CADC Crisis Intervention and Suicide Risk Management — Questions and Answers
Question 1: A client in early recovery tells you they have a plan to overdose tonight and have the pills at home. What is the counselor's FIRST priority?
- Explore the childhood origins of the client's despair
- Ensure immediate safety, including assessing lethality and restricting access to means (Correct answer)
- Have the client sign a no-harm contract and schedule a follow-up next week
- Refer the client to a support group meeting
Correct answer: Ensure immediate safety, including assessing lethality and restricting access to means
When a client has a specific plan and access to means, the counselor's first duty is immediate safety. That means assessing lethality and intent, limiting access to means, and arranging a higher level of care or emergency evaluation if needed. Exploration and routine referrals come after safety is secured.
Question 2: Which of the following is generally considered the strongest single predictor of a future suicide attempt?
- A previous suicide attempt (Correct answer)
- Being unemployed
- Occasional alcohol use
- Having a family pet
Correct answer: A previous suicide attempt
A prior suicide attempt is among the most robust predictors of later attempts and death by suicide. Substance use disorders, hopelessness, and access to means also raise risk, but prior attempts carry the most weight.
Question 3: Which statement about asking a client directly about suicidal thoughts is most accurate?
- It plants the idea and increases risk
- It should only be done by a physician
- It does not increase risk and is a necessary part of assessment (Correct answer)
- It should be avoided until rapport is built over several months
Correct answer: It does not increase risk and is a necessary part of assessment
Research consistently shows that asking directly about suicidal ideation does not increase suicidal behavior. Direct inquiry is a core part of risk assessment and often brings relief to the client.
Question 4: Which approach is best supported as a crisis tool for suicidal clients, in preference to a 'no-suicide contract'?
- A collaboratively developed written safety plan with warning signs, coping steps, contacts, and means restriction (Correct answer)
- A verbal promise to call the counselor the next day
- Discharging the client from treatment
- Increasing session length only
Correct answer: A collaboratively developed written safety plan with warning signs, coping steps, contacts, and means restriction
No-suicide contracts have no solid evidence base and can give a false sense of security. Collaborative safety planning (for example, the Stanley-Brown Safety Planning Intervention) identifies warning signs, coping strategies, supports, crisis lines, and steps to limit means.
Question 5: A client arrives at a program after heavy daily drinking and shows confusion, severe tremor, hallucinations, fever, and a racing heart. What should the counselor do?
- Encourage the client to rest and drink fluids in the waiting room
- Begin a motivational interviewing session
- Treat it as a medical emergency and arrange immediate emergency care (Correct answer)
- Schedule an intake for next week
Correct answer: Treat it as a medical emergency and arrange immediate emergency care
These symptoms suggest delirium tremens, a life-threatening complication of alcohol withdrawal that needs urgent medical care. It is a medical emergency, not a counseling situation.
Question 6: A client tells their counselor they intend to seriously harm a specific, identifiable person. Under the duty to protect/warn principle (Tarasoff), what is the counselor's appropriate action?
- Maintain absolute confidentiality in all cases
- Take reasonable steps to protect the intended victim, such as notifying them and/or law enforcement, consistent with state law and agency policy (Correct answer)
- Wait until the client actually acts before responding
- Refer the client to a different counselor without further action
Correct answer: Take reasonable steps to protect the intended victim, such as notifying them and/or law enforcement, consistent with state law and agency policy
Confidentiality has limits. When a client poses a serious, specific threat to an identifiable person, counselors must take reasonable protective steps as defined by state law and agency policy, and should consult a supervisor and document.
