providing him with community support. It is an effective means of management of such cases of self harm (Nock, 2010). It is with the help of such intervention individuals may be realized that they are not alone going though such phase which makes it easy for clients like Steven to cope up easily. This would also help him in dealing with the isolation in an impactful manner.

In his case issue of alcohol consumption was to be a matter of concern. For the purpose of managing the issue of alcohol consumption, providing him with assistance with the help of alcohol support groups would also he impactful in motivating him in eradicating such practices (drugsandalcohol, 2010).

He can also be seen to be suffering from depression. This acted as a major contributing factor in taking such initiative on the part of Steven. In order to manage the issue of depression he would be needed to provide with psychological intervention like CBT.

Conclusion 

In the conclusion it may be stated that self-harm and suicidal tendencies are major concern across the globe which results in number of death. Such incidents can be successfully prevented with the help of timely risk assessment and mental state exam. It is due to the fact that every individual associated with self harm disseminated certain behavioral traits. If it can be identified in the early stage, they may be provided with the needed intervention that would help in preventing such occurrences.

References               

almostadoctor. (2017). Mental State Exam. [online] Available at: https://almostadoctor.co.uk/encyclopedia/mental-state-exam#Appearance_and_behaviour [Accessed 26 May 2018].

Ceuschool. (2018). Assessing Client Risk for Self Harm. [online] Available at: https://www.ceuschool.com/librarydocs/soc219.pdf [Accessed 26 May 2018].

Cross, C. L., & Ashley, L. (2007). Trauma and addiction: implications for helping professionals. Journal of psychosocial nursing and mental health services, 45(1), 24-31.

drugsandalcohol. (2010). Self-harm, suicide and risk: helping people who self-harm. [online] Available at: https://www.drugsandalcohol.ie/20686/1/Self_harm_helping_people_who_self-harm.pdf [Accessed 26 May 2018].

health. (2018). Suicide risk assessment. [online] Available at: https://www2.health.vic.gov.au/mental-health/practice-and-service-quality/safety/suicide-prevention-in-mental-health-services/suicide-risk-assessment [Accessed 26 May 2018].

Hume, M., & Platt, S. (2007). Appropriate interventions for the prevention and management of self-harm: a qualitative exploration of service-users' views. BMC Public Health, 7(1), 9.

Kapur, N., Cooper, J., Rodway, C., Kelly, J., Guthrie, E., & Mackway-Jones, K. (2007). Predicting the risk of repetition after self harm: cohort study. Bmj, 330(7488), 394-395.

Kendall, T., Taylor, C., Bhatti, H., Chan, M., Kapur, N., & Guideline Development Group. (2011). Longer term management of self harm: summary of NICE guidance. BMJ, 343, d7073.

Lindsay, T. (2017). Risk assessment and self-harm. Cancer, Sex, Drugs and Death: A Clinician Guide to the Psychological Management of Young People with Cancer, 76.

Nock, M. K. (2010). Self-injury. Annual review of clinical psychology, 6, 339-363.

patient. (2014). Suicide Risk Assessment and Threats of Suicide. [online] Available at: https://patient.info/doctor/suicide-risk-assessment-and-threats-of-suicide [Accessed 26 May 2018].

Potter, D. (2018). Mental state examination - OSCE guide. [online] geekymedics. Available at: https://geekymedics.com/mental-state-examination/#1 [Accessed 26 May 2018].

Rajwal, M., & Gash, A. (2006). Risk assessment in self-harm. The Psychiatrist, 30(11), 436-436.

Randall, J. R., Rowe, B. H., Dong, K. A., Nock, M. K., & Colman, I. (2013). Assessment of self-harm risk using implicit thoughts. Psychological assessment, 25(3), 714.

rch. (2018). Mental state examination. [online] Available at: https://www.rch.org.au/clinicalguide/guideline_index/Mental_state_examination/ [Accessed 26 May 2018].

rcpsych. (2018). Link to Clinical Risk Assessment Policy 1 Clinical Risk Assessment and Management. [online] Available at: https://www.rcpsych.ac.uk/pdf/Camden%20risk%20assessment%20and%20management.pdf [Accessed 26 May 2018].

YouTube. (2018). Suicide and Self Harm Crisis Interview. [online] Available at: https://www.youtube.com/watch?v=fLXfDepZ-o0&t=293s [Accessed 26 May 2018].

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