Understanding the Wellness Check Criteria

If caller is Amber-flagged/Red-flagged AND second Self-harm/Suicide Scale answer is 5 - 10/10.

The table above is a guide to help you determine the flag you will assign to a caller. A caller who has a history of self-harm or suicide attempt/planning is put on medium to high alert level because compared to those who have none, they are likelier to act impulsively or push through with their plan. This is why it's important that we ask about their history.

Those who are currently planning are put on high alert level because *detailing a self-harm/suicide plan is different from having passing thoughts of wanting to die. We all have our limits. And when we get very close to reaching it, it's common to feel like giving up -- including on ourselves at times. But fixating on it, creating a plan on how, when, and where you are going to end your life is not common nor is it normal. Hence as crisis responders, we ask about this.

We do the pre-helpline support (1st instance) Self-harm/Suicide Scale so we can gauge the severity of caller's distress. This isn't always accurate for various reasons (caller's too emotional, caller doesn't know how to answer, etc.) but it's good to have a number so we can somehow get a measurable description of how caller sees his situation.

Once you have all these information, do your best in providing support. Use your SAVE skills, SF skills, and the Safety Assessment Checklist. (Check the Resources page for a copy.)

When you're done, ask caller again on the likelihood that he will harm himself to re-assess the situation. This is the post-helpline support (2nd instance) Self-harm/Suicide Scale. When caller is less than 50-50 on the probability of harming themselves, then we can slowly bring the call to its end.

Whatever number they give, don't take it personally.

If their answer is still within 5 - 10, it's alright. Again, how the call turns out is not always a measure of your skills as a responder. Let go of the case by endorsing them for a Wellness Check. Both of you need to pause and rest.

If they gave less than 5, well done! You have every right to celebrate this win. But keep in mind that the caller played their part in this call too. Their lives are still their responsibility. All we can do is help them save themselves -- which, still, is not easy to do. So thank caller and give yourself a pat in the back. You both deserve it!

• When Should You Worry About Suicidal Thoughts?
• Suicidal Thoughts and Suicide Prevention: How Can We Help?

Scenario

Caller Alpha has tried to overdose with OTC medicines before and is planning to do it again later before he sleeps. (1st) Self-harm/Suicide Scale answer: 9.

After receiving emotional support from you, his (2nd) Self-harm/Suicide Scale answer is 4.

Assessment

Not qualified for a wellness check.

Why?

Alpha is red-flagged (with past attempt and with plans now) but (2nd) Scale answer is 4.

Scenario

For months now, caller Bravo has been hearing voices in her head. She's scared of giving in to them but this week has been very difficult for her. Two days ago, she thought of cutting her wrist with a pair of scissors when everyone at home is asleep, like what the voices tell her. She scared of doing it but the ideation is strong. She said she's at a 7/10 in the scale.

After receiving emotional support from you, her 2nd answer is at a 5 because she's still unsure if she can stop herself tonight.

Assessment

Qualified for a wellness check.

Why?

Bravo is amber-flagged (no past attempt, has planned before) and (2nd) Self-harm/Suicide Scale answer is 5.

Scenario

Caller Charlie feels like giving up on life. Every night, the thought that he won't wake up the next day passes his head. His (1st) Self-harm/Suicide Scale answer is 5.

During your support, you were able to clarify the following from him: he has never self-harmed, he also doesn't know how he'll "give up on life". The thoughts enter his mind but he never actively engaged with them. His 2nd Scale answer is still a 5 because he still doesn't understand why he feels this way.

Assessment

Not qualified for a wellness check.

Why?

Charlie is regular-flagged (no past attempt, no plans now) though 2nd Scale answer is 5.

Scenario

Caller Delta used to self-harm and is thinking of cutting himself again at the moment. He cooperates sometimes and answers your questions but it's apparent that he hesitates. You were able to get a (1st) Self-harm/Suicide Scale answer of 8.

You started giving emotional support but the call suddenly got cut.

You made an outgoing call to him but he rejected it. After 5 minutes, you called him once more but again, you were not able to connect with him.

Assessment

Not qualified for a wellness check.

Why?

Even though Delta is red-flagged (with past attempt, with plans now) and his (1st) Self-harm/Suicide Scale answer is 8, you were not able to do the second scale, you don't have his consent for a Wellness Check, and he rejected your attempts to continue helping him.

Remember our boundaries:

• we cannot force help on those who are not yet ready to take it

• Wellness Checks need caller's consent

Because we don't have caller's permission to have someone else call and check in on them, no need to escalate this case anymore. Just detail in your Crisis Line Intake Report what happened and let us know if you need to debrief.

A different group of people conducts the Wellness Checks, which is why we need consent. Callers have to be informed that someone from In Touch will check up on them and see how they're doing. If they're not informed of this, they might not answer the call or they may be surprised to be receiving one from someone they have never talked to before.