suicide risk Flashcards
Principles of suicide risk
assessment in an in-patient unit
■ Suicide risk assessment must be conducted
on admission.
■ Re-assessment of suicide risk is regularly
conducted throughout the admission.
■ Observation levels are re-assessed according
to current level of risk.
■ There is participation of the patient and,
where appropriate, involvement of family/partner
in the management plan
Other service providers involved with the patient are
communication
(eg general practitioner, community case manager)
are included in the development of the
management plan.
■ Good communication, both verbal and written,
is essential for consistent and coordinated care.
Consultant psychiatrist
Every patient admitted to a psychiatric in-patient
unit is under the care of a consultant psychiatrist.
The consultant psychiatrist must:
■ see and assess all patients as soon as practicable
following admission
■ document the assessment and their findings
as well as management recommendations
■ review face-to-face each patient under their care
at least weekly
■ be informed about and approve the patient’s
discharge.
Assessment
Patients admitted to acute psychiatric units require
comprehensive psychiatric and medical assessment on
admission. Suicide risk assessment is also performed
on admission. The patient’s mental state and suicide risk
status is re-assessed regularly throughout the admission.
Psychiatric assessment
The clinician needs to assess for depression,
schizophrenia, other psychotic illness, bi-polar
disorder, anxiety disorders, the patient’s personality
style, current and previous drug and alcohol use
and organic and physical conditions.
Assess whether the person has the capacity and
willingness to enter into a therapeutic alliance.
For example, a person who is distressed and deluded,
such as believing that they are responsible for the
AIDS epidemic, cannot give a meaningful reassurance
they have no intention of harming themselves.
Suicidal behaviours are frequently symptoms of
underlying mental health problems or disorders.
Therefore, a suicide risk assessment cannot be
undertaken in isolation from an overall mental
health assessment.
A complete psychiatric assessment requires
a medical assessment and physical examination
and may require investigations to detect or
rule out organic illnesses
Exploration of these areas will provide further
important information
on the changeability of risk status. For example, a person with a history of impulsivity under stress would be assessed as
having a high level of changeability. How plausible
is the denial of suicidal ideation in the context
of a patient’s recent psychotic experiences or
with the current severity of their depression?
