Citation

Shea SC. Psychiatr. Ann. 2004; 34(5): 385-400.

Copyright

(Copyright © 2004, Healio)

DOI

10.3928/0048-5713-20040501-19

PMID

unavailable

Abstract

The CASE Approach is designed to allow clinicians to enter patients' worlds of suicidal preoccupation sensitively and deeply. The information garnered complements a careful collection, during other parts of the interview, of the risk factors for suicide. By gathering both sets of data, clinicians may uncover as many pieces of the puzzle as possible. By optimizing both the quality and the amount of data, clinicians will hope to enhance the likelihood of an accurate prediction of risk. Simultaneously, clinicians also will develop an outstanding set of data for use by future clinicians in determining the safety of the patient. During this assessment process, something else very important may have been accomplished, because the interviewer has helped the patient to share painful information that the patient has borne alone for too long in many instances. Perhaps the thoughtfulness and thoroughness of the questioning, as illustrated with the CASE Approach, will convey that a fellow human cares. To the patient, such caring may represent the first realization of hope. By using this strategy routinely, clinicians can become adept at it, learning how to alter it flexibly to fit the unique needs of the clinical setting. In most suicide assessments, the CASE Approach can be completed within several minutes. Even with more complicasted patients, as seen in complex emergency department situations, it rarely requires more than 5 to 10 minutes. It is hoped that the CASE Approach may prove to be a valuable addition in the ongoing attempts to improve the quality of suicide assessments and the training of all clinicians, from differing disciplines, who perform them. Since its appearance in the literature in 1998, it has been well received among mental health professionals, substance abuse counselors, crisis clinicians, school counselors, and primary care physicians. It is well documented that at least 50% of patients who kill themselves have seen a primary care clinician within 1 month of their deaths.25 A typical primary care clinician is seeing patients who warrant a suicide assessment on a daily basis. To prepare medical students for this future task - as part of the numerous competency skills they are required to demonstrate before graduation - every student could be asked to learn and effectively demonstrate the use of an interview strategy for eliciting suicidal ideation, such as the CASE Approach. It is likely that these medical students would be significantly more competent in eliciting suicidal ideation than the typical medical graduate of today. Perhaps even more important, because the students would understand the importance of asking for suicidal ideation and simultaneously become more comfortable with a way of doing it, they might be considerably more aggressive in seeking it out in their future primary care settings. The result could be a tangible decrease in the death rate related to suicide. In addition, the behavioral specificity of the CASE Approach makes it ideal for rigorous empirical study, which could confirm the validity of the strategy or demonstrate the superiority of other strategies. Such research could provide the foundation of an evidence-based model for effectively eliciting suicidal ideation, much in the same fashion that cardiopulmonary resuscitation was developed. As with cardiopulmonary resuscitation, such an evidence-based interviewing strategy could be used as the basis for certifying clinicians across disciplines throughout the country. The subsequent results on the rate of suicide are unknown, but the possibilities are exciting.

Language: en

Keywords

human; mental health; suicide; anxiety; suicide attempt; interview; suicidal behavior; hospitalization; risk assessment; accuracy; risk factor; review; symptomatology; clinical practice; health care organization; behavior disorder; psychologic assessment; self report; validation process; automutilation; behavior therapy; mental stress; mental patient; doctor patient relation; anamnesis; patient counseling; defense mechanism; denial; skill; chronology