I've changed my mind about ASIST (Applied Suicide Intervention Skills Training). It is useful. I used it yesterday. And I was surprised...the method worked. I didn't think it would.
The problem with ASIST though is that it's suicide first aid. There's no aftercare, it's all about referral, which is fine. But when people already have community supports, then it's hard to refer them to community supports. I mean, you tell them to go see their therapist and follow up with that, but aside from that, there's not much you can do.
Part of ASIST is having them promise you to stay safe for a set amount of time of their choosing. If the person picks a week, that's great. When they pick one day, but don't have a therapist appointment for a week, that's harder. You talk to them after a day, they say another day, do you do it all week? The model would say so... how realistic is that though? Plus, you're supposed to go through the whole intervention again... that's really redundant. In this case, I just made another safety plan with the person and arranged another check in time as well as reassessed for risk. Thankfully there was a lower risk then the day before.
There is no easy answer in cases like these. There are always options (calling mobile crisis, getting a form two and having them forcibly assessed, calling 911, involving the persons other supports), but there are still no easy choices. How much do you put on yourself, how much do you transfer to others. Ultimately though, it's the persons life. Whatever happens, it will not be my fault (or at least I keep telling myself that).