Negotiation Strategies for Depression

Guidelines for Negotiating with a Major Depressive Episode

• Initial Considerations: If psychomotor retardation is present, a longer response time is expected. Friends and family may exacerbate feelings of worthlessness and guilt. Sudden improvements unrelated to the negotiation should be viewed with caution. Focus on the present moment. The individual will typically be honest and straightforward. Beware of "suicide by cop." Prioritize empathy and attempt to postpone action instead of altering the mood.

Effective Techniques

• Emotional Exploration: Continuously explore the individual's feelings and encourage them to express their emotions. Allow the person to experience anger at the negotiator. Discuss the finality of death and suicidal thoughts directly. Inquire if they are considering suicide and what they have done to implement the plan. Have them describe fantasized suicide scenarios and focus and explore what aspects of their life are most meaningful.

• Perspective and Time: Center the discussion on the specific incident that triggered the crisis. Help the person focus on their perceived crisis and the meanings associated with it. Discuss what suicide might resolve and highlight alternative solutions. Emphasize that suicide is not the only option and express personal concern.

Suicide Clues

• Expressions of hopelessness: The individual may express hopelessness and helplessness through their words or behaviors.
• Indirect verbal clues: Clues may include indirect statements or hints about suicidal thoughts.
• Behavioral clues: Watch for behavioral shifts that might indicate suicidal ideation.
• Situational clues: Consider the surrounding events potentially triggering suicidal feelings.
• Direct verbal clues: Direct expressions of suicidal intent need to be addressed.
• Time clues: Clues about how time is viewed are useful indicators.
• Relationship clues: Identify how the person feels about their relationships and others.

How to Determine if a Person is Suicidal

• Ask directly: A direct question like "Are you going to commit suicide?" can help to assess the individual's intention.

Determine Motivation

• Purpose: Assess the reason behind the suicidal thoughts. Uncover the objectives and goals the person is trying to achieve with their thoughts.

Telephone Calls from Suicidal Individuals

• Reasons for contact: Suicidal calls can be manipulative and controlling, a way to gain attention or be validated.

Pre-Suicidal Situations

• Sudden loss: Sudden or significant losses can trigger suicidal ideation.
• Social isolation: Feeling isolated and lonely can contribute.
• Deep loneliness: Deep loneliness and feelings of emptiness can be triggers.
• Illness and pain: Physical health issues or pain can lead to suicidal thoughts.
• Changes in life style: Changes in lifestyle can trigger stress.
• Burden to others: Feeling a burden to others can incite suicidal thoughts.
• Unfulfilled expectations: Unmet or unrealistic expectations can be significant triggers.

Suicide - Ten Basic Assumptions

• Responsibility: Every individual has the ultimate responsibility for their own life.
• Crisis: Suicidal acts or thoughts often trigger a crisis, highlighting the severity of the situation.
• Volatility: Suicidal situations tend to be volatile and uncertain.
• Threats: Suicidal threats should be taken seriously.
• Ambivalence: Suicidal individuals often have ambivalent feelings about life or death.

Feelings Common to Suicide

• Ambivalence: The individual might not want to die, but rather the feelings of hopelessness or helplessness.
• Hopelessness: Inability to see a positive outcome.
• Helplessness: Feeling unable to change the situation.
• Tunnel vision: Inability to see realistic options
• Paraphrasing: Restating what the person said in different words.
• Active listening: Paying attention to the person's tone and feelings.
• Validation: Acknowledge and validate their feelings without judgment.
• Support: Providing encouragement and support, while avoiding advice giving.
• Probe Response: Asking follow-up questions to further understand the individual's feelings.

Putting the Subject in Touch with their Strengths and Resources

• Past experiences: Evaluate how previously similar situations may have been managed.
• Alternatives: Exploring options such as support systems, community resources and family.
• Brainstorming: Generating ideas together.

Assessing Lethality

• Stressors: Identifying the stressors in the individual's life.
• Losses: Recognizing any perceived losses.
• Suicidal thoughts and ideas: Understanding and questioning these thoughts.
• Suicide plan: Inquiring about a potential plan for suicide or self-harm.
• Previous attempts: Assess their history of suicidal behaviors or ideation

Establishing a Relationship

• Safe environment: Providing empathy, concern, acceptance, and understanding.

Effective Phase (Silence)

• Constructive time: Allow think time to assess the situation.
• Absorbing information: Giving time to process the shared information. Collecting thoughts.
• Feelings: Giving space to collect feelings.

Minimal Encouragers

• Conversations: Engaging in conversations to build rapport.
• Non-threatening manner: Communication should be non-accusatory.

Suicide Clues - Situation References

• Statements reflecting suffering: Statements expressing the burden of suffering associated with current challenges.
• Statements about hopelessness and no treatment: Expressing despair or feeling hopeless, or believing no treatment is available.
• Unsuccessful attempts to overcome difficulties: Describing past or ongoing attempts to deal with difficulties. Indicating a sense of failure or lack of progress.
• Uncertainty: Uncertainty about the future and lack of a solution.
• Questions about care for others: Asking about the well-being of pets or children, suggesting concerns about leaving loved ones behind.
• Leaving the body/property: Considering arrangements for the after-life or belongings.
• Desire to cease suffering: Expressing a desire to stop the suffering.
• Fatigue/exhaustion: Suggesting the person has reached the limit; has nothing left.

Suicide Clues - Relationship References

• Statements about better-off-ness without the person: Indicating the person is not needed in existing relationships.
• Statements like "nobody cares": Expressing a lack of perceived support or concern from others.
• Statements about others' sorrow when finding the person: Expressing desire for others to feel sorrow about the eventual outcome.
• Statements about seeing the person's pain: Suggesting the person wants others to witness their pain/suffering.

Suicide Clues - Time References

• Statements about the lack of a future: Expressing dissatisfaction with the current or future and wanting to end their life.
• Statements about the end or lack of future: The desire not to go through the future or a specific unpleasant part of the future.
• Statements about the lack of a future now: Feeling that their present or near future is unbearable/unsatisfactory.

Additional Considerations

• Reducing Lethality: Addressing physical risk and immediate dangers to prevent death quickly.
• Active listening: Focusing on listening and understanding the individual's feelings and perspectives.
• Obtaining information and follow-up: Collect additional information to further assess and resolve the situation.
• Referral: If appropriate, refer the person to professional mental health assistance.

Methods

• Pills: Gather details about the type, amount and timing of ingestion.
• Toxic substance: Gather details about the type and timing of ingestion.
• Gun/knife: Assess and mitigate risk of harm. Establish the status of the instrument and ensure its secure disposal.
• Gas/carbon monoxide: Inquire about the use of gas and carbon monoxide as a means for suicide. Secure the location and address the issue.

This quiz covers key guidelines and effective techniques for negotiating with individuals experiencing a major depressive episode. It emphasizes the importance of empathy, emotional exploration, and understanding the nuances of psychomotor retardation in communication. Test your knowledge on the best practices for handling such sensitive situations.