Uncovering Unusual Methods of Suicide

Mar 08, 2017

“Thank God, they cannot cut down the clouds.”

Henry David Thoreau
New England Transcendentalist

Uncovering Unusual Methods of Suicide

TISA Description of the Problem: There are many reasons for a person to withhold suicidal ideation. In this light, two problems that can arise for the clinician when eliciting suicidal ideation, especially when interviewing in hectic circumstances such as an emergency department, include simply forgetting to ask about a common method of suicide (such as a gun) or having a client who has thought seriously about an unusual method of suicide (such as drinking drano). Sarah Davila asks a simple question that can help address both of these potential errors of omission.

Tip: In order to make sure that I do not miss an important method which the client has been contemplating with regard to suicide, after I have covered the main ways, I simply ask, “Is there one that I missed?” The answers are sometimes surprising. I have found this to be a very sound practice.

TISA Follow-up: As we have found so many times before on the pages of the TISA website, simple questions are often powerfully useful, and Sarah’s question is a nice example of this axiom.

For the reader interested in learning much more about the delicate art of uncovering suicidal ideation and intent, you might enjoy the following brand new two- article series on suicide assessment. It appeared in the Psychiatric Times, and it is both free and online.

I am very grateful to the editor of the Psychiatric Times, Natalie Timoshin, who allowed me to create something which I think shows the power of the web to enhance education. The first very brief article introduces a new idea in the field of suicide prevention. It is a concept that hopefully will help clinicians to better understand and transform the difficulties associated with uncovering suicidal intent — a concept called the “Equation of Suicidal Intent.” I think you will really like it.

The unusual part was that, because the web has little length restriction compared to hard-copy in a journal, I was able to write a concise but quite detailed “monograph” on the flexible interviewing strategy for uncovering suicidal ideation, planning, behavior and intent called the Chronological Assessment of Suicide Events (CASE Approach) as the second “article” in the series. The added space allowed me to create the best depiction of the CASE Approach I have ever written, exactly the way that I think it can be best described. I was able to fill the short monograph with specific sample questions and reconstructed dialogue that bring the CASE Approach to life, as if I was sitting down with you in an hour of supervision. I tried to create the best possible article I could for graduate students in social work, psychology, nursing, counseling and psychiatry as well as front-line clinicians manning our crisis teams, clinics, inpatient units and crisis lines.

If you get a chance I hope that you will take a look at it, for I truly believe that the CASE Approach can save lives. And I think your students will love it. The articles should be read in order, and the link to the second article appears in the final paragraph of the first article. Here is where to find the articles:


The titles of the two articles are as follows:
1) Suicide Assessment — Part 1: Uncovering Suicidal Intent — A Sophisticated Art
2) Suicide Assessment — Part 2: Uncovering Suicidal Intent Using the Chronological Assessment of Suicide Events (CASE Approach)


Tip provided by:

Sarah Davila

TISA is a site dedicated to advancing the science and art
Of preventing suicide and teaching clinical interviewing