Need Help? Click Here to Contact Us
30-day money back guarantee
If you have shopped with us before, please enter your details below. If you are a new customer, please proceed to the Billing section.
Username or email *
Lost your password?
Account username *
Create account password *
First name *
Last name *
Street address *
Town / City *
Country *Select a country / region…United States (US)CanadaUnited Kingdom (UK)AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSão Tomé and PríncipeSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited States (US) Minor Outlying IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamVirgin Islands (British)Virgin Islands (US)Wallis and FutunaWestern SaharaYemenZambiaZimbabweUpdate country / region
Pay via PayPal.
There are THREE agreements below. “Terms and Conditions of Use”, “Mendability Suicide Prevention Mandate”, and “SENSORY ENRICHMENT THERAPY MODALITY AGREEMENT” You must read and agree to all three agreements to take the certification course. You will also be shown these agreements separately and agree to them separately and specifically during the registration of a professional account with Mendability.
WE ADVISE USERS TO ALWAYS SEEK THE ADVICE OF A PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER WITH ANY QUESTIONS REGARDING HEALTH OR MEDICAL CONDITIONS.
THE SITE DOES NOT PROVIDE MEDICAL ADVICE
Welcome to mendability.com (the “Site“), websites owned and operated by Mendability LLC (“Mendability“). The Site or any product or service offered on the Site are provided by Mendability, conditional on your acceptance of the terms and conditions of use set out below (referred to as the “Terms and Conditions of Use” or the “Agreement“).
Mendability reserves the right to modify or amend the Terms and Conditions of Use without notice at any time. Any changes will be posted at the Terms and Conditions of Use section of the Site and any such changes will become binding and effective on the date the changes are posted. As such, it is important that the Terms and Conditions of Use be read on a regular basis so that you are aware of any such changes.
IMPORTANT – READ BEFORE ACCESSING OR USING THE SITE OR ANY SERVICES, SOFTWARE, GAMES, PROGRAMS, QUESTIONNAIRES, TOOLS, APPLICATIONS, FEATURES OR FUNCTIONALITY AVAILABLE ON OR THROUGH THE SITE (COLLECTIVELY THE “SERVICES”).
BY SELECTING THE “CONTINUE” BUTTON or BY SELECTING THE “I have read, understood and I agree to the above Terms and Conditions of use” CHECKBOX ON THE TERMS AND CONDITIONS FORM, OR BY ACCESSING OR USING THE SERVICES, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS OF THIS AGREEMENT AND YOU AFFIRM THAT YOU ARE OVER THE AGE OF 18, AS THE SITE IS NOT INTENDED FOR CHILDREN.
IF YOU DO NOT ACCEPT THESE TERMS AND CONDITIONS, YOU AGREE THAT SERVICES WILL NOT BE PROVIDED AND YOU WILL NOT ATTEMPT TO ACCESS OR USE THE SITE OR SERVICES. THE SITE AND ITS SERVICES ARE FOR CONSUMER EDUCATION USE ONLY.
NOTHING CONTAINED IN THE SITE IS OR SHOULD BE CONSIDERED, OR USED AS A SUBSTITUTE FOR, MEDICAL ADVICE, DIAGNOSIS OR TREATMENT.
BY SELECTING THE “Neither I nor any person within my care on Mendability is at risk for suicide.” CHECKBOX ON THE TERMS AND CONDITIONS FORM, OR BY ACCESSING OR USING THE SERVICES, YOU AGREE THAT THE SITE IS NEITHER INTENDED TO BE USED BY INDIVIDUALS NOR FOR INDIVIDUALS WHO ARE AT RISK FOR SUICIDE AND THAT NEITHER YOU NOR ANYONE IN YOUR CARE ON MENDABILITY IS AT RISK FOR SUICIDE. IF YOU ARE AT RISK FOR SUICIDE OR YOU INTEND TO USE MENDABILITY TO WORK WITH ANYONE IN YOUR CARE WHO IS AT RISK FOR SUICIDE, THEN YOU WILL NOT ATTEMPT TO ACCESS OR USE THE SITE OR SERVICES.
IF YOU OR ANY PERSON WITHIN YOUR CARE IS AT RISK FOR SUICIDE, PLEASE SEEK PROFESSIONAL HELP IMMEDIATELY AND PLEASE CALL THE SUICIDE PREVENTION LIFELINE NUMBER 1-800-273-TALK (8255)
The contents of the Site, including any reports generated from use of the Services and any other information, data, analyses, editorial content, graphics, images, audio and video clips, hyperlinks and references (collectively, the “Content“), are for informational purposes only and are not intended to substitute for professional medical advice, diagnosis, or treatment. You should seek the advice of a physician or other qualified health provider with whom you have such a relationship if you have questions regarding any medical or psychiatric condition or if you are experiencing any symptoms of or believe you may have a medical or psychiatric condition, regardless of any information contained within the Content. You should not ignore professional medical advice or delay in seeking it because of any Content. Furthermore, you should not interpret any reports or any other Content as recommending any specific treatment plan, product or course of action. You should always consult your physician or other qualified health provider before starting any new treatment or stopping any treatment that has been prescribed by your physician or other qualified health provider.
Information on the Site is not intended to replace medical advice from a health professional and Mendability does not accept any liability for any error or omission, injury, expense, loss or damage incurred by you or another party as a result of you using or relying on any information contained on the Site or any linked website. All users are urged to seek advice from a qualified health care professional for diagnosis and answers to their medical questions.
While side effects are generally temporary and mild in nature, they may include eating changes, mood swings, sleeping irregularities or changes, seizures in at-risk individuals, increase in crying, changes in the smell of the person’s urine, changes in stool consistency, bladder / bowel incontinence, tantrums, defiance.
PLEASE CALL YOUR DOCTOR OR 911 IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL OR PSYCHIATRIC EMERGENCY.
Certain portions, components, Services, Content and features of the Site are only available to users who purchase a membership (“Member Services“). The Member Services are not intended to be used by any person under the age of eighteen (18) years old. Should you choose to purchase or subscribe to certain Member Services, you agree as follows:
Mendability can disable your Site account, and take all further action against you it deems appropriate if, in the opinion of Mendability:
You agree not to share your username or password with others and to choose a password that cannot be easily guessed by others. Mendability is not responsible for any consequences which may result from you sharing your username or password. If Mendability has reason to believe that the security of your Site account has been compromised it retains the right to:
You must inform Mendability immediately if you have reason to believe your password has become known to others, or if the security of your username or password has become compromised in any way.
If you make any such submission you agree that you will not send or transmit to Mendability by email, (including through the email addresses listed on the “Contact Us” page) or any other communication means any communication or content that infringes or violates any rights of any party. If you submit any business information, idea, concept or invention to Mendability by email, you agree such submission is non-confidential for all purposes.
If you make any submission to a Public Area or if you submit any business information, idea, concept or invention to Mendability by email or other communication means, you automatically grant-or warrant that the owner of such content or intellectual property has expressly granted Mendability a royalty-free, perpetual, irrevocable, world-wide nonexclusive license to use, reproduce, create derivative works from, modify, publish, edit, translate, distribute, perform, and display the communication or content in any media or medium, or any form, format, or forum now known or hereafter developed. Mendability may sublicense its rights through multiple tiers of sublicenses. If you wish to keep any business information, ideas, concepts or inventions private or proprietary, do not submit them to the Public Areas or to Mendability by email.
You agree to only post or upload media including but not limited to photos, videos and audio that you have taken yourself or that you have all rights to transmit and license and which do not violate trademark, copyright, privacy or any other rights of any other person. To protect your privacy, you agree that you will not submit any media that contains personal information which may include name, phone number, email address or web site URL of you or of anyone else. Uploading media like images or video of other people without their permission is strictly prohibited. By uploading any media on the Site, you warrant that you have permission from all persons appearing in your media for you to make this contribution and grant rights described herein. Never post a picture or video of or with someone else unless you have their explicit permission.
By uploading any media you: (i) grant to Mendability a perpetual, non-exclusive, worldwide, royalty-free license to use, copy, print, display, reproduce, modify, publish, post, transmit and distribute the media and any material included in the media; (ii) certify that any person pictured in the submitted media (or, if a minor, his/her parent/legal guardian) authorizes Mendability to use, copy, print, display, reproduce, modify, publish, post, transmit and distribute the media and any material included in such media; and (iii) agree to indemnify Mendability and its affiliates, directors, officers and employees and hold them harmless from any and all claims and expenses, including attorneys’ fees, arising from the media and/or your failure to comply with these Terms and Conditions of Use.
Mendability reserves the right to review all media prior to submission to the Site and to remove any media for any reason, at any time, without prior notice, in their sole discretion.
If you use a Public Area, you are solely responsible for your own communications, the consequences of posting those communications, and your reliance on any communications found in the Public Areas. Mendability is not responsible for the consequences of any communications in the Public Areas. In cases where you feel threatened or believe someone else is in danger, you should contact your local law enforcement agency immediately. If you think you may have a medical emergency, call your doctor or 911 immediately.
In consideration of access to use the Public Areas, you agree that the following actions shall constitute a material breach of these Terms and Conditions of Use:
Mendability reserves the right but is not obligated to do any or all of the following:
Mendability shall have no liability or responsibility to users or members of the Site and Services or any other person or entity for performance or non-performance of the aforementioned activities.
The opinions expressed by those providing comments in any Public Areas do not necessarily reflect the opinions of Mendability. The Public Areas comment sections are not intended as, and is not, a substitute for professional medical advice. All decisions about clinical care should be made in consultation with your treating physician.
When participating in a Public Area, never assume that people are who they say they are, know what they say they know, or are affiliated with whom they say they are affiliated. Mendability is not responsible for the content or accuracy of any information, and will not be responsible for any reliance or decisions made based on such information. When using a Public Area, you may not post, transmit, link to, or otherwise distribute any information, materials or content that do not generally pertain to the designated topic or theme of the particular Public Area. Use of a Public Area for commercial purposes of any kind is strictly prohibited. Please note that Mendability reserves the right to refuse to post or to remove any information or materials, in whole or in part, that, in its sole discretion, are unacceptable, undesirable, or in violation of these Terms and Conditions of Use.
Any of the above actions will constitute “Misuse“.
Any acts you commit, or cause to be committed, which, in the sole opinion of Mendability, intentionally expose the Site or Services to cyber threats such as viruses or hacking, increase the likelihood of a security breach, or cause or may cause any reputational harm to Mendability will also constitute Misuse. Mendability retains the right to take steps to identify and prevent Misuse of the Site or Services.
Mendability limits the uses of the account. Except with our written permission, you shall not:
Engaging in prohibited uses is grounds for immediate termination of your Mendability account, and may also subject you to civil or criminal penalties.
You will be liable for any damage resulting from the following:
The use of the Site, Services and the Content is at your own risk.
When using the Site, information will be transmitted over a medium that may be beyond the control and jurisdiction of Mendability. Accordingly, Mendability assumes no liability for or relating to the delay, failure, interruption, or corruption of any data or other information transmitted in connection with use of the Site.
The Site, Services and the Content are provided on an “as is” basis. MENDABILITY, ITS LICENSORS, AND ITS SUPPLIERS, TO THE FULLEST EXTENT PERMITTED BY LAW, DISCLAIM ALL WARRANTIES AND CONDITIONS EXPRESS OR IMPLIED, STATUTORY OR OTHERWISE, INCLUDING BUT NOT LIMITED TO THE IMPLIED WARRANTIES AND CONDITIONS OF MERCHANTABILITY, NON-INFRINGEMENT OF THIRD PARTIES’ RIGHTS AND FITNESS FOR PARTICULAR PURPOSE. Without limiting the foregoing, Mendability, its licensors, and its suppliers make no representations or warranties that the Site, Services or Content will meet your needs, or about the accuracy, reliability, completeness, currentness or timeliness of the Services and Content, software, text, graphics, links or communications provided on or through the use of the Site. Mendability does not warrant that the Site, Services or Content are accurate, reliable or correct, that the Site will be available at any particular time or location, that any defects or errors will be corrected or that the Site, Services or Content are free of viruses or other harmful components. Further, nothing on the Site constitutes advice, nor should the Site or any part thereof, be relied upon in making, or refraining from making, any decision, medical or otherwise.
Mendability is not liable for any losses you may suffer which result from any viruses, “Trojan Horses”, “worms”, “cancelbots” or other harmful, disruptive or destructive files or computer programs that may infect your computer equipment or other property on account of your access to, or use of the Site, Services or Content. Mendability is not liable for any losses you may suffer which result from any attack from third parties on your Site account, Account Data or the Site.
In the event that you have a dispute with one or more users or members, Mendability hereby disclaims and you hereby waive any recourse to or against Mendability and agree to release and indemnify Mendability and its directors, officers, employees, agents and third-party contractors and suppliers from and against any and all claims, demands, damages, losses, costs and expenses of every kind and nature, known and unknown, suspected and unsuspected, disclosed and undisclosed, arising out of or in any way connected with such disputes or any breach of these Terms and Conditions of Use.
You understand and agree that any material or data downloaded or otherwise obtained through the use of the Site is done at your own discretion and risk and that Mendability will not be responsible for any damage or loss suffered by you as a result of the download or use of such material or data, including damage to your computer system or loss of data.
Under no circumstances will Mendability, its licensors, its suppliers or any third parties mentioned on the Site be liable to you for any damages (including, without limitation, incidental and consequential damages, personal injury/wrongful death, lost profits, or damages resulting from lost data or business interruption) resulting from use of or inability to use the Site, Services or Content, whether based on warranty, contract, tort or any other legal theory, and whether or not Mendability, its licensors, its suppliers, or any third parties mentioned on the Site has been informed in advance or ought reasonably to have known of the potential for such damages.
The entire liability of Mendability, its licensors and its suppliers, and your exclusive recourse, in the event of any claim(s) for which the Mendability parties or any of them may properly be held liable under this Agreement, regardless of the form of action or basis of liability (including statute, contract, tort, negligence, gross negligence, strict liability, breach of a fundamental term or fundamental breach), shall be limited in the aggregate (regardless of the number of claims), to the amounts paid by you to Mendability. No legal action or proceeding arising out of this Agreement, regardless of form or basis in law, may be brought by you against Mendability or any of the other Mendability parties more than twelve (12) months after the facts giving rise to the cause of action have occurred, regardless of whether those facts by that time are known to, or ought reasonably to have been discovered by you. The limitation of liability provisions of this Agreement reflect any informed voluntary allocation of the risks (known and unknown) that may exist in connection with the performance by Mendability of their respective obligations and responsibilities hereunder and such voluntary risk allocation represents a material part of the Agreement reached between you and Mendability in respect of the Site, Services and Content.
The Site may contain links to other websites maintained by independent third parties over which Mendability has no control. Any such links are provided solely as a convenience for users of the Site and do not constitute an endorsement by Mendability of the content of such third party sites. Mendability makes no representations and disclaims all responsibility for such privacy practices, contents or accuracy of content on any such third party websites. Your use of such links is solely at your own risk. Links to this website may also be provided from other sites either known or unknown to Mendability and access to any other website linked to or from the Site is at your own risk. The Internet is not a secure medium and is subject to possible interception, loss, corruption, or alteration of communication for which Mendability assumes no liability.
Mendability specifically disclaims any liability to any users in jurisdictions in which the uses of services such as those offered by Mendability are illegal. Mendability is not liable for any consequences resulting from the use of the Site, Services or Content by users in jurisdictions where such use is illegal.
You agree to defend, indemnify, and hold Mendability, its officers, directors, employees, agents, licensors, and suppliers, harmless from and against any claims, actions or demands, liabilities and settlements including without limitation, reasonable legal and accounting fees, resulting from, or alleged to result from, your violation of these Terms and Conditions of Use.
Mendability will not be liable for any delay or failure to perform to the extent due to causes beyond its reasonable control.
You cannot transfer your rights or commitments arising from this Agreement to anyone. Mendability retains the right to transfer its rights or obligations arising from this Agreement to others without your consent.
You cannot transfer your account to anyone without Mendability’s consent.
You agree that sending an email to the email address associated with your Site account and Account Data will constitute effective notice. If you need to contact Mendability you can do so through the Site, and an email sent to the Mendability email address displayed on the Site will constitute effective notice. Notice will be effective once the email is sent, unless the party sending the email becomes aware that it was not deliverable.
ANY CLAIM, DISPUTE, OR CONTROVERSY (WHETHER IN CONTRACT, TORT, OR OTHERWISE, WHETHER PREEXISTING, PRESENT OR FUTURE, AND INCLUDING STATUTORY, COMMON LAW, INTENTIONAL TORT AND EQUITABLE CLAIMS CAPABLE IN LAW OF BEING SUBMITTED TO BINDING ARBITRATION) AGAINST MENDABILITY, its agents, employees, officers, directors, successors, assigns or affiliates (collectively for purposes of this paragraph, “Mendability“) arising from or relating to these Terms and Conditions of Use, their interpretation, or the breach, termination or validity thereof, the relationships between the parties, whether pre-existing, present or future, (including, to the full extent permitted by applicable law, relationships with third parties who are not signatories to these Terms and Conditions of Use), Mendability’s advertising, or any related purchase SHALL BE RESOLVED EXCLUSIVELY AND FINALLY according to the Utah Uniform Arbitration Act 78B-11. The place of arbitration shall be American Fork, Utah, USA. The language of the arbitration shall be English. The arbitration will be limited solely to the dispute or controversy between the user and Mendability. Any award of the arbitrator(s) shall be final and binding on each of the parties, and may be entered as a judgment in any court of competent jurisdiction.
This Agreement shall be deemed to have been made and performed exclusively in Utah and shall be governed by and interpreted in accordance with the laws of the State of Utah and the federal laws of the United States of America applicable therein without regard to conflict of laws principles. Subject to the Arbitration provision above, you agree to submit to the exclusive jurisdiction of the Courts of the State of Utah, and hereby waive the application of any conflict of laws or rules that would result in a different forum, including physical location, residence or domicile.
Mendability’s failure to insist upon or enforce strict performance of any provision of this Agreement will not be construed as a waiver of any provision or right.
The individual clauses of this Agreement are valid independent of each other and, should any part of this Agreement be declared invalid or unenforceable by a court of competent jurisdiction, this will not affect the validity of any remaining portion and such remaining portion shall remain in full force and effect as if the invalid portion of this Agreement had been eliminated.
This Agreement was written in English and, in any legal dispute, this English version will be legally binding.
ALL RIGHTS NOT EXPRESSLY GRANTED HEREIN ARE RESERVED.
I CERTIFY THAT I AM NOT A MINOR AND THAT I AM ABLE TO ENTER INTO THIS AGREEMENT; AND
I ACKNOWLEDGE HAVING READ THE TERMS AND CONDITIONS OF USE AND HAVING PRINTED A COPY OF THE TERMS AND CONDITIONS OF USE; AND
I ACKNOWLEDGE AND UNDERSTAND THAT THE SITE DOES NOT PROVIDE MEDICAL ADVICE AND THAT THE INFORMATION ON THE SITE IS NOT INTENDED TO REPLACE MEDICAL ADVICE FROM A HEALTH PROFESSIONAL; AND
I ACKNOWLEDGE THAT I AM NOT AT RISK FOR SUICIDE NOR INTEND TO USE MENDABILITY TO WORK WITH ANYONE IN MY CARE WHO IS AT RISK FOR SUICIDE; AND
I UNDERSTAND THAT IN ORDER TO USE THE SITE, I MUST ACCEPT AND ABIDE BY THESE TERMS AND CONDITIONS OF USE. OTHERWISE I WILL NOT ACCESS OR USE THE SITE, SERVICES OR CONTENT.
AS A REQUIREMENT FOR JOINT COMMISSION CERTIFICATION AND FOR YOUR HEALTH AND SAFETY AND THE HEALTH AND SAFETY OF THOSE WITHIN YOUR CARE, WE ARE REQUIRED TO HELP YOU IDENTIFY SPECIFIC CHARACTERISTICS AND ENVIRONMENTAL FEATURES THAT MAY INCREASE OR DECREASE THE RISK OF SUICIDE AND TO PROVIDE YOU WITH SUICIDE PREVENTION INFORMATION.
BY USING MENDABILITY SERVICES OR THIS SITE YOU AGREE THAT YOU HAVE READ AND UNDERSTOOD THE CONTENTS OF THIS DOCUMENT AND CERTIFY THAT YOU AGREE TO SEEK PROFESSIONAL HELP IF YOU OR ANYONE WITHIN YOUR CARE SHOWS OR DEVELOPS SIGNS OF SUICIDE RISK. YOU FURTHER CERTIFY THAT NEITHER YOU NOR ANY PERSON WITHIN YOUR CARE ON MENDABILITY IS AT RISK FOR SUICIDE.
If after you have read the document you feel unqualified to assess the suicide risk of the individual, you must seek professional help in determining the suicide risk prior to proceeding any further with any interactions on Mendability.
Suicide Emergency / Professional Help
24/7 lifeline: 1-800-273-8255 (TALK)
Main Source: http://www.mentalhealth.va.gov/docs/Suicide_Risk_Assessment_Guide.doc
This introduction provides general information regarding the nature and prevalence of suicidal behaviors and factors associated with increased risk for suicide and suicide attempts.
Suicidal thoughts and behaviors (including suicide attempts and death by suicide) are commonly found at increased rates among individuals with psychiatric disorders, especially major depressive disorder, bipolar disorders, schizophrenia, PTSD, anxiety, chemical dependency, and personality disorders (e.g., antisocial and borderline). A history of a suicide attempt is the strongest predictor of future suicide attempts, as well as death by suicide. Intentional self-harm (i.e., intentional self-injury without the expressed intent to die) is also associated with long-term risk for repeated attempts as well as death by suicide.
Psychiatric co-morbidity (greater than one psychiatric disorder present at the same time) increases risk for suicide, especially when substance abuse or depressive symptoms coexist with another psychiatric disorder or condition.
A number of psychosocial factors are also associated with risk for suicide and suicide attempts. These include recent life events such as losses (esp. employment, careers, finances, housing, marital relationships, physical health, and a sense of a future), and chronic or long-term problems such as relationship difficulties, unemployment, and problems with the legal authorities (legal charges). Psychological states of acute or extreme distress (especially humiliation, despair, guilt and shame) are often present in association with suicidal ideation, planning and attempts. While not uniformly predictive of suicidal ideation and behavior, they are warning signs of psychological vulnerability and indicate a need for mental health evaluation to minimize immediate discomfort and to evaluate suicide risk.
Certain physical disorders are associated with an increased risk for suicide including diseases of the central nervous system (epilepsy, tumors, Huntington’s Chorea, Alzheimer’s Disease, Multiple Sclerosis, spinal cord injuries, and traumatic brain injury), cancers (esp. head and neck), autoimmune diseases, renal disease, and HIV/AIDS. Chronic pain syndromes can contribute substantially to increased suicide risk in affected individuals.
Patients with traumatic brain injuries may be at increased risk for suicide. In comparison to the general population TBI survivors are at increased risk for suicide ideation (Simpson and Tate, 2002), suicide attempts (Silver et al. 2001) and suicide completions (Teasdale and Engberg, 2001). TBI-related sequelae can be enduring and may include motor disturbances, sensory deficits, and psychiatric symptoms (such as depression, anxiety, psychosis, and personality changes) as well as cognitive dysfunction. These cognitive impairments include impaired attention, concentration, processing speed, memory, language and communication, problem solving, concept formation, judgment, and initiation. Another important TBI sequelae that contributes to suicidal risk is the frequent increase in impulsivity. These impairments may lead to a life-long increased suicide risk which requires constant attention.
Although relatively rare, suicidal thoughts and behaviors are not uncommonly reported in the general population. A recent national survey (Kessler, et al., 1999) found that 13.5 % of Americans report a history of suicide ideation at some point over the lifetime, 3.9% report having made a suicide plan, and 4.6% report having attempted suicide. Among attempters, about 50% report having made a “serious” attempt. The percentages are higher for high school students asked about suicidal ideation and behavior over the preceding year: 16% report having seriously considered attempting suicide, 13% report having made a suicide plan, and 8.4% report having made an attempt during the prior 12 months (CDC, YRBS 2005). These numbers are even higher when a psychiatric disorder is present.
Often there is a transition that takes place along the continuum from ideation to plan to attempts. 34 % of individuals who think about suicide report transitioning from seriously thinking about suicide to making a plan, and 72% of planners move from a plan to an attempt. Among those who make attempts, 60% of planned attempts occur within the first year of ideation onset and 90% of unplanned attempts (which probably represent impulsive self-injurious behaviors) occur within this time period (Kessler, et al., 1999). These findings illustrate the importance of eliciting and exploring suicidal ideation and give credence to its role in initiating and fueling the suicidal process.
What are warning signs and why are they important?
There are a number of known suicide risk factors. Nevertheless, these risk factors are not necessarily closely related in time to the onset of suicidal behaviors – nor does any risk factor alone increase or decrease risk. Population-based research suggests that the risk for suicide increases with an increase in the number of risk factors present, such that when more risk factors are present at any one time the more likely that they indicate an increased risk for suicidal behaviors at that time.
A recent review of the world’s literature has identified a number of warning signs that empirically have been shown to be temporally related to the acute onset of suicidal behaviors (e.g., within hours to a few days). These signs should warn you of ACUTE risk for the expression of suicidal behaviors, especially in those individuals with other risk factors (Rudd, et al., 2006). Three of these warning signs carry the highest likelihood of short-term onset of suicidal behaviors and require immediate attention, evaluation, referral, or consideration of hospitalization.
The remaining list of warning signs should alert you that a mental health evaluation needs to be conducted in the VERY near future and that precautions need to be put into place IMMEDIATELY to ensure the safety, stability and security of the individual.
Other behaviors that may be associated with increased short-term risk for suicide are when the patient makes arrangements to divest responsibility for dependent others (children, pets, elders), or making other preparations such as updating wills, making financial arrangements for paying bills, saying goodbye to loved ones, etc.
Risk and protective factors:
Factors that may increase risk or factors that may decrease risk are those that have been found to be statistically related to the presence or absence of suicidal behaviors. They do not necessarily impart a causal relationship. Rather they serve as guidelines for you to weigh the relative risk of an individual engaging in suicidal behaviors within the context of the current clinical presentation and psychosocial setting. Individuals differ in the degree to which risk and protective factors affect their propensity for engaging in suicidal behaviors. Within an individual, the contribution of each risk and protective factor to their suicidality will vary over the course of their lives.
No one risk factor, or set of risk factors, necessarily conveys increased suicidal risk. Nor does one protective factor, or set of protective factors, insure protection against engagement in suicidal behaviors. Furthermore, because of their different statistical correlations with suicidal behaviors, these factors are not equal and one cannot “balance” one set of factors against another in order to derive a sum total score of relative suicidal risk. Some risk factors are immutable (e.g., age, gender, race/ethnicity), while others are more situation-specific (e.g., loss of housing, exacerbation of pain in a chronic condition, and onset or exacerbation of psychiatric symptoms).
Ideally, with the elucidation and knowledge of an individual’s risk and protective factors as a backdrop, you will inquire about the individual’s reasons for living and reasons for dying to better evaluate current risk for suicide.
Factors that may increase a person’s risk for suicide include:
Factors that may decrease the risk for suicide are also called protective factors. These include:
Asking questions about suicidal ideation, intent, plan, and attempts is not easy. Sometimes the individual will provide the opening to ask about suicide, but usually the topic does not readily flow from the presenting complaint and gathering of history related to the present illness. This can be particularly true in medical as opposed to behavioral health type settings. Nevertheless it is important to ask a screening set of questions whenever the clinical situation or presentation warrants it. The key is to set the stage for the questions and to signal to the individual that they are naturally part of the overall assessment of the current problem. A great deal depends upon your familiarity with the key screening questions and the ease and comfortableness he/she has with the topic and the asking of the questions. Introductory statements that lead into the questions pave the way to ensuring an informative and smooth dialogue and reassure the individual that you are prepared for and interested in the answers.
I appreciate how difficult this problem must be for you at this time. Some people with similar problems/symptoms have expressed that they have thought about ending their life. I wonder if you have had similar thoughts?
Are you feeling hopeless about the present or future?
If yes ask…..
Have you had thoughts about taking your life?
If yes ask….
When did you have these thoughts and do you have a plan to take your life?
Have you ever had a suicide attempt?
It is worth keeping in mind that suicidality can be understood as an attempt by the individual to solve a problem, one that they find overwhelming. It can be much easier for you to be nonjudgmental when s/he keeps this perspective in mind. You can work with Professionals in this area that can help find solutions to these problems.
Why is it important to ask about a history of attempts?
Most people who attempt suicide do not attempt again. However, about 16% repeat within one year and 21% repeat within 1-4 years. (Owens et al., 2002: Beautrais, 2003). The majority of repeat attempters will use more lethal means on subsequent attempts – increasing the likelihood of increased morbidity or mortality. Approximately 2% of attempters die by suicide within 1 year of their attempt. The history of a prior suicide attempt is the best known predictor for future suicidal behaviors, including death by suicide. Approximately 8-10% of attempters will eventually die by suicide.
Why is it important to ask about feeling hopeless?
Hopelessness – about the present and the future – has been found to be a very strong predictor of suicidal ideation and self-destructive behaviors. Associated with hopelessness are feelings of helplessness, worthlessness, and despair. Although often found in depressed patients, these affective states can be present in many disorders – both psychiatric and physical. If present it is important to explore these feelings with the individual to better assess for the development or expression of suicidal behaviors.
Why is it important to ask about ideation?
In most cases, suicidal ideation is believed to precede the onset of suicidal planning and action. Suicidal ideation can be associated with a desire or wish to die (intent) and a reason or rationale for wanting to die (motivation). Hence, it is essential to explore the presence or absence of ideation – currently, in the recent past, and concurrent with any change in physical health or other major psychosocial life stress.
Many individuals will initially deny the presence of suicidal ideation for a variety of reasons including: 1. the stigma that is associated with acknowledging symptoms of a mental disorder; 2. fear of being ridiculed, maligned and/or being judged negatively by yourself; 3. loss of autonomy and control over the situation; and 4. fear that you might overreact and hospitalize the individual involuntarily.
Even if denied, certain observable cues (affective and behavioral) should prompt you to remain alert to the possible presence of suicidal ideation. Some signs and symptoms include: profound social withdrawal, irrational thinking, paranoia, global insomnia, depressed affect, agitation, anxiety, irritability, despair, shame, humiliation, disgrace, anger and rage. You may find an apparent disparity between the current observable condition (what is seen and felt by the individual) and a denial of suicidal thinking on the part of the individual. This will be a good indicator of the need still to seek professional advice regarding the situation.
Asking about suicidal ideation and intent does not increase the likelihood of someone thinking about suicide for the first time or engaging in such behaviors. In fact, most patients report a sense of relief and support when a caring, concerned caregiver non-judgmentally expresses interest in exploring and understanding the individual’s current psychological pain and distress that leads them to consider suicide or other self-injurious behaviors.
All suicidal ideations and suicidal threats need to be taken seriously.
Why is it important to ask about timing of ideation and presence of a plan?
Although a minority of individuals are chronically suicidal, most people become suicidal in response to negative life events or psychosocial stressors that overwhelm their capacity to cope and maintain control, especially in the presence of a psychiatric disorder. Hence it is important to understand what elicits suicidal thoughts and the context of these thoughts. Knowing how much time has been spent thinking about suicide alerts you to its role and influence in the daily life of the individual. Knowing what makes things better and what makes things worse regarding the onset, intensity, duration and frequency of suicidal thoughts and feelings assists the Professional in developing a treatment plan. Also knowing what situations in the future might engender the return of suicidal thoughts helps you and the Professional, along with the individual to agree upon a safety plan and techniques to avoid or manage such situations.
The presence of a suicide plan set out by the Professional indicates that the individual has some intent to die and has begun preparing to die. It is important to know the possibilities and potential for implementation of the plan, the likelihood of being rescued if the plan is undertaken, and the relative lethality of the plan.
Although some research suggests a relationship between the degree of suicidal intent and the lethality of the means, you should not dismiss the presence of suicidal planning even if the method chosen does not appear to be necessarily lethal (Brown, et al., 2004). It is also important to know whether the individual has begun to enact the plan, by engaging in such behaviors as rehearsals, hoarding of medications, gaining access to firearms or other lethal means, writing a suicide note, etc.
What is a crisis?
A crisis is when the individual’s usual and customary coping skills are no longer adequate to address a perceived stressful situation. Often such situations are novel and unexpected. A crisis occurs when unusual stress, brought on by unexpected and disruptive events, render an individual physically and emotionally disabled – because their usual coping mechanisms and past behavioral repertoire prove ineffective. A crisis overrides an individual’s normal psychological and biological coping mechanisms – moving the individual towards maladaptive behaviors. A crisis limits one’s ability to utilize more cognitively sophisticated problem-solving skills and conflict resolution skills. Crises are, by definition, time-limited. However, every crisis is a high risk situation.
Crisis intervention and management:
In a crisis, seek Professional help immediately and if necessary call 911 or the Suicide Prevention Lifeline number 1-800-273-8255. The goals of crisis intervention are to lessen the intensity, duration, and presence of a crisis that is perceived as overwhelming and that can lead to self-injurious behaviors. This is accomplished along with the Professional by shifting the focus from an emergency that is life-threatening to a plan of action that is understandable and perceived as doable. The goal is to protect the individual from self-harm. In the process, it is critical for the Professional with your help to identify and discuss the underlying disorder, dysfunction, and/or event that precipitated the crisis. Involving family, partners, friends, and social support networks may be advised by the Professional.
The objectives of the Professional are to assist the individual in regaining mastery, control, and predictability. This is accomplished by reinforcing healthy coping skills and substituting more effective skills and responses for less effective skills and dysfunctional responses. The goal of crisis management is to re-establish equilibrium and restore the individual to a state of feeling in control in a safe, secure, and stable environment. Under certain circumstances this might require hospitalization. Professionals are especially equipped and trained to manage the crisis and make the call. Do not attempt to manage the crisis on your own.
The techniques the professional may employ or offer include removing or securing any lethal methods of self-harm, decreasing isolation, decreasing anxiety and agitation, and engaging the individual in a safety plan (crisis management or contingency planning). It also involves a simple set of reminders for the individual to utilize the crisis safety plan and skills agreed upon by you, the professional, and the individual.
Referrals for mental health assessment and follow-up:
Any reference to suicidal ideation, intent, or plans mandates a mental health assessment. If the individual is deemed by a professional not to be at immediate risk for engaging in self-destructive behaviors, then the Professional needs to collaboratively develop a follow-up and follow-through plan of action. This activity best involves the individual along with significant others such as family members, friends, spouse, partner, close friends, etc.).
Here are some ways to be helpful to someone who is threatening suicide or engaging in suicidal behaviors:
Individuals contemplating suicide often don’t believe that they can be helped, so you may have to be active and persistent in helping them to get the help they need. And, after helping an individual during a mental health crisis, be aware of how you may have been affected emotionally and seek the necessary support for yourself.
There are many myths about suicide and suicidal behavior that have been passed down through the generations that some people still believe today and may have actually been taught. Examples of these myths are:
American Association of Suicidology: http://www.suicidology.org
American Foundation of Suicide Prevention: http://www.afsp.org
Suicide Prevention Action Network (SPAN): http://www.spanusa.org
Suicide Prevention Resource Center: http://www.sprc.org
US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA): http://www.samhsa.gov
American Psychiatric Association. (2004). Practice Guidelines for the Assessment and Treatment of Patients with Suicidal Behaviors. In: Practice Guidelines for the Treatment of Psychiatric Disorders Compendium, 2nd edition. pp. 835-1027. VA: Arlington.
Beautrais, A.L. (2003). Subsequent mortality in medically serious suicide attempts: A 5 year follow-up. Australian and New Zealand Journal of Psychiatry; 37: 595-599.
Brown, G.K., Henriques, G.R., Sosdjan, D., & Beck, A.T. (2004). Suicide intent and accurate expectations of lethality: Predictors of medical lethality of suicide attempts. Journal of Consulting and Clinical Psychology; 72, 1170-1174.
CDC. Youth Risk Behavior Survey, (2005). Morbidity and Mortality Weekly, Surveillance Summaries, Volume 55, No. SS-5 (June 6, 2006), 1-108.
Kessler, R.C., Borges, B., & Walters, E.E. (1999). Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Archives of General Psychiatry; 56, 617-626.
Owens, D., Horrocks, J., & House, A. (2002). Fatal and non-fatal repetition of self-harm. Systematic review. British Journal of Psychiatry; 181, 193-199.
Rudd M.D., Berman, A.L., Joiner, T.E., Nock, M.K., Silverman, M.M., Mandrusiak, M., Van Orden, K., & Witte, T. (2006) Warning signs for suicide: Theory, research and clinical applications. Suicide and Life Threatening Behavior; 36, 255-62.
Silver, J.M., Kramer, R., Greenwald, S., Weissman, M. (2001). The association between head injuries and psychiatric disorders: findings from the New Haven NIMH Epidemiological Catchment Area Study. Brain Injury, 15, 11, 935-945.
Simpson, G. & Tate, R. (2002). Suicidality after traumatic brain injury: demographic, injury and clinical correlates. Psychological Medicine, 32, 687-697.
Teasdale, T.W. & Engberg, A.W. (2001). Suicide after traumatic brain injury: A population study. The Journal of Neurology, Neurosurgery, and Psychiatry, 71 (4), 436-440.
Berman, A.L., Jobes, D.A. & Silverman, M.M. (2006) Adolescent Suicide: Assessment and Intervention. NY: Guilford Publications.
Brown, G., Ten Have, T., Henriques, G., Xie, S., Hollander, J. & Beck, A. (2005). Cognitive Therapy for the Prevention of Suicide Attempts, A Randomized Controlled Trial. JAMA, 294(5). 563-570.
Institute of Medicine. (2002) Reducing Suicide: A National Imperative. Washington DC; The National Academies Press.
Jacobs, D.G. (Ed.) (1999). The Harvard Medical School Guide to Suicide Assessment and Intervention. San Francisco, CA: Jossey-Bass.
Jacobs, D. & Brewer, M (2004). American Psychiatric Association practice guidelines provides recommendations for assessing and treating patient with suicidal behaviors. Psychiatric Annals, 34 (5), 373-380.
Jobes, David A., (2006) Managing Suicidal Risk: A Collaborative Approach. New York, NY: The Guilford Press.
Joiner, T. (2005). Why People Die By Suicide. Cambridge, MA: Harvard University Press.
Maris, R. W., Berman, A.L., & Silverman, M.M. (2000) Comprehensive Textbook
of Suicidology. New York, NY: The Guilford Press.
Rudd, M.D. (2006) The Assessment and Management of Suicidality. Sarasota, FL: Professional Resource Press.
Shea, S. (2002). The Practical Art of Suicide Assessment: A Guide for Mental Health Professional and Substance Abuse Counselors. Hoboken, NJ: John Wiley & Sons.
Shea, S. (2004) The Delicate Art of Eliciting Suicidal Ideation. Psychiatric Annals, 34 (5), 374-400.
Shneidman, E.S. (2004). Autopsy of a Suicidal Mind. London, Oxford University Press.
Shneidman, E.S. (1996). The Suicidal Mind. London, Oxford University Press.
Simon, R.I. (2004). Assessing and Managing Suicide Risk: Guidelines for Clinically Based Risk Management. Washington DC: American Psychiatric Publishing, Inc.
Simon, R. & Hales, R. (2006). Textbook of Suicide Assessment and Management. Arlington, VA: American Psychiatric Publishing, Inc.
Neither I nor any person within my care on Mendability is at risk for suicide
THIS SENSORY ENRICHMENT THERAPY MODALITY AGREEMENT (“Agreement“) is entered into effective as of the date of digital signature of acceptance by Therapist (“Effective Date“), by and between Mendability LLC., a Utah Limited Liability Corporation, located at 12 W 100 N, Ste 201E, American Fork UT, 84003 (“Company” or “Mendability“) and the undersigned (“Therapist”). The Company and Therapist may collectively be referred to hereafter as the “Parties” or each, individually, as a “Party“.
WHEREAS, Company has made a substantial investment with respect to research and development of proprietary protocols, methods, processes and modalities for treatment of individuals with disorders related to ASD and other neurological disorders and conditions, which treatment protocols are identified with more specificity below and include, among others, the Sensory Enrichment Therapy that is proprietary to the Company and which is used by speech-language clinicians and physical and occupational therapists pursuant to the terms of licenses granted by Company (“Therapy Modality“);
WHEREAS, Company has maintained certain information and materials related to the Therapy Modality in confidence and has taken reasonable measures to protect such confidential information as trade secrets;
WHEREAS, Company has agreed to provide Therapist with instruction, education, teaching and training in connection with the Workshops (defined below) and other proprietary programs (collectively, “Training“) during which Company will disclose to Therapist the Therapy Modality and other valuable confidential information, trade secrets and intellectual property;
WHEREAS, Company has agreed to grant to Therapist, during the term of this Agreement, a nonexclusive, non-transferrable, revocable, limited license to use Company’s confidential information and other proprietary intellectual property, including without limitation patents, trademarks, service marks, copyrights and trade secrets, subject to the terms and conditions of this Agreement;
WHEREAS, in return for such disclosure and license grant by Company, Therapist has agreed to abide by the terms and conditions of this Agreement, which among other things permits Therapist to use Company’s confidential information and intellectual property only during the term of this Agreement and only as expressly permitted herein, and Therapist expressly acknowledges and agrees that using any modified form of the Therapy Modality is expressly prohibited because doing so may cause harm to patients and may tarnish or dilute Company’s goodwill and reputation;
WHEREAS, Therapist has also agreed that following the termination of this Agreement, Therapist may not use or disclose any of Company’s confidential information or intellectual property for any purpose, which restrictions survive and continue in full force and effect indefinitely following termination of this Agreement;
NOW, THEREFORE, in consideration of the covenants contained herein, and for other good and valuable consideration, the sufficiency of which is hereby acknowledged, the Parties agree as follows:
As soon as Therapist has attended the Workshop as required under Section 3(a)(i), has passed the Therapy Modality certification exam described in Section 3(a)(ii) and has paid all applicable fees set forth in Section 3(a)(iii), the Company shall provide a written certificate acknowledging that Therapist has been certified by Company to provide the Therapy Modality under a Temporary Provisional Certification (the “Temporary Certification“), which will allow Therapist to use the License, so long as such Temporary Provisional Certification has not lapsed or this Agreement has not been otherwise terminated.
Once Therapist has evidenced possession of an active Temporary Provisional Certification and has passed the practicum requirements, Company shall provide a written certificate acknowledging that Therapist has been certified by Company to provide the Therapy Modality with title of “Sensory Enrichment Therapy Practitioner” (the “Certification“) The Certification will allow Therapist to continue use of the License until this Agreement is terminated.
IN WITNESS WHEREOF, The Parties hereto have executed this Agreement as of the date of acceptance by Therapist.
I have read, understood and I agree to the above
I have read and agree to the website terms and conditions *
Keep me up to date on course updates and exclusive offers.
© Mendability 2011-2023 / All Rights Reserved