Suicide Risk Assessment Flashcards
What’s the acronym for the components of a SRA according to lecture notes?
Every day, people ideate death (and) consider planning.
Engagement Detection Preliminary SRA Immediate interventions Documentation throughout Confidentiality Professional consultation
What does engagement mean?
Engaging with individual, family and other immediate supports
Rapport building skills are essential
Professional, non-judgemental and non-threatening
Show genuine interest and concern; empathetic;
What does detection mean?
Always important to ask the question, whether or not it is raised by the client
Obviously enquiry is especially warranted if the client indicates signs of helplessness/hopelessness, or are in crisis.
No clinical evidence to suggest that asking the question will put the idea in their head.
IF the response is indefinite, or you get a ‘gut feeling’ that the client may not be 100% truthful, dig deeper.
What does a Preliminary SRA involve?
IN a defence context we use CPR++
Current plan/ideation Pain Resources \+ prior suicidal behaviour \+ mental health hx
If the person says they have had previous attempts, what might you say?
Explore the seriousness of the attempts (without asking that question directly). Questions may revolve around:
Number of previous attempts
How long ago they happened
Where the person was at the time
What their mood was like at the time
What methods were used
Whether theere was drug/alcohol influence
If they were diagnosed with a MH disorder at the time
What are the four criteria for assessing the seriousness of a suicide plan?
Method? (vague or specific?)
Availability?
Specificity?
Lethality?
What demographics are most at risk of suicide?
Males (women attempt more, but men succeed more - possibly lethality of method choice?)
Youths
Unemployment
Aboriginality and being a white american!
Living alone
Those with specific, recent stressors
What do we need to consider when managing immediate risk?
Safety of the client and yourself
Arrange a calming support person to remain with the person at risk
Remove all items that could be used for self harm
If the person is in possession of a firearm, you are to notify police
If risk is high-medium, you should refer to mental health service. The State mental health act should be used in this instance if necessary.
You might consider a ‘no self harm’ contract if there is a good therapeutic relationship - as a component of management. This serves mainly to strengthen the therapeutic alliance
What are the documentation considerations when dealing with SRA?
APS indicates we need to clearly document all psych casework - SRA is no exception, and should include:
Circumstances surrounding suicidal Crisis
Risk assessments undertaken, and outcome
Clinical decisions made
Steps taken to address safety
Other people consulted
Rational for intervention
Basis of any considered disclosure of information
Confidentiality can be broken when…
the person gives consent (preferably in writing)
when the psych considers that failure to disclose info could place individual at serious risk of harm/death
when there is a need to consult a supervisor or colleauge
What does ‘Professional Consultation’ mean WRT SRA?
The consultation with other professionals IOT:
- receive much needed professional support
- receive and provide feedback about standards of practice
What should be assessed in a good SRA?
DISCARDS PLAP Depression Isolation/Withdrawal Suicide Plan Coping Strategies Alcohol/drug use Resources Daily functioning Significant others Previous suicide attempts Lifestyle Anxiety Psychiatric help
What sort of things do you look for when assessing harm to others?
Demographics/personal history
- hx of violence
- making violent threats or have violent fantasies
- Hx of abuse
- lower socioeconomic status
- low intelligence
Clinical variables
- head injuries, organic brain conditions
- substance-related disorders
- personality disorders
- acute symptoms like delusions/hallucionations
- non-adherence to treatment
Situational variables
- proximity of person at risk
- availability of weapons
- reduced social support
Clinican variables
- knowledge of base rates
- poor therapeutic alliance
- unhelpful cognitive biases
RSVP is a good psychometric measure of violence - the irony! :P Also the SONAR
