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to guns, medications, etc.). The last part of a safety plan includes a list of people to whom the client can turn for support, with their contact information. Whatever you do for a safety plan, you should include a copy in your file and be sure the client leaves the office with another copy.
Your clinical records should reflect that you have paid attention to clinical risk. The clinical record is
the criteria on which your treatment will be judged—ensure that it includes evidence
of competence.
Essentially, the creation and practice of a safety plan bridges suicide risk assessment and the proposed treatment. One of the important items to cover in a safety plan is the client’s willingness and ability to enact a safety plan when in need. If the client is able and willing to enact a safety plan, document this. Having family members involved in this process who
can agree to help enact a safety plan can be very useful. If
the client is unable or unwilling to take the steps necessary to stay safe, then hospitalization, or at least an increased level of care, should be discussed. Contacting family members about the increased level of risk is recommended (Sokol & Pfeffer, 1992). An essential part of proposed treatment and the safety plan should be when to follow up. If the client is at increased risk of suicide, document what the client will do to stay safe until the next session and when you will check in to follow up. Then, be sure that you do actually follow up and document it!
Suicide is scary—but it does not need to be for legal reasons as a therapist. No clinician is expected to be perfect, but there is an expectation to seek consultation when needed,
to evaluate suicide risk, and make an informed judgment about how to proceed with treatment. Your clinical records should reflect that you have paid attention to clinical risk. The clinical record is the criteria on which your treatment will be judged—ensure that it includes evidence of competence (Bishop, Tedeschi, & Caldwell, 2015). The record should include: informed consent, risk factors (acute and chronic), risk formulation and judgment for treatment, treatment
plan, means restriction and management, consultation with colleagues and supervisors, and finally treatment progress and outcomes (Jobes & Berman, 1993; Hall, 2016).
Should a client die by suicide, do not be afraid to be human. Three of the most common things found to be helpful from
a clinician after a suicide are: 1) making contact, 2) offering condolences, and 3) discussing the experience and sense of loss as a clinician (Peterson, Luoma, & Dunne, 2002). Further, clinicians who are viewed to be grieving and openly respond to bereaved family members are less likely to be sued.
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