Elements and Performance Criteria

General context of the suicide intervention work:
A telephone counselling service will normally be provided in the context of a 24-hour telephone counselling service within the framework of the organisations guidelines and competency requirements
Telephone counsellors will have received training in generalist telephone counselling skills and in the principles and practices of crisis intervention
Supervision on 24-hour call may be accessed during a call when needed and must be consulted in certain mandated situations such as a potential suicide in progress

Suicide refers to any thoughts or acts which involve deliberate self-harm irrespective of whether death is or was the contemplated or intended outcome. Since some suicidal behaviour also involves harm to others, managing risks to third parties also falls within the scope of this unit. Vigilance about suicide risk needs to accompany bereavement support for those affected by another's suicide.

Factors which help estimate risk include, but are not limited to:
the presence of a suicide plan
suicide methods being considered
access to means
prior suicidal behaviour
strength of current coping resources and available supports

The range of available resources include informal support and professional help.

Appropriate counselling support to people with thoughts of suicide will include:
Identifying the frequency and duration of these thoughts
Asking whether they are linked to particular events or experiences
Seeking to understand the source of the emotional pain and associated thoughts and feelings
Explore achievable steps which address problems in living and strengthen supportive life links and relationships
Decide on a safety plan to reduce access to suicide methods and promote ready access to support and help when needed
Appropriate counselling support to people concerned about someone at risk include the above set of actions and deciding on the role the caller might have in reaching out to the person at risk and on who else may need to be involved

Appropriate counselling support to people impacted by someone's suicide includes:
Determining the nature of the caller's relationship to the person who died by suicide
Exploring and responding to the pain and impact of the loss in feelings such as sadness, anger, guilt or remorse
Asking the caller what aspects of the death or the loss they most need to focus on now and attend to these concerns
Assessing for suicide risk in the caller
Exploring internal coping strengths and external supports likely to provide support

Internal referral systems may include:
Training
The organisations referral database and files
Supervisory and on call network
Support personnel
Protocols for supervisory consultation during a suicide call and accessing emergency services when necessary
Literature - including books and brochures

Ethical guidelines and policy requirements that affect duty of care include:
Compliance with the organisations policies and procedures related to delivery of the telephone counselling service
Disclosure and confidentiality
Responsiveness to client requests
Meeting the organisations training standards
Seeking assistance and providing referrals
Participation in supervisory activities and professional development and training

Critical aspects of assessment:

Counsellors must demonstrate the capacity to work competently and independently according to the principles of their training and within the general context of the supervisory relationship noted above. They shall be accountable for their own professional conduct and practice including:

Carrying out assigned tasks
Working effectively under the pressure of crisis situations
Maintaining the quality of services to the organisations callers
Strengthening links to life-sustaining options and supports for calls featuring suicide.
Demonstrating a commitment to attend to the pain of persons considering or affected by suicide and to work toward life-affirming outcomes
Work will be assessed in accordance with professional standards of care commensurate with the telephone counselling role

Essential knowledge:
Common indicators of suicide risk
Identifying the range of calls which may feature suicide
Principles and practice of crisis intervention, including relevant ethical guidelines and policy requirements which affect duty of care
Applications of crisis intervention principles and practices to the telephone counselling medium
Principles and practices of suicide intervention - particularly the tasks of suicide risk assessment, risk management and ongoing support
Procedures for facilitating referrals and emergency interventions
The specific requirements of crisis intervention and how they relate to and complement general telephone counselling
Knowledge of personal attitudes, beliefs and values and how these might facilitate or impede effective crisis interventions
Examination of common notions about suicide in the light of available evidence
General awareness of how mental health issues may impact on crisis intervention and suicidal crises
Principles of self-care and support-seeking relevant to involvement in crisis and suicide intervention work

Essential skills:
Competent telephone counselling skills
Effective general telephone crisis-intervention-skills
Suicide risk recognition, assessment, and management (suicide first aid) over the telephone
Facilitating links with higher levels of care including emergency services where necessary
Self-monitoring and self-care
Seeking and integrating supervisory support

Resource Implications for training and assessment:

Resources for training in and assessment of crisis intervention competencies needs to be available to:

Provide initial and ongoing training
Ensure baseline knowledge and skills following basic training
Observe implementation of these competencies in actual counselling situations and simulated role plays
Facilitate learning through reflection on practice and integration of supervisory feedback

Methods of assessment:

Consistent performance and development would be expected to be demonstrated involving a combination of oral and written media while also featuring simulated and actual practice. Examples might include:

Group exercises
Written (e.g. Journal) and verbal responses to questioning
Simulated exercises
Observation of practice on telephone shifts
Response to and integration of supervisory feedback

Context for assessment:
Assessment must occur in the workplace or similar environment conducive to professional work over a number of occasions