Scenario: Joe, a recently divorced, 56-year-old Caucasian man presents to you, his primary-care provider, with complaints of insomnia and fatigue. He denies any recent injury or specific pain and was last seen in your office 11 months ago. Joe has taken an antihypertensive medication to control his blood pressure for 3 years and does not report any adverse side effects. Joe has worked in law enforcement for 14 years. He recently discharged his firearm for the first time. Even though no one was injured, Joe has been attending mandated appointments with the department psychologist. Joe reports that he does not have a regular exercise regimen. To relax he typically goes fishing or has a few beers after his shift. Other than the mandated appointments with the department psychologist, Joe has not sought any mental health treatment.
1. What factors in the scenario demonstrate an increased risk for suicide?
2. What should you include in a suicide risk assessment?
3. During the appointment, Joe states that it’s hard for him to talk about how he is feeling and begins to cry. Taking the opportunity to ask Joe about his intentions, what specific questions could you ask?
4. You understand that the best predictor of suicide risk is a history of a previous suicide attempt. When asked, Joe admits to placing one of his firearms in his mouth a few times, indicating that the likelihood of Joe attempting suicide is very high. How should you proceed?
5. Could Joe benefit from a no-suicide contract? Why or why not?
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