Introduction to Risk Assessment & Suicide Flashcards
What are some of the meanings that emerge within services surrounding risk?
Retrieve
How might different identity characteristics moderate risk?
Rather than saying “no risk” how should we refer to risk?
Self-generate
1) Define what is meant by “Risk” in mental health services and what factors are
considered within this.
3) What are some of the different sources of risk?
1) Concerns the occurrence of a “negative event” and its:
▪ Nature (type of event)
▪ Likelihood
▪ Proximity
▪ Severity
▪ Moderators
3) The source of risk is multi-faceted:
▪ Self (suicide, self-harm, neglect)
▪ Others (violence, abuse, neglect)
▪ Environment (context)
Risk is dynamic, not static…
1) How is self-harm defined according to Nice, 2022?
2) What did the ONS say was the main reason men are more likely to end their life?
3)In 2021 how many people died by suicide?
1) “Intentional self-poisoning or injury irrespective of the apparent purpose of the act?
2) Men had the will/means to use lethal force against themselves - expand?
3) In 2021, 5,583 died by suicide in England and Wales (¾
were male) → highest rates between 45–49 (ONS, 2021)
1) What are the different potential risks from others possible?
2) What did the RCPsych, 2021 say about risk of harm from other?
1) Domestic, Physical, Sexual, Financial, organisational, emotional, modern slavery, omission.
2) “Patients are more a risk to themselves or from others,
than posing risks to others”
What are the relevant features of the NICE (2022) risk policy for Mental health clinicians?
- Non-mental health, emergency department
and social-care professionals should review
self-harm and signpost accordingly - Do not delay a psychosocial assessment of
suicide / self-harm - Support and information may need to be adapted for subject to discrimination
(neuro-divergence, race & ethnicity LGBT+) - Risk assessment tools should NOT be used to
predict future suicide or self-harm! - Low / medium / high categories should NOT
determine who should be offered treatment - Family members and carers can be involved
in risk assessment and management, if consent is given - Mental health professionals should undertake
a risk formulation as part of every assessment
Why should a risk assessment tool not be used to predict future suicide or self-harm?
2) What quantitative questionnaires can we use to triangulate our assessment?
Tools were poor at predicting suicide rates within a low risk group.
2) PHQ-9
1) What should be included in a risk assessment?
2) What should be included in a risk assessment where suicidal ideation is present?
3) What prompt questions can be asked to help risk assess around suicidal ideation?
1)
-Explanation of risk and consequences of the conversation.
-Where the risk is coming from.
2)
(A) Suicidal ideation:
▪ Ideation (content, frequency)
▪ Triggers (current and future)
▪ Plans (method, means, access)
▪ Actions
▪ Intent
▪ Prevention
3) Prompt questions:
“Do you have thoughts of ending your own life?”
“Do you ever think life isn’t worth living?”
“Do you have thoughts of being better off dead?”
“Do you ever feel better off not here?”
Follow-up questions:
“Can you tell me more about that?”
“What thoughts / images go through your mind”?
“What do you think in that moment?”
Frequency / Duration:
“How often do you think this?”
“How long do they [thoughts] last?
Triggers:
“When do you have these thoughts?”
“What makes them more / less intense?”
Plans:
“Do you know how you would end your life?” (method)
“Have you made plans to act on this?” (planning)
“Do you have access to ___?” (access)
Actions:
“Have you made any preparations / taken steps towards this?”
Intent:
“On a scale of 0-10 how likely is it that you will act on these thoughts (or plan)?”
Prevention and Protective Factors:
“What’s stops you from acting on your thoughts (plans)?”
“What makes you more likely to act on your thoughts (plans?)”
“What helps to keep yourself safe?”
“What makes you feel unsafe?”
“What support do you need to stay safe?” Check whether the
protective factors
are in place!
“Have you made an attempt to end your life in the past?”
1) What should be included in a risk assessment where self-harm is present?
2) What are some prompt questions that will help gather information about each of these things?
1)
(B) Self-harm:
▪ Ideation vs action
▪ Triggers (current and future)
▪ Method and Frequency
▪ Severity
▪ Function
▪ Prevention
2) Ideation:
“Do you think about harming yourself?”
“Do you intend to act on this?” / “have you?”
…“How often?”
Method:
“How do you harm yourself?”
“Where do you harm yourself?”
Triggers: “where?” / “when?”
Severity:
“Did you require medical attention?”
Function:“why do you harm yourself?”
“Do you see the self-harm as a problem?”
“How do you feel afterwards?”
1) (C) Self-neglect:
▪ Lifestyle
▪ Impact of MH
1) Between what percentage of people visited the GP prior to attempts on their life?
2) Which group have highest suicide rates?
3) What percentage of people that commit suicide have major affective disorder?
4) What is major affective disorder?
5) Those with bipolar disorder are the highest-risk group from suicide but often combined with what?
1) 32-69% visited the GP the week prior to an attempt on their life? But didn’t
2) Highest in elderly males? and 3rd leading cause of death in prison and the military.
3) 60 -70% have major affective disorder.
4) Major affective disorders are divided into bipolar disorders, in which the prevailing pathological mood state may be manic, depressed, or mixed, and major depression, in which mood is primarily dysphoric. From: EEG and Evoked Potentials in Psychiatry and Behavioral Neurology, 1983.
5) Comorbid alcohol or substance abuse?
1) What are two of the main factors given via the interpersonal theory of suicide?
1) Perceptions of being a burden to others
2) Social alienation
Joiner TE. Why people die by suicide. Cambridge, MA: Harvard University Press; 2005.
Joiner Jr, T. E., Van Orden, K. A., Witte, T. K., Selby, E. A., Ribeiro, J. D., Lewis, R., & Rudd, M. D. (2009).
Main predictions of the interpersonal–psychological theory of suicidal behavior:
Empirical tests in two samples of young adults. Journal of abnormal psychology, 118(3), 634.
1) What are some of the main predictors of suicide?
Perceived difficulties with problem solving (Linehan)
Hopelessness and Helplessness (Beck)
Social comparison (O’Connor)
What are some of the risk factors behind suicide?
SELF-HARM
social isolation
substance misuse
hopelessness
impulsiveness
suicidal ideation
low self-esteem
poor coping skills
poor sense of control over events
unemployment
severe psychiatric illness
Why are people more likely to commit suicide on their way out of therapy?
The ending of the therapeutic relationship can be triggering and the end to the primary source of current coping in their life.
