The scenario

You are an exercise physiologist at a hydrotherapy centre that provides services for all members of the community, including people with disability. The person you are working with, Karen, uses a wheelchair. She has cerebral palsy and attends fortnightly hydrotherapy treatment to improve her strength and coordination.
Karen has had four treatment sessions with you, and she has always been enthusiastic and happy to chat with you during the sessions. Karen is assisted by a care worker who brings her to the centre, helps her with changing, and returns at the end of the session to take her home. Karen’s care worker tells you briefly that Karen has seemed down.
When you greet Karen, she doesn’t respond. When you mention that her care worker has said she seems to be down and ask if everything is alright she says, “I don’t want to talk about it.” During the session she is lethargic and isn’t concentrating. When you offer to stop the session, she says, “Fine, I am not worth spending your time with. I may as well be dead anyway.” 
 

Tips for responding in the moment

By making this statement, Karen has provided you with an opportunity to respond.
How you react is important:
  • Take all thoughts of suicide seriously. Do not dismiss Karen’s thoughts as “attention seeking” or a “cry for help”.
  • Don’t panic, thoughts about ending one’s life are a common experience.
What you could say:
  • State what has concerned you about what Karen has said and ask whether she is thinking of ending her life.
  • Don’t trivialise what Karen has said by saying things like, “It can’t be that bad”, “Lighten up” or “Just put a smile on your face”.
  • Encourage Karen to talk to you.
  • If Karen does respond, listen without interrupting or expressing judgement. Then reflect back what Karen has said, summarising in your words, to show you are listening and to check that you have understood.
  • Let Karen know that she does not have to talk to you about how she is feeling and what she is thinking, but that you are concerned and would like to help.
  • Ask how long she has been feeling this way.
  • Ask if she has talked to anyone about how she is feeling.
  • Ask if there is someone she knows and trusts that she can talk to about this. Encourage her to do so.
What approach you could take:
  • It is important to take action and support Karen to be assessed by someone who is qualified to do so as soon as possible.
  • If you are concerned that Karen is at immediate risk of taking her life, call 000.
  • If not, let Karen know that because you are concerned about her that you think it best you speak to her care worker or someone she knows and trusts so they can help.
  • If Karen asks you not to tell anyone about her suicidal thoughts or plan, do not agree to keep this secret. Explain that you have a legal obligation to tell someone who can keep her safe.
  • Do not leave Karen until you have obtained support for her.
  • Always follow your organisation’s policies and procedures regarding your own and client safety.
Support escalation if needed: You can call the Mental Health Line 1800 011 511. If you feel it is an emergency situation call 000.
 

Tips to help prepare for next time

  • Contact your supervisor and provide the details of what occurred to obtain advice on future contact.
  • Follow up with Karen’s care worker or nominated contact person prior to her next scheduled therapy session to agree on the best approach for your future involvement.
  • Look after yourself. Speak with your supervisor and ask for help if the situation has left you with feelings of unease. Many organisations will have an Employee Assistance Program where you can talk to someone confidentially.

Resources

Mental Health First Aid: Suicidal thoughts & behaviours guidelines
This guideline includes outlines how to respond to someone who you think is suicidal.
Type: Guidelines (PDF)
Length: 4 pages
Produced by: Mental Health First Aid
 
Black Dog Institute: Suicide and self-harm – how you can help
This site provides brief information on steps you can take to assist someone who you are worried may be thinking about suicide including “four steps for suicide prevention”.
Type: Web page
Reading time: 5 mins
Produced by: Black Dog Institute
 
Everymind: Conversations Matter
This site provides basic tips to help you talk to someone who you suspect is thinking about suicide. Resources include fact sheets, videos and podcasts.
Type: Web page with various resources
Length: Video (15 mins), Fact Sheet (reading time 30 mins), Podcasts (vary between 4 and 16 mins)
Produced by: Everymind (funded by NSW Health)
Current as at: Tuesday 15 November 2022
Contact page owner: Mental Health Branch