Please review the instructions on conducting the Mindspace Suicide Assessment located in this week’s folder. Also, please review last Thursday’s live lecture for more review and demonstrations on conducting the assessment.
Find a willing volunteer and practice conducting the Mindspace Suicide Assessment. Write up the results in a format similar to the following weeks.
Scores of Absolutely False; Absolutely True; Unspecified Responses
Visual Graph of Scores
99% of you should discover a No Risk assessment. Challenge yourself to still give me four recommendations, one in each category. Think of it this way. What is your subect doing that is providing them with a No Risk assessment? Have them do more of it. Behaviorally, emotionally, cognitively and socially. That is a legitimate recommendation!! Many of us are at least tangentially familiar with Maslow’s Hierarchy of Needs pyramid. It is formally a theory of motivation, i.e. what moves us to do the things we do. Yet, there are many applications of this theory that aren’t so easily determined at first glance. Once of these is a suicide assessment.
5) Self-Actualization — helping others meet their first four needs
4) Self-Esteem — having the competance to achieve your goals/do what you set out to do no matter how trivial
3) Love/Belonging — feeling loved/feeling like you belong to a group of like minded individuals
2) Safety — clothing/shelter/removal from physical harm by the elements or other people
1) Physiological — food/drink/rest/O2
I do not have the ability to create a pyramid, so this numbering system will have to suffice as a reminder of the theory.
When we put our energies into addressing the needs that arise in ourselves, the following resulting emotions spontaneously arise.
1 — Satisfaction
2 — Hopeful (This may sound awkward. That when I am safe, I feel Hopeful. It was explained to me, when asked “Can you achieve your goal?” You should first enquire, “Has anyone every achieved it?” If the answer is, “Yes, someone has acheived it,” then you have hope it can be done. This is an attitude from the biproduct of living in a safe world. “I have hope that it can be done.”
3 — Loved (“Can you achieve your goal?” It is next you should enquire, “Do I have friends and family who will support me in achieving my goal?” If the answer is “Yes, I have a network of people who support me.” Then you feel loved. This is an attitude from the biproduct of living in a loving world. “I am loved & supported in what I choose to do.”)
4 — Powerful (“Can you achieve your goal?” It is next you should enquire, “Do I have what it takes to achieve my goal?” If the answer is, “Yes, I have the ability and the competance to achieve my goal.” Then you feel powerful. This is an attitude from the biproduct of living in a world you have mastered.
5 — Helpful (Can you achieve your goal?” lastly, enquire “Do you help other people achieve their goals?” If the asnwer is, “Yes, I enjoy helping others achieve their goals like I have achieved mine.” Then you will feel helpful. This is an attitude from the biproduct of living a world where you help others.
If all of the above questions are answered with a whole hearted YES, then the stacking feelings and cognitive attittudes create a Meaningful Life. Look to the writings of Existential Psychologists Rollo May, Erich Fromm, Viktor Frankl and others; there is an emphasis on gaining meaning in your life. Having meaning in your life is the royal road to overcoming all tragedy!
On the flip side, when one believes “it cannot be done”, there is a feeling of Hopelessness. When one asserts “No one loves me, there is nowhere I belong,” a feeling of Unloved arises. When one entertains the notion that they are incompetant at life, powerlessness becomes the dominant attitude. And if one raises the idea that they can’t even take care of their own needs, let alone help anyone else with theirs, they will feel Helpless. A stacking of all these unpleasant and destructive cognitive constructs leads to a Meaningless Life, and therefore is the royal recipe for depression and suicide.
So how do we use this as a Suicide Assessment? Do we just ask, “Do you feel loved?” etc. etc., on down the five rungs of the pyramid? That’s kinda obtuse, and probably 99.9% of the time you will get an affirmative answer. Who willingly will admit they don’t feel loved? In theory, that makes for a good suicide assessment, but in practice it would be a lousy, ineffectual one.
What we need to do is learn the client’s Mindspace. Mindspace is the actual space a person’s mind is shaped and organized with their thoughts. A bit obscure upon first learning, but quickly one will attest of the simpleness and accurateness of this concept. As we emerge in the world, the means with which we come to know the external world is with our five senses. We see light, we hear sounds, we feel temperatures. Then, as language develops, we base our concepts on our senses. Intelligent people are brilliant, relationships can be harmonious, and friends can be cool. This inward mirroring of external perceptions is easily seen during children at play. Watch them play with blocks or leggos or other assorted objects. They naturally take all of the red objects and put them in a pile to one side of them. Then they will take all the blue objects and put them in a pile on the other side of them. And if you were to come over and jumble it all up, they may cry from the duress.
In short, we organize our minds like we always have been at play. We put ideas in categories and arrange them on one side of our Mindspace, and we put opposite ideas in similar categories on the other side of our Mindspace.
Try this simple exercise. Close your eyes and imagine the last time you were VERY Hungry, but weren’t able to eat. Perhaps you were on a road trip and didn’t see a turn off for food. Or maybe you were at a wedding or funeral and the ceremony went extra long and you waited longer than you expected before the food arrived. Now as you think of this idea of being hungry and not being satisfied, where you physically sense this idea? To the left of you or to the right of you? It can be slightly or glaringly obvious, but however, when you pay close attention, it will be on one side or the other. Then, notice is it above your nose or below your nose? Again, it can be slightly or glaringly obvious, but howerver, when you pay close attention, it will be above or below your nose.
Now we have four quadrants of our Mindspace. Left/Right vs Up/Down. A cross, if you will.
Back to our simple exercise. Close your eyes, and continue where you were….and then bring yourself to the point that you finally find food and can eat. Go to the point where you are wonderfully satiated. Now….as you think about being satiated….is it to the left of you or the right of you? Is it above your nose or below your nose? If you are a normally organized individual, they should be on opposite quadrants. (Cognitively disorganized people have opposite ideas in the exact same quadrant. This creates a host of cognitive disturbances and psychological problems.)
Now that you know it can be done, discovering someone’s organization in Mindspace, i’d like you, along with the rest of the students in class, to conduct a suicide assessment. You now have the ability to do so and with a little practice, you will be competant in determining if a person’s internal world is dominated by pleasing and motivating emotions, or destructive, painful emotions that drag them down to a point where they may contemplace suicide.
It begins like this….
1) Ask the subject to think about something ABSOLUTELY TRUE. NOT an opinion, but a fact. We all like to think our opinions are true, but for this exercise we are looking for the glaring obvious facts that are unshakably and unquestioningly true. The Sun revolves around the Earth. You are standing indoors. You live in the U.S.
2) Ask the subject, where in their Mindspace they are thinking of this idea that is absolutely true? To the left of them or to the right of them? Above the nose or below the nose?
3) On a pad of paper, draw a cross and write the following in the designated quadrant, “Absolutely True”.
4) Ask the subject to think about something that is ABSOLUTELY FALSE. NOT an opinion, but something contrary to the facts. You are standing on the moon. You are made of raspberry jello. The world is small enough to fit in your pocket. etc. etc.
5) Repeat steps 2 & 3, writing in the designated quadrant, “Absolutely False”
You should now have drawn on a piece of paper a large cross creating four empty quadrants. In one quadrant there should be “Absolutely True” written in ink, and in the exact opposite quadrant there should be “Absolutely False” written in ink. IF the two words are side by side and not in precise opposite quadrants, that’s ok. A minor blip that you can still work with. IF the two words are in the same exact quadrant, you will not be able to continue with this type of assessment. The results have indicated the subject is severely cognitively disorganized and an alternative method to assess suicide should be employed.
6) Ask the subject to state out loud the following, “I feel safe.”
7) Repeat steps 2 & 3 to determine where they imagine the statement “I feel safe.” Then document which quadrant that statement is in.
8) Continue repeating steps 2 & 3 with the statements, “I am loved”; “I am competant”, and “I enjoy helping others”.
It is ok to elaborate. “I am a loved by friends and family.” “I feel I have the ability to meet my goals.” “I try and help others when I can.” Or your favorite variation. But stick to a positive statement reflecting a need we discussed at the beginning.
9) After you have allocated the Mindspace for all of the Maslow Needs (minus the satiety, that one is important, but does not impinge upon one’s determination of suicide or not) count the statements that are in the Absolutely True category, count the statements that are in the Absolutely False category, and count the statements in the “Unspecified” category.
The number of statements in the Absolutely False category determines strength of risk of suicide.
0 = No Risk
1 = Slight or Low Risk
2 = Moderate or Medium Risk
3 & 4 = High Risk
Recommendations. (These aren’t written in stone, but suggestions. Feel free to add your personal favorites) No Risk = Continue with no change in lifestyle. Slight or Low Risk = Loosely monitor for additional signs. Recommend methods of emotional regulation and coping. Moderate Risk = Consider weekly counseling sessions. High Risk = Implement weekly counseling sessions, strictly monitor for additional signs.
Suicide is a Big Deal and you don’t want to ever encounter it. But the reality is there is a possibility you will. So don’t take it lightly. Demonstrate that you take it seriously. Demonstrate this in your write ups and in your recommendations.