Self-harm and suicide risk: identifying some of the professional and ethical considerations
This chapter offers an introduction to some of the major professional and ethical considerations that need to be taken into account when working with a client expressing suicidal ideation. Suicide is always a shocking event and unfortunately, during their career, most therapists will work with clients who have self-harmed, expressed suicide ideation, or in the worst-case scenario, actually commit suicide. A complex interaction of genetic, psychological, biological, cultural, sociological and environmental factors contribute to suicide (World Health Organization, 2006) and this chapter identifies some of the client groups who statistically are most ‘at risk’ and also distinguishes some of the current legal issues for therapists. It may be useful to clarify some of the terminology used in discussing self harm and suicide. Self-harm can be defined as any deliberate act of self-poisoning or self-injury. In the past, various other terms have been used, including ‘parasuicide’ and ‘attempted suicide’. Suicide refers to the deliberate act or instance of killing oneself intentionally and voluntarily. Suicidal ideation/intention refers to thoughts of a plan or intent a person has to commit suicide. Suicidal threats are warnings that an individual might carry out the act of suicide. Suicidal risk is the chance or possibility that a person may die by suicide. Although suicide is no longer illegal in the UK (Suicide Act 1961), it is an offence to aid, abet, advise, conspire, or knowingly give assistance to another attempting to commit suicide. The finality of suicide creates a problem unlike any other in psychological therapy. The threat may require absolute choices and immediate decisions. Thus assessing the level of risk and balancing the needs of the client with the obligation of a ‘duty of care’ on the part of the therapist is challenging, to say the least.