from YAPRap April 2005
by Courtney Innes, YAPA
I am a Social Worker by training, and spent five years working with people who were homeless or at risk of homelessness. During this time I worked with many suicidal clients, furthering my skills in addressing the issues presented.
Organisational policies
Before being faced with a client who is suicidal, there are steps that should be taken to minimise the impact of the situation on the worker and to encourage a professional response to the young person. Every organization should have policies and procedures in place to assist them in the day to day running of their service, and to allow them to be strategic and consistent with their long-term objectives. As such each organization should have a policy and procedure in place to deal with suicidal clients. Workers should ensure that they are familiar with the steps outlined in these procedures. If your organization does not have such policies and procedures in place, it is very important to lobby and encourage them to do so. YAPA has recently completed Model Policies for youth services and are there for anyone to use as a base and/or guide in developing policies and procedures.
Until such time as your organization has these in place it is important for a worker to establish clear procedures for themselves should they have a suicidal client. When determining these steps, consult with other professionals and consider current best practice procedures. For guidance check out YAPA's Suicide policy in the Model Policies. A well thought out response covering any concerns that may arise, will allow a clear professional response to the client, as opposed to a panicky, reactive response, that is laden with fear and heightened emotions.
Worker self care
The job of a youth worker is extremely demanding and exhausting. There are never enough resources to achieve all that is expected, and to meet all the demands placed upon you. Dealing with people's feelings and emotions can be very draining, particularly if there are clients in your caseload who have very high needs. Because of this it is very important to ensure that at work you have a manageable workload, and that once you have left work, your personal time is your own.
At work, workers need to build in stress and time management techniques to successfully manage their demanding days. Placing realistic caps on workloads, building in debriefs and accessing regular supervision, are just a few of the strategies workers can use to ensure that their workload is manageable and not placing them on the road to burnout.
After work it is important that clients (or your workplace) do not expect that you are contactable 24/7. Clients must be aware of the clear boundaries that exist between your work time and personal time. One of my biggest learning curves whilst doing direct service delivery, was the awareness that regardless of how much clients believed they would not cope without my constant support (or that I believed this), humans are very resourceful creatures and will survive until the next 20 to 48 hours before their next appointment/contact. Being accessible on tap after hours is one of the surest ways to experience burnout. It is avoidable, and should not be expected of you by your organization.
If a worker was faced with a situation where the client (or their friend) calls them at 2am because they are highly suicidal, it is appropriate for the worker to pursue other options rather than attending the call. There are services, (admittedly not always the best) that are in place to deal with these situations after hours. If your area does not have any other after hours service, then the next step is to call the ambulance or police. This is not just an OH&S issue in terms of burnout and stress; it is also a safety issue. It may be extremely unsafe to make a homevisit by yourself to a client at 2am.
Safety still needs to be considered throughout working hours. If the crisis call was made during the day and the worker is unsure of the safety of the situation, they should attempt to take a second worker or have a worker ready to attend upon a phone call. If after making an assessment of the potential visit, the worker feels that it is still very unsafe, then they are not the appropriate person to attend and the police or ambulance should be called. If the rapport that a worker has with a client is important in terms of them seeking help, then they may be able to negotiate their attendance with the ambulance or police. YAPA's Model Policies cover home visits and risk assessments.
The one variation to this is if the organisation is paying you to be oncall or do after hours work. It is obviously then reasonable to be expected to take these calls, however there should still be stringent policies and procedures in place to protect the worker. For example, an established break time before starting work again
There is no good burning yourself out as a worker, or putting yourself at continual risk. You will be of no assistance to this client or any other client in the future. It is vital for workers to protect themselves, so they can maintain a professional working career. To be blunt, if we're not looking after ourselves in this profession, no one else will.
Regular supervision and debriefing
Regular supervision is a very important strategy in addressing worker burnout, and encouraging strategic well thought out responses to crisis situations. Supervision with a professional who you respect and who has been in the field for some time, allows the worker to vent, debrief and discuss any fears or concerns in a completely neutral and safe environment. Supervision allows the worker to explore how their theory of practice relates to their day to day work. The role of the supervisor is to gently question and challenge what the worker is discussing, to help explore and analyse further how they feel about certain situations. It assists the worker in identifying their 'pressure points', and in doing so assists them in not being reactive to clients.
Supervision is especially important for youth workers who are sole workers, or who work in an isolated area, and have little contact with other youth workers. The supervisory relationships encourages the professional development of the worker, and assists them in becoming more educated on the various work tasks of their job. Finally it can provide support and debriefing during difficult times.
See YAPA's Model Policies section on Casework for standard policies on supervision.
Debriefing is similar to supervision, but is often more instant and not as in depth. The opportunity to debrief provides an important tool in assisting workers to 'vent' their feelings of fear, frustration, confusion, anger and so on. It allows the worker to express their emotions, then move on to address what could or could not have been done differently. It also allows the worker an opportunity to brainstorm future strategies. Debriefs can be informal, and/or a structured debrief time with one or more co-workers from within or outside the organisation. When I worked with homeless people, my team had two hours a week set aside for debrief (like a staff meeting). It was invaluable in assisting us to deal with the day to day stresses of the job.
For immediate crisis, critical incident debriefing is also important to have readily accessible by your organisation. Someone suitable within the organisation or an external consultant can provide this. Having the opportunity to discuss immediate feelings, thoughts and actions can really assist in the addressing the impact of a distressing event.
Ongoing Training
Ongoing training is imperative for youth workers to keep constantly updating and refreshing their knowledge. Again this is something that needs to be built into the policy and procedures of an organisation. YAPA's Model Policies mentions training on suicide issues. Further, Suicide Prevention Australia provides training and manuals.
Practical tips
This article is not meant to provide practical tips when working with a suicidal client. The Model Policies provide some strategies to consider in terms of organisational procedures. The Youthwork topics: suicide page also provides links to helpful websites for practical tips and strategies when dealing with suicidal clients.
However there are some final comments that I want to make to youth workers faced with a client who is considering suicide. Whilst every worker must obviously take every professional step possible to reduce the risk of suicide for a young person, they must also be aware that suicide is always the final choice of the young person. If the worker has done everything they reasonably can do to assist, and the young person still chooses suicide, then it is not the worker's fault. A worker cannot be in control of their client's actions. Many youth workers work in, or have contact with, multi-disciplinary teams. Each discipline will have different knowledges and training in regards to suicide. For example, my theoretical framework as a social worker may vary slightly to that of a psychologist, or specifically trained youth worker, or to those who come from a medical background. This is important to bear in mind when considering what I have written, and when working with others. The issue of choice is always a contentious one that varies across professions and individuals beliefs. My strongest comment would be to encourage workers to use reflective, critical practice to understand their beliefs/thoughts on suicide and choice, before they are confronted with the situation.
Resources
- Youthwork topics: suicide has a set of resources for youth workers & students
- Model policies on working with young people, for non-residential youth services in NSW
Notes
Published: 2005
Applicable to:
- Australia
- youth workers in non-government agencies and local councils providing accommodation, welfare, social or recreation services to young people
- may not be consistent with laws and guidelines outside NSW
- may not be consistent with laws and guidelines in out-of-home care or health services
- young people: unless the text says otherwise, young person/people means people aged roughly 12-25 years old.
To the best of our knowledge this is an accurate summary of the relevant facts at the time of publishing, without the assumption of a duty of care. We have no health, occupational health and safety, or legal qualifications, unless stated above. This information is general and should not be relied on as a substitute for legal or other professional advice. You should refer to any publications and authorities listed above and if necessary get qualified advice for your specific situation.
