Suicide Risk Assessments
When suicide risk is suspected it is important for the caring professional to inquire if the person is feeling suicidal. Suicide risk is not increased by a professional asking about the possibility of suicide risk.
If the person is intoxicated then please keep the person safe until they have sobered up and then commence the suicide risk assessment.
When a person in contact with your service has been detected to be at risk of suicide, a preliminary assessment is to be conducted by the appropriate caring professional prior to referral to specialised mental health services or other professionals (for example, general practitioner), where appropriate. The purpose of this assessment is to determine:
- the severity and nature of the individual’s problems
- the risk of danger to self or others
- whether a more detailed risk assessment is indicated.
There are a number of factors that need to be considered prior to the suicide risk assessment:
- What are the details of the presentation or referral or the circumstance (for example, an incident) that has brought the issue of suicide risk to the attention of staff?
- A brief chronological account of the presenting problem (why the person has come to the service) should be elicited.
- Is the person medically well enough to participate in the interview? Do they require medical assessment?
- Access any collateral information available, for example, medical records, nursing reports, family, other health providers.
- Given individual circumstances and if appropriate, it is highly desirable to contact a family member or carer of the person and involve them in the assessment.
- If the person is under 16 years, the carer must be actively involved in the management plan whenever possible and should be contacted prior to discharge from a service. If no carer is available, a suitable advocate for the young person should be contacted.
- Discuss with family and friends whether the person’s behaviour is out of character, how long it has been evident, how they deal with the crisis.
- Is the person known to a mental health service?
Essential aspects for preliminary screening of suicidal risk include:
- current predicament, stressors, social situation
- current thoughts of suicide
- previous suicide attempts or threats
- drug or alcohol use
- impulsiveness A hierarchy of screening questions that gently leads to asking about suicidal ideas is a generally accepted procedure for all caring professionals.
- Is the person experiencing any current psychiatric symptoms (presence of depressed mood and symptoms of depression such as reduced energy, concentration, weight loss, loss of interest, or psychosis, especially command hallucinations)?
- Is there a past history of psychiatric problems? (A history of a mental illness should raise the professional’s concern that the current presentation may be a recurrence or relapse.)
- Mental state assessment (GFCMA: Got Four Clients Monday Afternoon: – General appearance (agitation, distress, psychomotor retardation) – Form of thought (is the person’s speech logical and making sense?) – Content of thought (hopelessness, despair, anger, shame or guilt) – Mood and affect (depressed, low, flat or inappropriate) – Attitude (insight, cooperation).
- Have things been so bad lately that you have thought you would rather not be here?
- Have you had any thoughts of harming yourself? * Are you thinking of suicide?
- Have you ever tried to harm yourself?
- Have you made any current plans?
- Do you have access to a lethal means?
The safety of both the person being assessed and the clinician is the primary concern at all times throughout the assessment process.
The level of observation/supervision needs to be considered during the time that the person is waiting to be assessed and after the assessment while consultation or referral arrangements are being made. The level of observation required by a person will depend on the risk and the physical environment. Wherever possible, a person at risk of suicide should never be left alone. If possible, provide a calming support person to stay with the person at risk.
All items that could be used for self-harm (including belts, ties, shoelaces, dangerous objects) should be removed from the person and their immediate environment.
If at any stage of contact a staff member is made aware that the person is in possession of or can gain easy access to a firearm and there is concern about the person's mental state, the risk of suicide or threat to public safety, the police should be contacted to discuss the possibility of removing the firearm.
The use of the Mental Health Act 1990 (NSW) may be necessary in the following instances to enable the continued observation and safety of the person:
- if suicidal thoughts or verbal intentions are persistent and intense, or
- the self-harming is serious in nature, or
- there is evidence of a mental disorder or mental illness.
If the suicide risk is detected during a home visit and the person is willing, they may be escorted to the hospital emergency department for a comprehensive suicide risk assessment to be conducted. If possible, the person should be escorted by two staff members.
If a person who is considered to be at risk leaves the facility or other community setting, including the person's home, prior to management arrangements being finalised, every effort should be made to locate the person. If there is serious concern, the police should be immediately contacted and provided with a description of the person and the likely areas where they may be located. The mental health service should also be contacted if it is known that the person is a client of the mental health service.