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What alternatives are in place for mental health providers to enhance clinical skills in working with suicidal clients? Where can the providers turn for assistance with case conceptualization and therapy planning? How can patients become more engaged in self-treatment? In an effort to deal with these clinical issues within patients suffering from multiple sclerosis (MS), a suicide prevention consultation model is established.
The suicide prevention issue
The issue at hand is of a man showing signs of suicide because an ailment has made him incapable of helping his family. The man is suffering from multiple sclerosis and he is often hospitalized. In addition to hospital expenses, the family is poor and unable to clear other bills leading to an eviction threat. As a result, the man is extremely frustrated and it seems that he cannot withstand this frustration. Committing suicide seems to be the only solution that this man has settled on, hence the need for a suicide prevention initiative.
Consultation model
According to Granello (2010), clinical interventions with clients of suicide issues generally take a two-tiered approach: short-term stabilization and addressing associated vulnerability, stressors, mental disorders as well as risk factors. In regard to this, the ongoing work of counseling can only begin after the first tier of the approach has been accomplished.
This means that, in as much as consultation is concerned, the most effective suicide prevention model is that whose strategies incorporate the elements of the two approaches. Granello continues to explain that many models exist, but they typically include information on (1) performing consequential assessments; (2) developing treatment strategies; (3) determining levels of care; (4) embarking on psychiatric assessments for medications; (5) enhancing access to treatment; (6) coming up with risk management strategies; (7) managing clinician liabilities; and (8) evaluating outcomes (Granello, 2010, p.219).
Respectively, the most effective consultation model for the man with multiple sclerosis and showing signs of suicide is a service involving an interdisciplinary team of mental health providers with diverse backgrounds. The team may comprise of clinical psychologist, clinical nurse practitioners, psychiatrists, predoctoral fellows and interns.
The referrals that can be received from such a case include diagnostic and treatment questions (like the degree to which cognitive harm contributes to suicide risk), the link between the history of multiple sclerosis and suicidality, and therapeutic alternatives for managing psychiatric trauma.
The assessment model to be used will involve a flexible combination of far-reaching review of the medical records, psychological and neuropsychological testing, inclusive clinical interview, and guarantee data collection including interviews with other significant individuals in the family.
One of the clinical psychologists can act as the director for the service to make sure that the case loads for the team members are balanced and the referral questions answered appropriately. The primary aims should be to meet with the referring practitioner to elucidate both the reason for the medical appointment and the expectations of the consultee to achieve a working understanding of the present nature of therapeutic correlation.
Here, obtaining information on the interventions that have already been attempted with or without observed success will be important. Moreover, the initial goals will involve demystifying the process of consultation. The tasks involved are obtaining informed consent, building rapport and establishing consultation goals (Jobes, Rudd, Overholser & Joiner, 2008). This initial session is important in laying the platform for establishing collaborative relationships amongst client, consultee and consultant.
After collecting background information through interviews and psychological testing, measures to be used can be selected based on psychometric properties, suitability for use with the man suffering from multiple sclerosis, capacity to evaluate a range of risks and protective factors, as well as offering convergent validity for the gathered information.
The consultant can then discuss preliminary results with the consultee during the assessment and record progress at each appointment. This activity supports efficient information sharing among team members, with the aim of persuading the consultee to participate actively throughout the process.
Due to the quick response required in this case and the nature of multiple sclerosis, the client and consultant can meet for an average 6 to 9 hours. The patient consults should be completed in a week’s time where consideration should be on the historical events, personality structure, current stressors and medical co-morbidities in order to understand the nature and severity of the risk for suicide.
The information should then be incorporated by the client into a report before scheduling for a meeting with the consultee and other treatment team members. A summary of the findings and recommendations from the consultant are evaluated and feedback given to the client. The potential treatment modifications can be discussed by all parties involved after which the consultee solely provides an ongoing follow up regarding the case.
The suicide prevention model described is based on the model developed by Caplan (1995) in his mental health consultation work. This model puts emphasis on systematic and institutional tones as well as acknowledging how such factors affect the process of consulting.
Notably, the core of this model is the belief that consultation is an intrinsically complex process that involves triadic relationship among the client, consultant and consultee. For a consultation to be effective, the consultant is required to address the interpersonal dynamics of the relationships and to develop trust throughout every phase of the process (Caplan, 1995).
The key reason for establishing this suicide prevention service is to lower or eliminate the risk of negative or probably fatal outcome from the man with multiple sclerosis as well as improving the care available to such victims. It is a fact that multiple sclerosis is not an illness that can be treated immediately, but the condition can be improved continually (Leon, Gonzalez & Navarro, 2005). Partly, this can be accomplished by dealing with the needs of clinicians.
Dealing with suicidal clients suffering from multiple sclerosis can be quite demanding, partly because of the associated concern that the person will engage in fatal behavior. It is clearly documented in the literature that clinicians who have patients die by suicide experience emotional effects such as feelings of guilt, shame, anger and failure (Meichenbaum, 2005).
Similarly, establishing a cooperative alliance between the patient and the consultant is important. This extension communicates respect for the prejudiced personal experience of the patient, while providing important information pertaining to the manner and degree to which the man is willing to engage on his own therapy.
Level of consultation
The case of the man showing signs of suicide is a special mental health problem owing to the fact that the ailment that has led to this situation is incurable. In addition, the condition is characterized by psychological trauma, sociological impairment and physical harm.
The dad has MS that has led to his inability to provide for the family as he has to cover other expenses. The unpaid bills have accumulated to such a level that the family is just days away from eviction. It is also likely that the man perceives the future loss of employment because the condition is recurring. In this understanding, it can be argued that the client issue needs to be addressed continually. Therefore, this is a special case of an individual going through mental distress as a result of multiple sclerosis and requires case consultation.
As noted earlier, a consultation process that fosters collaborative relationship between the consultant and the consultee is vital. Fundamental to this model is the assumption that the consultant-consultee relationship is deliberate and non-coercive, meaning that the consultee can freely accept or reject the recommendations therein (Caplan, 1995).
The key aim of this approach is to offer a service that helps the consultee to solve a specific work-related issue (evaluating suicide risk and planning treatment related to multiple sclerosis) and to provide an educational aspect that assists the consultee to work with increased independence (clinical aptitude when dealing with suicidal clients suffering from multiple sclerosis) when facing similar situations in the future.
Conclusion
Consultants play a central role in providing clinicians with assistance to conceptualize suicide cases and plan treatments which eventually enhance their skills when working with such patients. For the patients suffering in multiple sclerosis crisis, the most effective consultation model is a collaborative service that involves all pertinent practitioners with a focus on assessing risk factors and planning treatment with respect to the findings.
Such a model requires case consultation in which the key aim is to offer a service that helps the consultee to solve a specific work-related issue and to provide an educational aspect that assists the consultee to work with increased independence when facing similar situations in the future.
References
Caplan, G. (1995). Types of mental health consultation. Journal of Educational and Psychological Consultation, 6(1), 7-21.
Granello, D. H. (2010). A suicide crisis intervention model with 25 practical strategies for implementation. Journal of Mental Health Counseling, 32(3), 218-335.
Jobes, D. A., Rudd, M. D., Overholser, J. C. & Joiner, T. E. (2008). Ethical and competent care of suicidal patients: Contemporary challenges, new developments, and considerations for clinical practice. Professional Psychology Research and Practice, 39(4), 405-413.
Leon, J. B., Gonzalez, J. M., & Navarro, J. R. (2005). Quality of life and its assessment in multiple sclerosis: integrating physical and psychological components of wellbeing. The Lancet Neurology 4(9), 555-566.
Meichenbaum, D. (2005). 35 years of working with suicidal patients: Lessons learned. Canadian Psychology, 46(2), 64-72.