Suicide risk assessment

Question 1

Step 1: Obtain details of the suicide attempt

Answer 1

• what happened?
• where was it?
• was it planned?
• how did they come to hospital?
• how was it discovered?
• why did they do it?
• what sort of things have been worrying them?

Question 2

Step 2: Assess the degree of suicidal intent and seriousness of the intent

Answer 2

Remember 4 Ps:
P – Planning/impulsivity
P – Performance in isolation or in front of others
P – Preparations made prior to the act
P – Precautions to avoid discovery of others

Question 3

Step 3: Explore depressive symptoms and psychotic symptoms

Answer 3

• symptom duration

- impact on functioning

Question 4

Step 4: Assess current mental state

Answer 4

• How do you feel in yourself?
• How do you see the future?
• Do you still feel that life is not worth living?
Suicidal thoughts and plans
• Do you still have thoughts of harming yourself in any way?
• What do you think you might do?
• Have you made any plans?
• When are you intending to do it?
• What prevents you from doing it?

Question 5

Step 5: Past history and background information

Answer 5

• Does she have a past history of suicidal behaviour?
• Does she suffer from a mental illness, for example depression, psychosis, anxiety disorder,
borderline personality disorder?
• Is there a history of non-compliance with treatment?
• Does she abuse alcohol or drugs?
• Is there a family history of mental illness, alcohol or substance abuse, violence or suicidal
behaviour?

Question 6

Step 6: coping methods and ability to seek help

Answer 6

• What were her reactions to previous stresses, failures and losses?
• What does she usually do when there is a problem?
• How does she usually cope?
• With whom does she share her worries?
• How supportive are family and friends?
• Does she get any help?
• In the past, did anyone offer her any help? How did she find it?

Question 7

Decision making and developing a management plan

Answer 7

a. Is there evidence of mental illness?
b. Is there ongoing suicidal intent?
c. Are there non-mental health issues, which can be addressed?
d. Ascertain the level of social support available

Question 8

Risk factors for completed suicide

Answer 8

 Male sex
 Elderly
 Single, divorced or widowed
 Living alone with poor social support
 Previous Para suicide or DSH
 Presence of mental illness/ recent history of inpatient psychiatric treatment
 Concurrent physical illness
 Social/life events- Recent bereavement, unemployment
 History of Alcohol and or drug dependence
 Serious attempt
 Violent method chosen
 Evidence of careful planning
 Active psychological symptoms
 Active suicidal ideation, communication and intent
 Feelings of guilt, hopelessness, worthlessness and depressive features