Suicide Risk Assessment Flashcards
Risk factors for suicide?
Male (3:1)
Divorced, widowed or single
History of self-harm
Psychiatric disorder - eating disorder, depression, dementia
Family history
Situation
- unemployment, psychosocial stress, loss event, occupation (doctors, farmers, dentists), social isolation, psychiatric admission and discharge, access to means
What are the symptoms of someone contemplating suicide?
Suicidal ideation, communication or intent Hopelessness Substance misuse - increases other risk factors Problem solving deficits Psychiatric disorder Physical illness - pain all the time, degenerative disorder
What are the protective factors in someone considering suicide?
Resilience Social support Views regarding previous attempts Concerns for family members Hope Fear of self-injury or pain Plans for the future Religious beliefs Treatment adherence and response to treatment
Definition of self-harm
An act of non-fatal self destructive behaviour that occurs when desperation outweighs their inherent self preservation instinct
Aetiology of self-harm patients.
1% die by suicide per year for five years after the event Female > Male Stress association - situation crisis - hopeless - frustrated - poor problem solving ability - meant to die
What do you consider when performing a suicide risk assessment?
Circumstances Preparation After the act Ongoing suicidal ideation PAST BEHAVIOUR
What is important about the circumstances of the suicide attempt when assessing further risk?
What had been happening
What did they take - how much
Was there anyone else around
Did they tell anyone else what they were going to do
Precautions against discovery - likelihood of someone coming in
Alcohol or drug involved?
What is important about the preparation of the suicide attempt when assessing further risk?
Was it planned? Was there a precipitating factor? Impulsive - alcohol or drug involvement (be aware of dutch courage) Suicide note Final acts - making a will or sorting out affairs
What is important about what happened after the suicide attempt, when assessing further risk?
Did they think what they did would kill them?
Do they still want to die
What did they do immediately after the attempt
- e.g. did they seek help
How do they feel about it now
- regret that it didn’t work
- regret that they attempted suicide
How to assess ongoing suicidal ideation after a suicide attempt when assessing further risk?
Do they still have thoughts of killing themselves
Do they feel safe to go home
Do they have a plan/new preparations
Any plans for the future
If you consider someone to still be at risk of attempting suicide, what is the management?
Acute situation - Refer to liaison psychiatrist Admit to a psychiatric hospital Use of the mental health act Long-term - discharge planning including arrangements to see GP, CPN and the crisis team
If you consider someone to be safe to go home after a suicide assessment, what is the management?
Admit for medical treatment is required
Discharge to GP
Refer to community mental health team
Crisis team referral
How can risk be reduced before an attempt has been made in those at risk?
Reducing available methods
Better employment opportunities
Depression management
Raising awareness of mental illness
What else would you ask the patient as part of a suicide risk assessment?
Full psychiatric history
- including previous self-harm
- past psychiatric history
- drug history
- etc.
Why are older people at higher risk of completed suicide (vs self harm)?
Hopeless and suicidal feelings are considered a normal part of ageing (not true) Feel they are a burden on society - economically - loss of productivity - burden on family or friends Social factors - loneliness and social isolation
