CLEE Crisis Intervention and Suicidality 2 — Questions and Answers
Question 1: A client tells their therapist they plan to overdose on pills at home that evening. The therapist's MOST appropriate first action is to:
- Call 911 immediately without further conversation with the client
- Consult the BBS ethics hotline before taking any action
- Conduct a thorough safety assessment and attempt to engage the client in collaborative safety planning (Correct answer)
- Document the conversation and schedule a next-day follow-up appointment
Correct answer: Conduct a thorough safety assessment and attempt to engage the client in collaborative safety planning
The clinically appropriate first response is to assess safety and attempt collaborative safety planning before escalating to involuntary intervention.
Question 2: A 'No-Harm Contract' or 'Safety Contract' in suicide risk management is best understood as:
- A legally binding document that protects the therapist from malpractice liability
- A clinical tool that may be useful as part of a broader safety plan but is insufficient on its own (Correct answer)
- A mandatory requirement under California law for all clients with suicidal ideation
- An evidence-based intervention that definitively and independently reduces suicide risk
Correct answer: A clinical tool that may be useful as part of a broader safety plan but is insufficient on its own
Safety contracts are clinical tools that can supplement a safety plan but carry no legal protection, are not mandated by California law, and have not been shown to independently reduce suicide risk.
Question 3: Which California Welfare and Institutions Code section authorizes a 14-day involuntary psychiatric hold for intensive treatment after an initial 5150 hold?
- WIC 5150
- WIC 5250 (Correct answer)
- WIC 5270
- WIC 5300
Correct answer: WIC 5250
WIC 5250 authorizes a 14-day involuntary hold for intensive treatment when a person continues to meet criteria after the initial 72-hour 5150 hold.
Question 4: A therapist's client is acutely suicidal and refuses voluntary hospitalization. The therapist's MOST appropriate response is to:
- Honor the client's autonomous decision, as competent adults have the absolute right to refuse hospitalization
- Immediately terminate the therapeutic relationship to avoid liability
- Consider initiating a 5150 hold if criteria are met and less restrictive options have not been sufficient (Correct answer)
- Obtain a court order before taking any involuntary action
Correct answer: Consider initiating a 5150 hold if criteria are met and less restrictive options have not been sufficient
When a client meets 5150 criteria and less restrictive alternatives have been insufficient, the therapist may initiate an involuntary hold to prevent imminent harm.
Question 5: A California licensed therapist who fails to take reasonable protective action when a client poses a foreseeable serious threat to a third party may face liability under:
- The Privacy Rule of HIPAA
- Tort law based on the Tarasoff duty to protect (Correct answer)
- California Business and Professions Code Section 2960 alone
- The Lanterman-Petris-Short Act exclusively
Correct answer: Tort law based on the Tarasoff duty to protect
The Tarasoff duty creates a tort-based legal obligation for therapists to protect identifiable third parties from clients' serious threats, and breach of this duty can result in civil liability.
Question 6: Which of the following is a PRIMARY dynamic (modifiable) risk factor for suicide?
- Family history of completed suicide
- Male gender
- Current hopelessness and acute psychological pain (Correct answer)
- History of childhood abuse or trauma
Correct answer: Current hopelessness and acute psychological pain
Current hopelessness and psychological pain are dynamic factors that can change with clinical intervention, making them key targets in suicide risk reduction.
Question 7: When documenting a suicide risk assessment, a therapist should include:
- Only the final conclusion of low, moderate, or high risk
- A comprehensive account of risk and protective factors, clinical reasoning, interventions taken, and the follow-up plan (Correct answer)
- A signed no-harm contract from the client as the primary documentation
- An attestation that the therapist consulted with a supervisor during the assessment
Correct answer: A comprehensive account of risk and protective factors, clinical reasoning, interventions taken, and the follow-up plan
Thorough suicide risk documentation must capture the clinical reasoning process, all relevant risk and protective factors, actions taken, and the follow-up plan—not just the risk level conclusion.
CLEE Crisis Intervention and Suicidality 2
A client tells their therapist they plan to overdose on pills at home that evening.
The therapist's MOST appropriate first action is to: