350 THE SEVERE AND PERSI STENT MENTAL ILLNESS PROGRESS NOTES PLAN NER D. The client was directed to contact the clinician or a 24-hour, professionally staffed crisis hotline if his/her suicidal ideation increases. E. The client declined to sign the suicide prevention contract and was told that arrangements would be made for commitment to a psychiatric facility or other supervised setting. F. The client was directed to go to an emergency room, local police unit, or other appropriate place should his/her suicidal ideation persist or increase. 12. Reinforce Positive Focus (1 2) A. The client was reinforced for his/her more positive focus and hopeful statements. B. As the client has been reinforced for his/her more positive focus and hopeful statements, he/she has been increasing such statements. C. It was noted that the client's suicidal ideation has decreased as he/she has continued to develop a more positive focus. D. The client did not display a very positive focus regarding his/her future and was provided with additional encouragement in this area. 13. Develop Structure (1 3) A. The client was directed to develop structure to his/her time, scheduling his/her acti vities for the next several hours or days. B. The client's specific plan for the next several hours or days was reviewed. C. The client has not developed structure to his/her time by the use of scheduling the next several hours or days and was redirected to do so. 14. Nurture Life-Affirming Part of Self (1 4) A. The client was reminded to focus on the portion of himself/herself that wants to go on living. B. The client's interaction with the clinician was noted as evidence that a part of him/her wants t o go on living. C. The client was supported as he/she focused on the part of himself/herself that wants to go on living. 15. Verbalize Context of Suicidal Ideation ( 15) A. The client's thoughts about suicide were identified as a common reaction to his/h er current problem areas. B. Emphasis was placed on the connection between the client's suicidal thoughts and emotional pain. C. The client acknowledged that his/her suicidal thoughts and comments are related to his/her emotional pain and began to proces s his/her emotional pain. D. The client was taught the importance of distinguishing between his/her thoughts of suicide and acting on those thoughts. 16. Talk Openly about Suicide Concerns ( 16) A. Concerns about the client's suicidal ideation were broug ht up in an open and honest manner. B. Emphasis was placed on the permanent nature of using suicide as a solution for a temporary problem or emotional state. C. The client was reinforced for his/her decreased focus on suicide as a solution for his/her temporary problems or emotional concerns. 