Suicidal threats and behavior in a person with developmental disabilities: Effective psychiatric monitoring based on a fundamental assessment
✍ Scribed by Peter Sturmey
- Publisher
- John Wiley and Sons
- Year
- 1994
- Tongue
- English
- Weight
- 682 KB
- Volume
- 9
- Category
- Article
- ISSN
- 1072-0847
No coin nor oath required. For personal study only.
✦ Synopsis
A psychiatric monitoring procedure was designed to better manage and treat suicidal behavior and threats in a person with moderate mental retardation, and psychiatric disorders. During the baseline suicidal threats and behavior were managed by assigning the person a counselor available to discuss his problems, keeping him in eyesight at all time, admission to the state school infirmary, counseling from his physician, and admission to a Multiple Disabilities Unit (MDU) located in a state hospital located 2 hr drive away from the state school in which he lived. A functional assessment indicated that these behaviors were not related to depressed mood or a depressive disorder. Rather, they were socially mediated operant behaviors in a person with poor impulse control, in which the attempts to manage the behaviors by the interdisciplinary team might have been counter-habilitative. A psychiatric surveillance procedure was based upon this functional assessment. The procedure consisted of increasing the number of apparently pleasurable activities available on the living area, asking for a no harm agreement following suicide threats or attempts, social isolation for 12-36 hr immediately contingent upon failure to give a no harm agreement, and release from social isolation contingent upon a no harm agreement. Data showed that this procedure was completely successful in reducing admissions to the MDU over a 7 month period. The social isolation was typically used once a week for approximately 25 hours over the 7-month period. It was noted that considerable savings were made by not using admissions to the state hospital over a 7-month period. Functional assessment can form the basis of developing and evaluating a variety of procedures relating to challenging behavior in persons with dual diagnosis including management of suicidal threats and behavior.
Acknowledgements: I should like to thank John Haynes, Unit Psychologist for assistance in monitoring this procedure, and Sandy West for assistance in data collection.