Cluster 5: Written Assignment

This assignment will contribute to your final result for the following three (3) units:
 CHCMHS007 – Work effectively in trauma informed care
 CHCMHS008 – Promote and facilitate self-advocacy
 CHCCCS003 – Increase the safety of individuals at risk of suicide

Before completing and submitting this

assignment, have you:
☐ Accessed the learning resources in Step 1?

What you have to do

In this assignment, you are required to:
 Read three (3) case studies. For each case study you are required to:

- develop a safety plan for each person, and

- discuss how you would address trauma issues in relation to each person by
answering the seven (7) questions that follow.

How you will be assessed

These units are competency based. In order to be deemed competent in these units you
must satisfy all elements specific to the units and the essential knowledge and critical
aspects of assessment in a range of situations. The assessment has been developed to
cover these criteria and your OTEN teacher will review all your work and assess your overall
result to deem you competent.
Please reference your work. Referencing guides are available in the Guidelines and
information area on the OLS.

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For each of the case studies, you are required to:
a. Develop a safety plan for each person according to your organisation’s requirements
b. Discuss how you would address trauma issues in relation to each person by
answering the questions below.

Your safety plan must include:

 Resources and strategies to minimise the risk of suicide, and
 Any other services and/or individuals who could form part of the plan.

Case Study 1
Mary-Jane is a 29-year-old woman who has been diagnosed as Borderline Personality
Disorder (BPD) and is self-harming. She has made two suicide attempts in the past. She
experienced severe physical (from infancy) and sexual abuse (from the age of 4) from her
parents and was removed from their care by the State child protection authority at age 8.
Mary-Jane had multiple foster placements due to her aggressive and sexualised behaviour
and was sexually abused by a relative of one foster carer at age 13. She has had several
admissions to a mental health inpatient facility from age 14, and also spent 6 months in
juvenile detention at age 16 for assault. She has been a polydrug user (alcohol,
benzodiazepines, opiates and cannabis) since age 17. She has a history of abusive
relationships, and her two children have been removed from her care 3 years ago due to
physical and emotional abuse by both Mary-Jane and several of her partners. She has
presented to your service as homeless and expressing thoughts of killing herself. The only
person she sees as supportive is one of her sisters.

Patient Name: Mary-Jane

Warning signs that a crisis
may be developing (i.e.
personal thoughts,
images, mood, situation,
behaviours)
Internal coping strategies
– things that can take
your mind of problems
without the need of
another person (relaxation
techniques, physical
activity)
Mary-Jane has shown a history of impulsive behaviour (drugs use,
abusive relationships, assault charges). She is self-harming and is
having reoccurring thoughts of suicide. These are common symptoms
of her BPD and it seems to be that she needs to seek specialised
treatment for this. She is attempting to recovery from physical and
sexual abuse which will need the help of a psychologist.
There are many strategies Mary-Jane can use to cope.
Mary-Jane needs to remember that thoughts do not have to be acted
on, no matter how overwhelming or often they are. You won’t have
these thoughts forever and suicide is a very permanent thing.
A distraction box can be filled with things that provide comfort, help
to lift your mood or remind you of good times in your life. This could
include something that is meaningful like photos, a letter or a note to
yourself.
Attempt to get a good amount of sleep (at least 8 hours), eat regularly
(and healthy) and exercise.
Mary-Jane should write down her feelings in a journal or diary to help
express what is happening, how she is feeling and what her thoughts
are. This can later be discussed with a psychologist, therapist or
support group. It can make it easier to find solutions.
Go for a walk, hike or a bike ride.

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People and social settings
that provide distraction
Social:
People whom I can ask
for help
People:
 Her sister
 Support worker
 Friends from a support group
 Spend time at the gym or gym classes
 Support groups
 Go for a walk to the shops or local park
 Counsellor or psychologist
 Support worker
 Sister
 Support group – there are many support groups available
for suicidal thoughts, drug problems and victims of abuse.
 Support services – Manning Support Services, Mission
Australia, Lifeline
 Homelessness services – Department of Housing

Professionals I can Counsellor or support worker

contact during a crisis
Agencies I can contact Beyond Blue - 1300 224 636
during a crisis
Mission Australia - 1300 883 067
Lifeline – 13 11 14
Suicide Call Back Service - 1300 659 467

Suicide Prevention Lifeline Phone: 13 11 14. 24 hours 7 days a

week.
Making the environment Mary-Jane should remove anything that she can use to hurt herself
safe from the room or space she is in or ask someone to do this with her or
for her.
Mary-Jane should avoid situations with alcohol and other drugs as
they can alter how you think and feel (mostly in negative ways).
One thing that is Children. Even if they aren’t in her care, it is important for them to
important to me and know their mother, where they have come from and all the things that
worth living for is make them who they are.

Case Study 2
Amira is a refugee from a country which has experienced a long period of civil war, with
various factions in the country fighting for control. Amira’s husband and two eldest sons were
killed in front of her when the militia raided their village. Amira and her two younger children
managed to escape, and with other survivors from their village made their way to a refugee
camp in a neighbouring country. Amira spent five years in the camp, during which time her
two children died from malnutrition and disease. Amira was also sexually abused in the
camp. Amira came to Australia to live with a cousin three years ago. There are few members
of her community in the town she is living in, and Amira struggles with learning English. Her
cousin has brought her to your mental health service saying that Amira is becoming more
withdrawn, is neglecting personal care, not eating, and saying she wants to die and be with
her husband and children. This began after Amira saw a programme on television about war
atrocities in her country.
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Patient Name: Amira
Warning signs that a crisis
may be developing (i.e.
personal thoughts,
images, mood, situation,
behaviours)
Internal coping strategies
– things that can take
your mind of problems
without the need of
another person (relaxation
techniques, physical
activity)
People and social settings
that provide distraction
People whom I can ask
for help
Professionals I can
contact during a crisis
Agencies I can contact
during a crisis
Suicide Prevention Lifeline Phone: 13 11 14. 24 hours 7 days a
Making the environment
safe
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Amira has lost all her family and has no friends or support other than
her cousin. She has been exposed to war and abuse which has left her
in a fragile state. Her not speaking English is a barrier to meeting
people in the community and potentially creating a support network.
Some signs of a crisis developing include, being withdrawn,
neglecting selfcare, not eating and triggering tv shows.
Amira should go for a walk and explore the community. She might
find there is a place or spot she likes and feels happy at.
Use a language app or translator to learn English
Listen to music, try yoga or mediation to relax
Take a time out to watch a movie
Reading
Amira could join a support group. This would provide a social setting as well
as meeting new support people.
Join a gym. Physical exercise is important and this would allow Amira to
meet new people in the community.
Take English classes.
Her cousin could show her the community and take her out places so she isn’t
staying in the house all day.
 Counsellor or psychologist
 Support worker
 Cousin
 Support group – there are many support groups for sexual
assault victims, war victims and grieving families
 Support services – Manning Support Services, Mission
Australia, Lifeline
 Services that help with translation and learn English
Counsellor or support worker
Beyond Blue - 1300 224 636
Mission Australia - 1300 883 067
Lifeline – 13 11 14
Suicide Call Back Service - 1300 659 467
These services have an interpreter that can be used so that each
person’s needs are met.
week.
Minimise or eliminate potential triggers. For example, movies or tv
shows about war, anything related to sexual abuse or reminders (that
may have a negative impact) of her husband and her children.
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 Eliminate anything that Amira can use to hurt herself.
One thing that is Cousin is important to me as he is one of the only family members I
important to me and have left and family is important.
worth living for is

Case Study 3
Phillip is a 25-year-old who was removed from his family at the age of 7 because of severe
physical abuse and neglect. Phillip lived with his grandparents until age 13, when he ran
away due to sexual abuse over 3 years by a friend of his grandfather. His grandfather
refused to believe Phillip when he disclosed and gave him a severe beating for ‘lying’.
Phillip’s grandmother is frightened of her husband but has secretary-maintained contact with
Phillip and gives him money when she can. Phillip has mostly lived on the street since then.
He has used a variety of drugs to cope and has worked as a sex worker to finance his drug
habit. Last week he was beaten up by a client who refused to pay and was also diagnosed
with Hepatitis C. Phillip has been coming to the drop-in centre for homeless people where
you have worked for some months, and you have a fairly good relationship with him. Today
he has presented saying he has come to say goodbye: he cannot see the point of living any
more.

Patient Name: Phillip

Warning signs that a crisis
may be developing (i.e.
personal thoughts,
images, mood, situation,
behaviours)
Internal coping strategies
– things that can take
your mind of problems
without the need of
another person (relaxation
techniques, physical
activity)
People and social settings
that provide distraction
People whom I can ask
for help
Professionals I can
contact during a crisis
Due to extreme abuse, Phillip is reliant on drugs and is using sex work
to fund this addiction. He is homeless and feeling alone. He does not
have a support network and is not seeking help. He is now needing
medical attention and help to manage his hepatitis c which he will not
be able to get from living on the street.
As Phillip is homeless, it may be difficult for him to find coping
strategies he can implement as other people may distract him or try to
help him. Phillip could try meditating, stretching, going for a walk in a
park or quiet area or reading.
Volunteer at the homeless centre as a way to give back and help others
in similar situations.
Friend he has made at the homeless centre
He could go for a walk through the local park
Me (friend at the homeless centre)
A support worker
Counsellor and psychologist
Doctor
Grandmother (this is limited)
Doctor
Psychologist
Councillor

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Agencies I can contact Beyond Blue - 1300 224 636
during a crisis
Mission Australia - 1300 883 067
Lifeline – 13 11 14
Suicide Call Back Service - 1300 659 467

Suicide Prevention Lifeline Phone: 13 11 14. 24 hours 7 days a

Making the environment
safe
One thing that is
important to me and
worth living for is
week.
Find accommodation for Phillip so he is not on the street with drugs
and people wanting to harm him.
Remove Phillip from triggering or upsetting situations.
Remove anything Phillip can use to hurt himself.
Grandmother – she is in a bad situation and needs support and to know
that she is not alone.

1. What coping resources and strategies would you collaboratively develop with the
person to minimise the risk of suicide?

Mary-Jane
Mary-Jane suffers from BPD. This could be a contributing factor to her suicidal
thoughts and other issues such as substance abuse. Mary-Jane would benefit from
seeing a psychologist for further assessment (showing signs of PTSD) and possibly
medication. It is important that Mary-Jane recognises the warning signs that she is
getting to a bad place again with her suicidal thoughts and strategies like physical
activity (going for a walk or to the gym) when she’s not feeling okay. The environment
Mary-Jane is in needs to be safe and supportive with friends, family and professional
help. Doing daily reminders of positives things in her life, reasons to smile etc and
keeping a journal of her thoughts and feelings can be helpful. Limiting alcohol and
drug use as well as having a healthy diet and amount of sleep would benefit Mary-
Jane as well. This could be done with the help of services such as support workers,
aa meetings and support groups. It is important to have a safety plan in place.
Amira
Amira has experienced a lot of trauma. She would benefit from counselling with a
psychologist that can possibly diagnose and further treat Amira’s possible PTSD.
Recognising her symptoms and her triggers are an important part of Amira’s
recovery. Eliminating triggers and making the environment safe by having a support
worker, her cousin (support person) and other services such as support groups for
refugees and sexual assault could help Amira work towards having a happier and
healthier life. Amira will need a safety plan and it would be beneficial to have Amira
join local community activities with a support worker to help her learn more about
speaking English and the community.
Phillip
It is important for Phillip to recognise his warning signs and what his triggers are. He
needs to be in a safe environment away from drugs and triggers of his abuse. He
needs to see a psychologist for possible PTSD (from sexual abuse, neglect and living
on the street) and to help with his suicidal thoughts. He needs to get treatment for his
Hepatitis C which can be organised by a support worker and other services. Phillip

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 needs some help to remember that things will get better and that there is always a
reason to live. He needs supportive and positive people in his life.

2. What other services and/or individuals could form part of the safety plan?

Mary-Jane
Other services such as support groups for BPD, self-harm, abuse and drug use
would be a great help for Mary-Jane. Her sister could also be a part of her safety
plan. A counsellor or psychologist and services for homelessness, child protection
and Mission Australia could all be involved in the plan as well.
Amira
Amira would benefit from having refugee support in her safety plan and other
services that can help deal with the lost and grief of her loved ones. Psychologist (or
something like that) would help as well.
Phillip
Phillip’s grandmother could be a part of the safety plan as well as services to help
with homelessness and mental health support. His psychologist can also be a part of
it.

3. What are the risk factors and possible triggers for suicide in each case study?

Mary-Jane
Risk factors for Mary-Jane include:
 Borderline Personality Disorder (BPD) – if Mary-Jane’s BPD is not managed
and under control, it can cause Mary-Jane to feel extremely low and
potentially suicidal. This may lead to self-harming and/or more suicide
attempts.
 Child abuse – Mary-Jane was abused as a child which is a very traumatic
experience. She was moved around a lot so make struggle with connection
and feeling like she belongs. These are all things that can make Mary-Jane
feel mentally unwell and cause a suicide attempt.
 Polydrug use – mixing drugs (especially depressants like alcohol) and mental
illnesses such as BPD can cause someone to lose control of their thoughts,
feelings and emotions. This may cause Mary-Jane to feel depressed and
suicidal.
 History of abusive relationships – Mary-Jane’s history of abusive relationships
shows a lack of support and influence of good people in her life. This has
caused her to lose her children which can further push Mary-Jane into a
suicidal state of mind.
 Homelessness and instability
 She has had multiple attempts at suicide previously and spent time in a
mental health unit.

Possible Triggers for Mary-Jane include:

 Being around people using drugs or partying with drug/alcohol involvement
 Spending time with friends or family that have young children (negative
reminder of her own children)

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  Abusive partners or relationships – this can be triggering to her childhood
trauma and lead to further drug use and suicide attempts.

Amira
Risk factors for Amira include:
 Amira is a refugee. Her English skills are limited and she does not have lot of
support people or networks in her life at the moment. This can leave her
feeling isolated, alone and hopeless. All these feelings can contribute and
lead to suicidal thoughts and tendencies.
 Amira has a traumatic past which she hasn’t being coping or dealing with very
well due to a lack of support, not being able to speak English well and being
in a foreign country.
 Amira potentially has other mental illnesses such as post-traumatic stress
disorder that are undiagnosed, untreated and not helping her suicidal
thoughts.
 She has continually expressed feelings of wanting to kill herself and now has
stop taking basic care of herself.

Possible Triggers for Amira include:

 Television programs about sexual abuse, civil war, disease, fighting or death.
 Seeing a psychologist that isn’t able to speak the same language as Amira.
 Seeing family units in town may make her think about the family she has lost.

Phillip
Risk factors for Phillip include:

 Phillip has not had a lot of stability or consistency in his life. This has left him
feeling scared, alone and vulnerable. He does not have a safe or stable home
leaving him open to being harmed.
 Phillip is afraid to seek help as he was beaten and abused when he sort help
previously.
 He does not have a lot of money or a job to sustain living in a rental property
causing him to continue living on the street with unsafe people.
 May have other conditions such as post-traumatic stress disorder that aren’t
being treated or managed.
 Phillip is now sick with Hepatitis C and not able to access medications and
relies on a drop-in centre for support. He no longer sees the point in living.

Possible Triggers for Phillip include:

 Seeing his grandfather or becoming in contact with him. This is likely to

happen in his grandmother gets caught sending Phillip money or being in
contact with Phillip.
 Being around anyone that is using drugs could be trigger as Phillip needs to
stop using in order to be able to begin his recovery process. Drugs can alter
Phillips mood and potentially make his suicide thoughts worse.
 Talking to a counsellor or psychologist about his issues.

4. How would you determine the level of risk?

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 For each client, to determine the level of risk, I would thoroughly assess the
individual including their body language, how they are acting, what they are saying
and how they are feeling. I would also look into their mental history and see if there
are any conditions previously diagnosed that may contribute to the behaviours and
suicidal thoughts. I would ask about their personal circumstances and what has
contributed to them feeling suicidal. I would then figure out whether or not they are
high, medium, low or no (foreseeable) risk. My questions would include:
 How are you coping with what’s been happening in your life?
 Are you thinking about dying?
 Are you thinking about hurting yourself?
 Have you thought about how or when you would hurt yourself or commit
suicide?
 Do you have access to weapons or something you could use to harm
yourself?

5. How would you respond to the person’s suicidal thinking?

Mary-Jane
I would explain to Mary-Jane that suicide is a very permanent solution to a temporary
situation and circumstances. I would let her know that I am here for her, that I care
about her and her safety and I want to help and work with her so that she is able to
live a happier and healthier life. Although she has unbearable traumatic experiences
in her life and is using drugs there is help and support out there to get her to a better
place and I can help link her in with some services that allow her to have a better
quality of life. I would discuss the reasons why Mary-Jane should not do this and help
to see all the things she has to live for as well as the positives in her life.
Amira
I would learn a few phrases in her language so that she does not feel so alone and
like she does not belong. I would ensure that there was a way that she could
communicate with me at all times (perhaps she could email or message me so that I
am able to translate what she is saying) and help her to understand that I will listen to
her and that she is being heard. I would look for a grief and trauma support group in
the area and attend these groups with her. I would make sure she understands that I
do not want her to hurt herself and that I want to work with her so that she is able to
enjoy her life again and take care of herself.
Phillip
I would explain to Phillip that this is a safe space. No harm will come to him from
speaking to me about what is going on and that there will be no judgement. I would
let Phillip know that I can help him get in touch with some services to help him find a
home so he does not have to live on the street anymore with the people who are
causing him harm. I would help Phillip get in touch with support groups for drug
abuse and let him know that things can get better, suicide is not the answer. I would
remind Phillip that there are people who love him and would miss him if he was to
commit suicide. I would encourage him to focus on the positive things happening in
his future (getting clean, getting help and finding a stable home free of violence) and
help to stay on track with his recovery.

6. How would you respond to disclosures of trauma by the person? I would explain to
the client that this is a safe space and no harm will come to them from speaking
about what is going on. I would thank the client for feeling that they can trust me
enough to share such a hard, traumatic, difficult and personal story with me and let
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 them know that I admire and appreciate the courage they have to speak up and
share their story. It is important for the client to feel that they have been listened to
and have been heard. I would ensure they understand that what happened wasn’t
their fault, they are not to blame or accountable for the actions of someone else and
they are not alone. They did not deserve this. Support and strategies to manage their
pain, suffering or other feelings they may be having is available if they need it and
that I can help them link in with services and people that might be able to help them
through this process. I would let them know that it is okay and things will get better
even though they’re hard or difficult right now.

7. How would you ensure that you do not re-traumatise the client in your interview?
To ensure I am not re-traumatising a client, I would make sure they have a fair
amount of time to recover and heal before proceeding with questions if they are
feeling overwhelmed, getting upset or showing signs of not being okay. Rather than
having one interview that takes several hours, it might be better for the client to
schedule shorter sessions to take place over a few days. I would ask the client what
they feel comfortable discussing and create a safe and familiar environment for them
but also let them know that it is okay if they do not want to answer the questions if it
will make them feel uncomfortable or upset. I would ask them to share with me what
things makes them feel safe and what makes them feel unsafe. I will not make
assumptions and will allow the person to tell their story without interruptions. I would
also make and provide resources available for them.

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