In Harm’s Way – Strategies to Support Patients at Risk

At the BC Physio Forum held in March, CPTBC hosted a panel discussion titled In Harm’s Way – Strategies to Address Self Harm and Abuse. We presented three case studies to psychologist Dr. Dana Thordarson, social worker Serena Kullar, and physical therapist Janet Lundie. They shared suggestions for physical therapists to consider if they were concerned about a client’s well-being. Following are key messages participants took away:

Things to know:

  • If a client discloses abuse, self-harm, or suicidal thoughts, be prepared to stop your physical therapy assessment/treatment and address the comments. As a physical therapist, it’s important to notice the red flags, to offer information about resources and supports, and to refer to the appropriate professional.
  • Remember that crisis lines are excellent resources for physical therapists to call as well as for guidance on how best to proceed if you are concerned about a client.
  • Spend some time gathering important crisis line phone numbers. Look into resources in your own community in case these scenarios arise.
    • Does your local hospital have a rapid access psychiatry assessment program? If not, where is the closest hospital that offers that service?
  • Privacy laws have caveats that allow for you to disclose information if you have reason to believe a person is at serious risk of harm. In some cases, you’ll want to disclose to a parent or spouse either in addition to, or instead of a physician, depending on the details of the scenario. Consider including clients’ emergency contact person/number on your intake form in case you need to contact a support person for your client.
  • Document the relevant information and actions taken in the clinical record, including only the critical details. For example: “Client commenting that they are contemplating suicide, phoned crisis line together with the client, client agrees to follow up with family physician today.” Be prepared to redact these details if a third party asks for a copy of the clinical record and the notes do not relate to the insured injury.
  • Stay within your scope of practice as a health care professional by responding to concerning comments, asking a few probing questions, and then deciding on your course of action. Depending on the scenario, the course of action might be to offer resource information, or to contact a family member or physician, or even to call 911 in extreme cases.

Regarding clients:

  • Don’t ignore concerning comments. Be human, be empathetic, and indicate your concern. For example: “That sounds very stressful, and I’m really concerned about you.” You may be the only health professional that the client feels comfortable enough with to disclose this information to; how you respond might open doors for the client to seek supportive services.
  • Ask your client some probing questions to get more information about the degree of danger present. Consider asking if the patient has a plan to commit suicide, or what motivates the cutting – is it a way to cope with stress, or is it an attempt at suicide? In an abusive scenario, you could ask if there are children witnessing the abuse, or whether there are guns in the home.
  • If you are in the middle of a hands-on technique when a client makes a disclosure that causes you concern, be aware of how touch can be impactful and be careful of the effect on your client if you suddenly take your hands off them after the disclosure.
  • Capable adults have the right to make their own choices, even if that means remaining in an abusive relationship. Offer your client available resources for support services if they are open to it.
  • Involve your client in your action plan whenever possible to foster trust. For example, say “I’m really concerned about your safety, I’m going to get the number for the suicide hotline and we’ll call them together for some advice.”
  • Suggest to your client that you’d like to create a team to support them. Explain that in addition to having a physical therapist involved, you think it would be beneficial for them to connect with the school counsellor, physician, social worker, or psychologist to ensure that all of their needs are addressed by the right professional with the right skills.
  • Follow-up with clients who stop therapy midsession, leave and cancel sessions. Physiotherapy has great restorative value for people who may not feel valued themselves and might need an open door reminder.

Regarding clients under the age of 19:

If these types of conversations make you uncomfortable, know that you are not alone. It’s important to discuss this with colleagues and to become more comfortable speaking about these topics so that if/when such a situation arises you can react professionally and appropriately with your client and not miss an opportunity to build trust and to provide critical support when it is needed.

For more information on this topic and how to apply these messages in practice, please see our upcoming webinar series schedule. You can also contact the College at 604.730.9193 or 877.576.6744, or by email to practicequestions@cptbc.org.