AGREEING A TREATMENT PLAN OR SFI

Informed consent is important when delivering any intervention. Informed consent is a first step in engaging someone as it orients them to the treatment (Wenzel &Jager-Hyman 2012). With someone suicidal it is critical to ensure that they clearly understand the goal of treatment (to prevent future suicidal behaviour) and have realistic expectations - that participating does not guarantee that the patient will not engage in suicidal behaviour (Rudd et al 2009).

Participating in an SFI is a voluntary process which cannot be done against a persons will and requires their consent for involvement. Efforts should always be made to try to establish consent and support a person’s capacity to engage. This can involve extended time working with the person or working with other staff or family members. If someone does not or cannot engage, we should also document our efforts to engage them. An SFI can take two to ten sessions, depending on the willingness, motivation risk level and complexity of the patient as well as (inevitably) the availability of time by the clinician.

Sharing one’s email addresses and phone numbers - the pros and cons

Conventional practice in mental health services avoided contact with patients other than via telephone or face-to-face. This is now outmoded and it became a priority during COVID-19 and lockdown to email patients URLs for communicating via remote platform. Despite all the challenges of patients communicating with us via text messages or emails (and associated risks), the advantages are clear. Patients at risk of suicide may be able or willing to contact us this way and would not necessarily do so by phoning. I would suggest therefore that within any intervention and an SFI in particular, it is helpful to discuss the preferred methods the patient has for contacting us and agree when, how and what for. My usual practice is to ask patients never to communicate suicide risk in a text or email which may not be read and on occasion may not even arrive. If patients don’t keep to the guideline, the agreement can be reviewed and more skilful communication “shaped”. See 3.10 (p 176) with regard to telephone coaching.

 
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