we as counselors become concerned that the caller might be at risk of harming themselves or someone else, we must ask very directly, “Are you thinking about hurting yourself or…?” If their answer indicates possible danger, then we must assess the “Emergency Risk”. Let the caller know that you are concerned for them and that you believe they are serious. The following questions are necessary in making an emergency risk assessment:
- Have you ever felt like this before? – Check history of assault. How did you handle it then? (Past behavior is good predictor of future behavior.)
- What is the plan? How is the caller planning to kill himself or a third party? Generally, the more clear the plan, the more serious the threat.
- Are you using alcohol or drugs? An intoxicated person is more likely to act impulsively.
- What is the precipitating event? Has there been a recent disruption of the relationship? i.e. divorce, break up, just discovered spouse to be unfaithful.
- Is the person threatening to kill himself after the homicide?
- Does the person have access to the means to carry off the threat?
Notice that we use close-ended questions. These make good assessment questions because they elicit specific information necessary to determine risk. The more yes answers you get, the higher the emergency risk.
When a high emergency risk is assessed, the counselor should focus on reducing the risk. i.e. getting rid of the means, stop drinking, rally support system: family, friends, paramedics, police. If the life of a third party is threatened, we have a “duty to warn”.
As mentioned earlier, crisis intervention should take place in very small steps, i.e. “I want you to take some deep breaths and let’s make a plan”. The plan should be short term and have a high probability for succeeding.
