Myron is a newly separated massage therapist who has always struggled with depression. He has trouble staying employed because he is moody and impulsive, even during a session with a client, and sometimes his demeanor makes clients slightly uncomfortable. When his wife tries to get him to take his medication, he always argues that “… we don’t do that in my family! We are not a family of nut cases, and we’re not weak.” They have argued about this intensely for years.

Four days ago, Myron’s wife of 17 years left both him and their 15-year-old daughter Becca, saying that his emotional instability is what has caused Becca to become “a problem child.” There is no indication that Becca’s mother is coming back.

Earlier today Becca came home from school and couldn’t find her father at first. Then she saw that his massage studio door was closed, and when she knocked, her father slurred the words, “Go away.”

She panicked and called her older brother, who lives on a military base 8 hours away. He is the one who called the police; when they arrive, Becca is sitting on the porch, her head in her hands. She is sobbing and says only, “He’s in the studio. At the back of the house.”

Two EMTs and a police officer enter the house, while a second officer sits down on the porch with Becca. Her face is smeared with a mixture of tears and heavy mascara. She wears a long-sleeved shirt, even though it’s a warm spring night.

“You want some water?” the officer asks.

She looks up. He smiles.

“Okay,” she says, and he stands.

“No wait!” she looks up at him. “Don’t leave me alone. Please?”

“Sure,” he says and sits back down. As he does, he notices that Becca’s sleeve has ridden up when she reached for him. She has a series of intricate, evenly spaced cuts up and down her forearm for as far as he can see.

“I’m Mike,” he says and extends his hand.

She looks at it but doesn’t take it, tugging her sleeve back down. “This is my fault, Mike. My mom’s off with some new boyfriend because I’m such a freak, and now my dad is stuck with me. So he’s tried to off himself—again. Why does this have to keep happening?”

“Well, I’m pretty sure this has nothing to do with you, Becca. You seem like a really nice girl. Becca? Is that your name?”

“How’d you know?” She raises her chin, nervous and suspicious, suddenly on alert.

“From your brother’s call to the dispatcher.”

“Oh.” She rests her chin on her knees again. “Right.” She wipes her eyes with her sleeve. Just then the EMTs emerge, carrying Myron, who is groggy and mumbling, on a gurney. He blinks once at Becca but doesn’t really acknowledge her. He looks the other way, possibly ashamed or embarrassed, as far as Mike can tell.

Becca begins to cry again.

“Hey, come on,” Mike says, putting one hand gently on her shoulder. “Let’s go to the hospital.”

1.What are some specific biological, psychosocial, and/or cultural factors that can potentially increase Myron’s risk of suicide?

2.2. Identify both the type of intervention (primary, secondary, or tertiary) that will be most helpful to Myron right now, and identify specific strategies within that type.

3.What concerns, if any, do you have for Myron’s daughter? What first steps in assessment, diagnosis, and/or intervention might help her most at this point?

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