Code red: When is the chronically suicidal client at acute risk?

CrossCurrents

Often clients with BPD chronically think and speak about wanting to die by suicide, and may have made many suicide attempts. Because they are at chronic risk of dying by suicide, it can be difficult to determine when they are at acute risk. “A client with BPD can resemble the boy who cried wolf,” says Dr. Paul Links, the Arthur Sommer Rotenberg Chair in Suicide Studies and a psychiatry professor at the University of Toronto. Links has researched how therapists can determine when chronically suicidal clients are at greater risk. Evidence for acute risk includes:

• recent (within several weeks) discharge from a psychiatric inpatient unit
• worsening of depression and feelings of hopelessness
• using more substances than normal
• reporting a series of negative life events, such as loss of family support followed by job loss

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