Jonah is a contract counselor who provides in-home counseling services to lower-income individuals. He is rarely in the office and often uses his cell phone as his primary point of contact with his clients. Titus, a 20-year-old African American male, is Jonah’s in-home counseling client. Titus has been diagnosed with bipolar disorder and has a history of suicide attempts, self-mutilation, and psychiatric hospitalization. Titus’s home life and natural support system is very unstable and his mother, with whom he lives, is verbally abusive. Due to the instability of Titus’s home life and Jonah’s inability to be reached at the office, he has given Titus his cell phone number to verify appointment times and meeting locations. Also, because of Titus’s tendency for suicidal ideation and self-harm, Jonah encouraged Titus to make phone contact (both during and outside of office hours) whenever he felt overwhelmed and had a desire to hurt himself. This was Jonah’s way to conduct a risk assessment outside of their meetings.
Over the course of time, Titus had a tendency to text Jonah instead of calling. Jonah typically called Titus, instead of texting back, when the client texted, but Titus stated to Jonah he was more comfortable with texting. Therefore, Jonah decided it was in the best interest of the client to communicate through Titus’s preferred means of communication, especially given Jonah’s unique situation of not being available at his office phone during business hours. As an in-home counselor, Jonah knew if he asked his clients to contact him via his office, it would not result in him being able to respond to crisis situations in a timely manner.
One day, Titus contacted Jonah via text to tell him he would not be available for their meeting the next day because he had been kicked out of his house. He stated he wanted to jump off a bridge and was currently on his way to do so. Jonah called Titus and tried to assess the situation over the phone and find out Titus’s location (in case he needed to contact authorities), but Titus became overwhelmed and hung up the phone stating, “I just want to end it all. I can’t handle any of this anymore.”
Jonah attempted to make contact again, but Titus would not answer the phone. When he texted him, Titus did respond but Jonah felt very uncomfortable making an assessment via text and left several voicemails for Titus, explaining why he needed to talk with him over the phone. Titus still refused to answer the phone. Jonah contacted Titus’s mother to notify her of the situation, and she hung up on him stating she did not care. Jonah contacted his supervisor, also an in-home counselor, and left a message. Feeling frustrated and desperate, Jonah waited for his supervisor to call him back.
