Suicidal threats and behavior in a person with developmental disabilities: Effective psychiatric monitoring based on a fundamental assessment

Abstract

A psychiatric monitoring procedure was designed to better manage and treat suicidal behavior and threats in a person with moderate mental retardation, and psychiatric disorders. During the baseline suicidal threats and behavior were managed by assigning the person a counselor available to discuss his problems, keeping him in eyesight at all time, admission to the state school infirmary, counseling from his physician, and admission to a Multiple Disabilities Unit (MDU) located in a state hospital located 2 hr drive away from the state school in which he lived. A functional assessment indicated that these behaviors were not related to depressed mood or a depressive disorder. Rather, they were socially mediated operant behaviors in a person with poor impulse control, in which the attempts to manage the behaviors by the interdisciplinary team might have been counter-habilitative. A psychiatric surveillance procedure was based upon this functional assessment. The procedure consisted of increasing the number of apparently pleasurable activities available on the living area, asking for a no harm agreement following suicide threats or attempts, social isolation for 12-36 hr immediately contingent upon failure to give a no harm agreement, and release from social isolation contingent upon a no harm agreement. Data showed that this procedure was completely successful in reducing admissions to the MDU over a 7 month period. The social isolation was typically used once a week for approximately 25 hours over the 7-month period. It was noted that considerable savings were made by not using admissions to the state hospital over a 7-month period. Functional assessment can form the basis of developing and evaluating a variety of procedures relating to challenging behavior in persons with dual diagnosis including management of suicidal threats and behavior.

Treatment of Psychopathology in People with Intellectual and other Disabilities

“…42,43 Other small N experiments have successfully implemented packages of behavioural interventions, such as modelling, self-monitoring, and social reinforcement, 44,45 and one nonexperiment has reported the application of contingency management to prevent suicidal behaviour. 46 Finally, one dissertation 47 reported an experimental evaluation of social skills training in adolescents with autism (but not clinical depression), which observed reductions in self-reports of depression and anxiety only in the experimental group. Currently, there is no systematic review or meta-analysis of this literature and thus the status of behavioural interventions for depression for people with DDs is uncertain.…”

Handbook of Intellectual and Developmental Disabilities

“…Although other correlational studies have confirmed the association between poor social skills and other factors related to depression in people with ID, no experimental analyses of depressed behavior in people with ID have been published. However, there are a few intervention studies indicating that the behavioral characteristics of depression, such as poor eye contact, lack of speech , psychosomatic complaints (Matson, 1984), and suicidal threats (Sturmey, 1995a(Sturmey, , 1995b can be effectively reduced through various combinations of reinforcement of appropriate speech and prosocial behaviors, and through role-play, modeling, feedback, and contingency management. There is also some evidence that cognitive behavior therapy may be effective for people with mild ID and depression (Lindsay, Howells, & Pitcaithly, 1993;Sturmey, 2004).…”

“…Another example, of such a potential conflict, might be that every time a client makes a suicide threat a psychiatrist might insist on conducting an assessment of suicide risk. During this assessment the psychiatrist might attempt to persuade the client not to kill himself or herself, and then place them on one-to-one staffing for at least 24 h. In contrast, a behavioral assessment might indicate that suicide threats are maintained by attention from medical and nursing staff (Sturmey, 1995a(Sturmey, , 1995b. Good team functioning and careful case management skills are needed to integrate conflicting recommendations.…”

“…In these two examples, weight management might be explicitly not addressed because the team might consider it to be of a lower priority than a behavioral or psychiatric emergency or it might be addressed through an exercise program, instead of changing diet. Likewise, behavioral interventions to manage suicidal threats could be devised that both ensure client safety, address professional liability issues, and reduce the problem (Sturmey, 1995a(Sturmey, , 1995b.…”

Diverse diagnostic and behavioural patterns amongst people with a dual diagnosis

“…1993 ), depression ( Nezu . 1995 ), and suicidal tendencies ( Benson & Lamar 1988; Sturmey 1994) have been identified among people with an intellectual disability.…”