Suicide Assessment and Crisis Intervention: NCMHCE Exam Review

This podcast episode, hosted by Dr. Dawn-Elise Snipes, provides a comprehensive review of crisis assessment and intervention strategies, specifically tailored for the NCMHCE exam. It begins by defining crisis, distinguishing between Erikson's concept of developmental crises and acute mental health crises, which are characterized as pivotal moments involving both peril and promise. A key definition from Kaplan (1961) describes crisis as facing an obstacle to important life goals that is temporarily insurmountable by customary problem-solving methods. The episode outlines the four primary symptoms of crisis: emotional distress, physical distress (linked to the HPA axis), cognitive disruption (impacting concentration, problem-solving, and memory), and behavioral changes (affecting eating, sleeping, and daily activities).

The discussion then delves into the precipitating factors of crises, often stemming from unmet basic human needs, drawing parallels to Maslow's Hierarchy. Dr. Snipes introduces the "CHARGES" mnemonic to guide a holistic assessment of these needs: Connection, Health and biological needs, Acceptance, Relationships, Goals and purpose, Efficacy and control, and Safety. Various types of crises are explored, including situational (unanticipated events like accidents, illness, death, abuse), interpersonal (relationship conflicts, divorce), cultural and societal (political unrest, discrimination, stigma), and maturational (normal developmental transitions such as graduation, empty nest, childbirth, marriage, and aging). A critical distinction is made between expected, normal reactions to developmental transitions and symptoms indicative of a diagnosable mental health issue, emphasizing the DSM's criterion of "clinically significant distress" for differential diagnosis, particularly for adjustment disorders.

Factors influencing an individual's response to stressors are systematically addressed using the "WHO DARES TO PERCEIVE BASIC COPING CRAP" mnemonic. This framework considers demographics (age, religion, ethnicity, situational and social supports), the perception of the event (its impact on biological necessities, acceptance, similarity to prior traumas, worldview, and sense of control), and existing coping resources (history of crises, coping skills, addiction history, and psychiatric issues). The stages of crisis are outlined as the initial event disrupting homeostasis, a vulnerable state where the individual attempts to cope, and an active crisis state if coping mechanisms are overwhelmed. An "emergent assessment" is introduced with the "BASICS" mnemonic, guiding clinicians to explore the behavioral, affective, somatic, interpersonal, cognitive, and spiritual impacts of the crisis, alongside past coping strategies and current support systems.

A crucial segment differentiates between a general crisis assessment, which identifies the cause of disequilibrium and needed resources, and a suicide assessment, which is an ongoing process designed to determine the probability of a suicide attempt. Direct assessment involves explicitly asking about suicidal intent, frequency, intensity, and duration of thoughts, while indirect assessment considers a comprehensive list of risk factors. These include gender (with specific age ranges for higher risk), prior suicide attempts, substance misuse, co-occurring mental disorders (especially emerging from bipolar depression), history of abuse, access to lethal means, exposure to suicide, social isolation, chronic illness, recent life changes (childbirth, major surgery, medication changes), stressful life events, and the individual's motivation for suicide (e.g., escaping pain versus impacting others). The episode also highlights specific high-risk populations such as non-Hispanic American Indian and Alaskan Natives, non-Hispanic white populations, veterans, military personnel, and sexual minority youth.

a full-out mental health crisis is a pivotal moment in which a decision must be made which involves both facing peril and promised crisis involves both risk and reward

people are in a state of crisis when they face an obstacle to important life goals that is for a time insurmountable by the use of customary methods of problem-solving

when we are in crisis we tend to not think real clearly that's partly because of some of the neurochemical stuff that's going on

when people are prevented from meeting their quote basic human needs it can precipitate a crisis

CHARGES stands for connection to something bigger than oneself or a system of meaning H stands for health and biological needs A stands for acceptance in relationships R stands for relationships the intimate kind G stands for goals and purpose our sense of identity E stands for self epic well efficacy and control a sense of efficacy in control and S stands for safety

determine which symptoms are expected reactions to a normal developmental transition versus a sign of an emotional or mental health issue

if the symptoms have a very clear precipitating factor precipitating stressor it is more likely an adjustment disorder diagnosis than a diagnosis of major depressive disorder or generalized anxiety yada-yada

a crisis assessment determines the cause of situational disequilibrium... and resources needed to help the client cope

a suicide assessment on the other hand is designed to determine the probability of a suicide attempt in the near future it's ongoing since the suicide risk changes over time

when people are coming out of a depressive episode of a bipolar disorder they are at a super high risk for suicide allottee

if somebody's motivation to die is to escape intolerable pain then their risk is pretty daggum high if their motivation to commit suicide is to impact another person their motivation or their risk is a little bit lower

the highest rates across the lifespan for suicide occurring occur among non-hispanic American Indian and Alaskan Natives and non-hispanic white populations