What is the Suicide Status Form?
The Suicide Status Form (SSF) is part of the Collaborative Assessment and Management of Suicidality (CAMS) completed in conjunction with the client’s sessions. This form helps assess the client, acquire suicidal behavior history, and create an individualized treatment plan. The Suicide Status Form is 1) a tool to integrate the client as an active participant in the therapeutic process and 2) a guide to creating a comprehensive suicide prevention model for the client-clinician.
The initial intake session provides the foundation, developing trust and engagement. For minority clients, the intake can be an intimidating process due to increased exposure to systemic disparities, mental health biases, and marginalization.1 The effectiveness of the SSF is found within its collaborative approach.2 Efficacious and valid treatment for marginalized clients centers client-focused and culturally informed treatment.3 This article is a comprehensive guide to formulating culturally informed questions and feedback during the interview process.
Section A of the Suicide Status Form: Psychological Assessment
Section A of the Suicide Status Form is an assessment of the client’s current suicidal behavior. This section is the baseline of the clinician-client relationship and guides the outcome of the intake. In this section, the client is directly involved in the response of the assessment, while the clinician guides the client. The collaborative approach establishes client autonomy, intimacy, and vulnerability between the clinician-client. Provided below are suggestions for culturally informed questions and feedback for Section A of the SSF:
Rate Psychological Pain
In my experience working with minority clients, the question of “psychological pain” can be difficult to answer. This is potentially due to the stigma of openly talking about suicidal behavior.4 It helps to reframe the discussion as one about physical pain, which then directs the conversation toward disclosing suicidal thoughts.
“When you begin feeling like hurting yourself, can you share with me where on your body you feel that pain most?”
Stress can result from both internal and external factors. It can also result from structural factors such as systemic and institutionalized disparities.5 Establishing an interview process which acknowledges the multiple factors of stress on the client’s mental health supports an effective, individualized treatment plan.
“I acknowledge that there are external stressors and situations that might impact your suicidal behavior. I would like you to know as we proceed with treatment that this is a safe space for you to share those stressors with me, without judgement”.
See above. As the client measures self-hate, it is suggested to frame the conversation by acknowledging both internal and external factors.
Thoughts and Feelings about Suicidal Behavior
It is important to consider that clients from underserved populations may have a history of experiencing stigmatization and other disparities during previous encounters with mental health providers.6 This may present itself in the form of distrust, lack of engagement, and discomfort with the therapeutic process. In reducing these responses, the provider can discuss the procedures of disclosure and confidentiality to re-affirm trust with the client.
“We are beginning to discuss more about your suicidal thoughts. This means we are going to talk about what makes you feel suicidal. Before we go any further, do you have any questions about the process?”
Reasons to Live; Reasons to Die
For some cultures, openly discussing suicidal thoughts is taboo. The reasons for these taboos range from beliefs of “keeping things in the family” to limitations with psychoeducation. This section is an intentional approach in comprehending the cultural, social, and individual factors that impact the client’s suicidality. For some clients, this is expressed in community and family being a protective and/or risk factor for suicidal behavior. The family/community might be a support system, but also can represent stressors to the client. Discussing these dynamics with the client will be helpful in future sections of the SSF.
“Thank you for sharing your experiences with me. I can understand this process has been very difficult, and I thank you for being open to the process. We are going to move at your pace, so if you need a moment, we can take a break. I am here to support you, and sharing how you feel is valid.”
Section B: History of Suicidal Behavior
This section of the Suicide Status Form is where the clinician and client discuss the client’s history of suicidal behavior. This section also details the history of physical and mental health, as well as interpersonal and socio-economic factors that may influence a client’s suicidality. The responses to this section will influence the treatment plan in Section C. Provided below are suggestions for culturally informed questions and feedback for Section B of the SSF:
- Reliving and discussing these factors might be traumatic to the client. Continuing to re-affirm and validate the client’s openness is beneficial.
- Burden to Others. Help-seeking behavior is reduced in racial minorities due to a multitude of factors, such as sense of burden on their family/community, fear of the mental health system, and experiences with discrimination.7
- History of Legal/Financial Issues. When discussing a client’s socioeconomic status, consider that financial stressors may impact a client’s ability to receive mental health support or contribute as a risk factor. Discussing the financial stressors of therapy is important in reducing overall stressors.
Section C: Treatment and Stabilization Plan
Following the responses from Section A and B, Section C of the Suicide Status Form is where the client and clinician work on establishing an individualized treatment plan. CAMS effectively integrates the client into the therapeutic process with its collaborative approach, which aids in establishing the treatment plan. Provided below are suggestions for culturally informed questions and feedback for Section C of the SSF:
In my experience, I have found that terminology can be confusing to clients. At this stage, the clinician needs to thoroughly explain the treatment plan and ask clients if they have any questions.
“I understand we have been sharing a lot today and that can be overwhelming. We have discussed your thoughts of suicide and your history. Now, I want to share your treatment plan for the remainder of your time with me. I can explain, and if you have any questions, we can discuss them. How do you feel about this plan?”
CAMS Stabilization Plan
As we have established in Section A, family/culture are very important aspects of an individual’s treatment, especially for racial/ethnic minorities.8
This means for some individuals the support system can be represented by external community services (i.e., therapist, social worker, support group, etc.). For others, the support system might include a complex network of friends, family, and religious/spiritual leaders.
Potential Barriers to Treatment
In section A, we discussed the potential barriers to accessible treatment. I suggest extending the conversation by asking about potential social and structural stressors that may hinder the client’s accessibility to your services. This might include lack of steady transportation, disability restrictions, unsafe family environments, lack of housing, financial instability, and a plethora of other societal factors. Having an early discussion to talk about minimizing those barriers will increase client retention and build trust.
Section D: Clinician Evaluation
In the final intake section of the Suicide Status Form, the clinician provides post-sessions evaluations of the client’s behavior and mental status. Provided below are suggestions for culturally informed questions and feedback for Section D of the SSF:
- While evaluating a client’s behavior and mental status, the clinician should reflect on their evaluation. Understand that biases and assumptions are a human reality. Our positionality influences our thoughts, ideologies, and assumptions. Check in to see if you are interpreting a certain body language, tone, or response with an open mind. For example, what might be perceived as aggression or hostility to a clinician might be a cultural expression of sadness or pain. Being informed on cultural expressions reduces mental health disparities and implicit biases.
Conclusion: Becoming a Culturally Informed Clinician
To be a culturally informed clinician means that the mental health provider acknowledges and integrates their client’s cultural identity into the treatment. It is not about being a professional anthropologist but being open to exploring and discussing the impact of social identity. This is important in establishing an effective treatment plan. The Suicide Status Form builds a collective understanding of a client’s suicidal thoughts, history, and individualized treatment. The recommendations in this article are a comprehensive guide in forming a culturally informed intake process.
- Foundations of Multicultural Psychology: Research to Inform Effective Practice, by T. B. Smith and J. E. Trimble Copyright © 2016 by the American Psychological Association
- Addressing Mental Health in the Black Community | Columbia University Department of Psychiatry (columbiapsychiatry.org)