Working with Refugees who Threaten Harm

A refugee’s history of witnessing violence and trauma may affect his or her ability to articulate his claim and also increase the person’s capacity for or consideration of suicide. Greater exposure to violence may make a refugee more likely to consider self-harm.

Additional factors that may make refugees more likely to self-harm are feeling culturally or linguistically isolated in a new country, the breakdown of community and traditional support networks, unrealistic expectations in the country of asylum, and prospects in the asylum system in the country of refuge, or decline of refugee status. Furthermore, shame or experiences that are against cultural beliefs may be so ingrained in people that they see suicide as a solution to alleviate themselves or their family of stigma.

These factors not only contribute to an increased risk of suicide, but also to rising tensions between family members, which can result in actual or threatened domestic violence.

A client’s threats to harm him or herself or others may come up at any point during a consultation. Although this situation may not come up often, it is important that case workers know how to deal with such a situation and assess the acuteness and seriousness of the threat.

This section will help you identify signs that a client may be considering suicide, help you asses how serious that person’s risk of suicide is, and then provide some strategies that you can use to assist a client who may be considering suicide or who has threatened to self harm or harm others.

Signs of suicide

Signs that most directly warn of suicide:

  • Threatening to hurt or kill onseself
  • Looking for ways to kill oneself
  • Talking or writing about death, dying, or suicide
  • Making plans or preparations for a serious suicide attempt
  • Giving away possessions

Other warning signs include depression coupled with:

  • Insomnia
  • Intense anxiety, usually exhibited as psychic
  • Pain or internal tension such as panic attacks
  • Feeling desperate or trapped
  • Feeling hopeless or like there is no reason to live
  • Rage or anger

The following behaviors can also serve as warning signs, particularly when the person does not normally behave in this manner.

  • Acting reckless or engaging in risky activities
  • Engaging in violent or self-destructive behavior
  • Increased alcohol or drug use
  • Withdrawing from family or friends
  • Has a sudden interest or disinterest in religion

Identifying the seriousness of the threat

High to Severe risk Moderate Risk Low Risk
Has a specific plan that is lethal. Has some suicidal thoughts. Has some suicidal thoughts.
Has the means necessary to carry out the suicide.

  • Stocking up on medication
  • Obtaining weapons
Does not have a concrete plan to commit suicide. Has no concrete plan to commit suicide.
Has a history of attempting suicide May still be deciding whether or not he or she wants to live. Has no past history of suicide attempts.
Has a specific timeframe in which he or she plans to commit suicide. Is unsure of when he or she will commit suicide. Does not have a timeframe in which he or she would commit suicide.
Has told others that he or she intends to commit suicide. Exhibits some level of intent to self-harm, but does not show a firm conviction or commitment to doing it. States that he or she will not commit suicide.
The following signs also indicate that a person has a high risk of committing suicide:

  • Stating that he or she will commit suicide.
  • Planning or preparing for death.
  • Giving away possessions.
  • Making elaborate goodbyes.
Is not sure how he or she would commit suicide and does not have the means to do it.

Source: “Suicide Precaution: How to Identify When Levels of Sadness or Depression are a Concern.” Gulf Coast Jewish Family and Community Services, http://gulfcoastjewishfamilyandcommunityservices.org/refugee/files/2011/05/Suicide_Precaution-FINAL-ak.pdf.

Since your organization may not have the in house capacity to provide professional psychosocial assistance to severely distressed or suicidal clients, it is recommended that your organization establishes a relationship with mental health professionals that cater to refugees and accept referrals or are able to provide assistance during incidents.

Question-persuade-refer

If one of your clients is exhibiting signs that he or she may be considering suicide, you should address that by using the question, persuade, refer strategy, which was developed by the Refugee Health Technical Assistance Center. The following guidelines are merely suggestions. In all cases, professional help should be sought.

Question

  • You need to ask a client who is showing signs of suicide if he or she is considering it.
  • If the person does not want to talk about it, ask about their intentions again at a later meeting.
  • Talk to the person in a private setting and ask if he or she would like to have any friends or relatives present.
  • Ask if the person would like to have an interpreter present for the discussion.
  • Make sure that you give yourself plenty of time to have this conversation. It could take a long time because of language or cultural barriers.
  • You could phrase the question indirectly by asking the person if he or she has been unhappy recently or directly by stating that you know he or she has been going through a hard time recently, and you’re wondering if he or she is considering suicide.

Persuade

  • Once you have established that the person is suicidal, let the client know that you care about him or her; that he or she is not alone; and that suicidal feelings are usually temporary.
  • Give the person your full attention and do not interrupt him or her.
  • Suggest that there are better ways to solve his or her problems than suicide.
  • Try to convince the person that he or she should seek help to deal with his or her suicidal thoughts.

Refer

  • Try to get the person to commit to accepting help.
  • Connect the person to psychologists and other mental health resources.
  • Stay in touch with the client and continue to let them know that you care about his or her well-being.
  • Ideally, identify a trusted friend or family member who can accompany the person though the referral process. It may be overwhelming for the person to do it alone.

How to handle refugees who make threats

Below are some examples of the policies that Asylum Access has implemented to handle these kinds of situations.

If your client threatens suicide, or has a history of suicide:

  • Take the threat seriously.
  • Respond to distressed clients immediately. If necessary, postpone other appointments to make time to attend to the distressed client.
  • For actively, suicidal clients, try to calm the person using a soothing, re-assuring, and confident tone.
  • Do not leave an actively suicidal client alone. Accompany him or her to a safe and supervised space.
    • Ask the client for permission to involve a mental health professional and then ask a counselor to assess how serious the threat of suicide is.
  • Establish whether the client is currently being seen by a mental health professional.
    • If the person is seeing a doctor, seek consent from the client to consult with that practitioner.
    • If the person is not seeing someone, refer him or her to mental health services.
    • Per the Nairobi Code, you may reveal minimal information about the client to a doctor to prevent the client from harming him or herself.
  • You should also check to see if your jurisdiction has different rules on reporting threats of suicide.

When a client threatens to hurt another person:

  • Take the threat seriously.
  • Ask for the client’s permission to involve a mental health professional and then ask a counselor to assess the client to see how serious the threat is.
  • Establish whether the client is currently being seen by a mental health professional.
    • If the person is seeing a doctor, seek consent from the client to consult with that practitioner.
    • If the person is not seeing someone, refer him or her to mental health services.
    • Per the Nairobi Code, you may reveal minimal information about the client to a doctor to prevent the client from harming others.
  • You should also check to see if your jurisdiction has different rules on reporting threats to others.