Client suicide is one of the greatest fears of all counselors, and suicide prevention is a difficult and commonly avoided area of counseling. Suicide rates in the United States have steadily increased from 10.4 per 100,000 in 2000, to 13.4 per 100,000 in 2014. This is a 27.6 percent increase over 15 years.
If this trend continues, the occurrence of suicide will be one issue that most counselors will unfortunately have to face at some point in their practice. There are many legal, moral, and ethical difficulties surrounding the topic that could ruin a career if not properly dealt with.
Client confidentiality is of utmost importance, but when a client indicates that he or she may be suicidal, counselors have a duty to report this to family members and authorities.
Contrary to common belief, there are several effective suicide treatments for adolescents and adults. Using these techniques, first counselors must help clients out of the actively suicidal state. Next they encourage and teach the client to develop the skills needed to create and uphold fulfilling, rewarding, and enjoyable lives.
In this paper I will explore an ethical dilemma involving suicide and highlight some of the areas of greatest difficulty in the event of a client death.
For most counselors, an ethical dilemma is apparent when they encounter a confounding situation in which they feel hindered in their decision-making due to various factors.
There may appear to be conflict between, or inconsistency among, the ethical standards. The situation could be so compounded that the ethical codes offer unhelpful guidance.
A discrepancy between ethical and legal standards could materialize, or there may seem to be a conflict between the moral principles that underlie most ethical codes. If the correct route to take in a counselling situation is unclear, the ACA’s ethical decision-making model may need to be employed.
When making an ethical clinical decision, it is essential to consider both personal bias (ACA, 2014, A.4.b) and level of professional competence (ACA, 2014, C.2.a). How is a counselor to proceed if a client has many symptoms of depression and suicidal ideation and fits into one of the most likely demographic categories for a suicide, but denies all thoughts of suicide?
Clients may be asked to sign a no-suicide contract or a commitment to treatment contract.
These can be helpful in certain instances, but if the counselor-client relationship is strained or new, clients can feel as though they are being made to sign the contract to shift moral blame away from the therapist in the event of a tragedy, although the contract is in no way legally binding.
Suicide is the third leading cause of death among 15 to 24 year-olds. Seventy-one percent of psychotherapists report having at least one client who has attempted suicide, and twenty-eight percent of psychotherapists report having had at least one client die by suicide. It is an unfortunately common event that most practitioners will experience in their careers.
As difficult as it may be, if a client is presenting symptoms of depression and suicidal ideation, the best course of action is to ask the client directly if he is or is not considering suicide as an option.
For counselors and counselors in training, client death is a difficult event to move past. The only thing we can do is be as prepared as possible if the event should occur.
According to Veilleux and Bilsky (2016), training in suicide prevention does not prepare trainees or training programs for the cataclysm that a suicide can ensue. Suicide postvention procedures exist in other fields to help those affected, but mental health clinicians are forced to adhere to the ethical mandate of confidentiality.
Therefore, therapist survivors are not free to openly grieve with others who knew the deceased. In combination, the feelings of responsibility related to the client’s mental health and the ramifications of breaching confidentiality can leave the counselor with an often great burden that must be endured in solidarity.
Understanding legal and ethical problems related to suicidality is important knowledge to have when counseling suicidal clients.
Mental health care providers should grasp state laws pertaining to suicide, recognize legal challenges that are painstaking to defend against as a result of poor or incomplete documentation, and ensure the safety of client records and rights to privacy and confidentiality following the Health Insurance Portability and Accountability Act of 1996 that went into effect April 15, 2003.
