Summary
Over the last years, suicide has become one of the most common causes of death among the youth. According to the Centers for Disease Control and Prevention (CDC), suicide occupies the second-leading place in death causes among youths aged 15-24 years (Hatchel et al., 2019). Lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth are more vulnerable to suicidal thoughts and behaviors (STB). For instance, research by Marshal et al. revealed that LGBQ youth were three times more likely to develop STB in comparison to their heterosexual peers (Hatchel et al., 2019). Therefore, young clients belonging to LGBTQ can be classified as higher risk cases since youth are already vulnerable to STB, and the sexual orientation factor creates additional danger. The therapist must exercise special caution and delicacy while evaluating the factors related to the case and engaging the LGBTQ client in the process of treatment.
Warning Signs
Eric, the client from the case example, has developed several warning signs attributed to his condition. For instance, he is showing depression-induced attitudes toward life on multiple occasions. In addition, Eric is hopeless about his family situation and does not see a day when his parents accept his sexual orientation. Moreover, he developed a drinking habit to cope with depression instead of using proper medication and recently started drinking alone. Eric has also admitted that he had suicidal thoughts in the past, which must also be considered a warning sign. Given the current situation, an increasing feeling of hopelessness and the developing reclusive tendencies point to the worsening mental condition of the client. Therefore, Eric made the right choice by reaching out for medical help, and the therapist must act swiftly to prevent the worst outcome of the case.
Risk Factors
Eric’s case is complicated by multiple risk factors, which might pose a challenge for the treatment process. First of all, the situation escalated after Eric came out as a gay person. Belonging to LGBTQ creates an additional risk of STB among the youth, and Eric falls into that category. Secondly, Eric’s altercation with his parents on the grounds of contradiction between his homosexuality and Christian ethics might provoke new episodes of depression. Moreover, Eric does not take any medications and primarily relies on his mental strength and alcohol, which is highly harmful to depression. In addition, Eric’s parents refused to help him pay the rent after he made his coming out. A difficult financial situation can create extra pressure on the client’s already problematic mental condition. Finally, Eric has also experienced a crisis of faith when he feels that his identity contradicts religion. His parent’s reaction to Eric’s homosexuality recently reinforced that rift. Overall, the risk factors present in the case can be classified as personal, medical, economic, and ethical.
Protective Factors
Luckily for Eric, several protective factors are present in his case, which can help win the time and improve his condition with treatment. Firstly, Eric is not alone in his problem, as he has a bisexual cousin disowned by his parents a few years before. The identification and activation of trusted adults who can help during suicidal urges may enhance the effectiveness of treatment regardless of its type (Asarnow & Mehlum, 2019). Therefore, reaching out to her might create necessary family support since Eric’s parents mistreated them both in similar circumstances. In addition, Eric still speaks with his younger brother, despite the possible reaction from the parents. That brother would make a second family member who did not disown Eric.
In addition, Eric has interests and dreams despite their developing hopelessness. His still-existing passion for art and reading might serve as an additional source of hope and distraction from problems. Eric continues to attend the local community college and has friends who know about his situation but do not judge him harshly, unlike his parents. Overall, Eric can gather enough emotional support from his family and friends, which would help him undergo the treatment.
Additional Information for Risk Level Determination
The details present in the case allow us to evaluate Eric’s current condition with a certain degree of accuracy. However, I reckon that it would be necessary to elicit additional information from the client. Right now, we know several warning signs, risk factors, and protective factors. According to them, it is possible to state that Eric’s condition poses a risk to himself. Before anything else, I assume that the client who came to seek help on his own will be honest and provide all the required information.
I would ask the client whether he experienced aggressive thoughts directed at others, especially at his parents. That information would help define the risk of destructive behavior from the client and his possible danger to people around him. I would also assess Eric’s medical history in order to see if he had been diagnosed with any other health conditions besides depression. Taking these steps would allow us to determine the client’s risk level and give an insight into the future treatment plan.
Level of Risk Represented by the Client
Judging by the warning signs, risk factors, and protective factors present in the client’s case, I believe that he presents risk only to himself. However, that risk is quite severe, and the situation tends to be getting worse. Eric had suicidal thoughts before; the harsh treatment from his parents, who deprived him of financial support, can add extra stress. In addition, the client still suffers from what seems to be a recurrent depressive disorder but self-treats it with alcohol instead of proper medications. Finally, acceptance of his sexual orientation came with hopelessness and fear, as his parents consider him flawed and see homosexuality as something that needs to be “cured.” Therefore, these clients’ case requires immediate intervention from the therapist. Otherwise, the client’s suicidal thoughts might return, and his depression catalyzed by the lack of proper treatment and family support might cause him to commit suicide.
Personal Factors Impacting Client’s Assessment
I believe that any client seeking help is a human being before anything else. Therefore, I would try to provide the best care possible regardless of the client’s gender, age, race, or sexual orientation. I see that stance as the only ethical choice for the contemporary medical professional. I would carefully and patiently listen to the client while being honest with him. I would show empathy and collaboration during the treatment process because trust between the therapist and the client is necessary for a good outcome. Unfortunately, discrimination and hatred have always followed humanity throughout the ages, which is unlikely to change. If anything, the new forms of discrimination would replace the pre-existing ones. However, that situation does not mean that we should not help the victims like Eric. I am deeply convinced that medical workers must stand above social, ethical, or political tensions and provide help to everyone in need.
Other Factors Impacting Client’s Assessment
Social-environmental factors influencing the client, such as difference and oppression, must be addressed during the assessment. According to Asarnow & Mehlum (2019), treatments and interventions which address the psychosocial environment yield better results. Therefore, I would explain to Eric that being different from the majority in sexual orientation does not make him “wrong” or a “sinner.” I would assure the client that he is not the guilty party in the conflict. I would also appeal to the source of oppression — Eric’s parents. I believe that contacting them on Eric’s behalf and using a professional therapist’s authority could help negate several risk factors, especially the economic one.
Engaging the Client in Treatment Process
In Eric’s case, the client’s engagement in treatment is necessary for a successful outcome. This responsibility lies with the therapist, who has to persuade the client into collaboration throughout the treatment process. Jobes et al. (2018) provided the evidence-based Collaborative Assessment and Management of Suicidality (CAMS) clinical intervention for suicide prevention, which focuses on patient engagement in treatment. According to CAMS, being empathetic is the central part of care (Jobes et al., 2018). Therefore, I would use the CAMS framework and engage the client in treatment by utilizing an understanding, non-judgmental, and non-coercive approach. I would try to reveal the “drivers” of suicidal thoughts in order to see the situation from Eric’s perspective. It would be crucial to show that I understand the client’s inner struggle and how his parents mistreated him. In addition, I would try to create an atmosphere of teamwork via side-by-side seating communication with Eric. I reckon that the feeling of belonging, which the client currently lacks, would positively affect his attitude to treatment.
Practice, Suggested to the Client
I would suggest Eric a treatment based on the CAMS approach to care since it facilitates teamwork in overcoming his depression and STB. CAMS would create a so-much-needed atmosphere of belonging by letting the client know that their thoughts and feelings are valued. Instead of a passive participant’s role, Eric would be enabled to influence the treatment plan as a therapist’s peer. In addition, I would explain to Eric that CAMS is helpful for understanding and prioritizing the most dangerous factors of his condition. As a result, we would be able to identify and address the most significant risk factors and warning signs together, thus strengthening the client-therapist trust in the process.
Specific Treatment Strategies
There are several specific strategies within the CAMS care practice that I would utilize. First of all, I would encourage Eric to fill out a CAMS Suicide Status Form (SSF) so that we could evaluate the risks of suicidal behavior as a team. The risks can be assessed via SSF Core Assessment at the beginning of every therapy session (Jobes et al., 2018). By doing that, we would discover the problems together and develop a collaborative solution. For instance, that practice would be helpful to convince Eric in favor of using actual medications to cure his depression. In addition, I would encourage Eric to use the CAMS Therapeutic Worksheet (CTW) in order to understand the nature of his suicidal drivers. Filling out the CTWs would allow us to evaluate, which suicidal drivers are “direct” (cause Eric to consider suicide), and which are “indirect” (force the activation of the direct drivers) (Jobes et al.,2018). Overall, these strategies would help resolve the challenges associated with the treatment and mitigate the risk factors around the case in question.
References
Asarnow, J. R., & Mehlum, L. (2019). Practitioner review: Treatment for suicidal and self‐harming adolescents–advances in suicide prevention care.Journal of Child Psychology and Psychiatry, 60(10), 1046-1054. Web.
Hatchel, T., Polanin, J. R., & Espelage, D. L. (2019). Suicidal thoughts and behaviors among LGBTQ youth: Meta-analyses and a systematic review.Archives of Suicide Research, 25(1) 1-37. Web.
Jobes, D. A., Piehl, B. M., & Chalker, S. A. (2018). A collaborative approach to working with the suicidal mind. In M. Pompili (Ed), Phenomenology of Suicide (pp. 187-201). Springer.