Suicide Risk Assessment

R45.8

DESCRIPTION

Suicide is the act of deliberately killing oneself. Self-harm refers to intentionally self-inflicting injury or poisoning, which may or may not have a fatal intent or outcome. Suicide risk assessment is a process of estimating probability for a person to commit suicide.

There are 5 important components when assessing suicide: ideation (thoughts), intent, plan, access to lethal means, and history of past suicide attempts.

Key risk factors for suicide include previous suicide attempt, current suicidal plan or ideation, and history of mental illness (most commonly major depressive disorder and substance abuse), access to lethal means, history of childhood sexual/physical abuse, family history of suicide and suicidality in males, adolescents, elderly patients and lesbian, gay, bisexual, and transgender (LGBT) patients (See: Special considerations: Sexual health and sexuality).

WARNING
Suicide risk assessment tools and guidelines do not replace clinical judgment.

GENERAL MEASURES

Screen for self-harm/suicide risk if any of the following present:

  • Extreme hopelessness and despair.
  • Current thoughts/plan/act of self-harm/suicide.
  • History of self-harm/suicide.
  • Mental health condition: depression, mood disorder, substance use disorders, psychoses, dementia.
  • Chronic condition: chronic pain, disability.
  • Extreme emotional distress.
  • Key population groups (LGBT) and adolescents.
  1. Reduce immediate risk
  • Manage the patient who has attempted a medically serious act of self-harm: see: Trauma and injuries.
  • If medically stable, assess for imminent risk of self-harm/suicide: imminent risk of suicide is likely in a patient who is extremely agitated, violent, distressed or lacks communication with any the following:
    • Current thoughts or plan of self-harm/suicide or
    • History of thoughts or plan of self-harm in the past month or
    • Act of self-harm.

2. Manage underlying factors:

  • Ensure optimal treatment and support of other conditions like chronic pain and mental health conditions (depression, mood disorders, substance use disorders, psychosis, dementia)
  • Identify psychosocial stressors like bereavement, intimate partner violence, bereavement, financial or relationship problems, bullying, divorce, separation.

3. Monitoring and follow-up:

  • For all cases of medically serious acts of self-harm/suicide or where there is an imminent risk of self-harm/suicide:
    • Do not leave person alone. Place in a secure, supportive environment in health facility while awaiting referral.
    • Remove access to means of self-harm/suicide (bleach, pesticides, firearms, medications) known to be toxic in overdose including paracetamol, amitriptyline, theophylline).
  • Maintain regular contact if possible - suggested weekly contact for the first 2 months. Follow-up for as long as the risk of self-harm/suicide persists. At every contact, re-assess for suicidal thoughts and plans.
  • Educate patient/carer:
    • If one has thoughts of self-harm/suicide, seek help from a trusted family member, friend or health worker.
    • Talking about suicide does not trigger the act of suicide, and may lower the risk of following through on suicidal plans.
  • Refer to mental health services, if available or community resources like religious centres, crisis centres or support groups.
  • Try to locate family/friends to care for and support patient during this phase. Encourage carers to find support for themselves as well.

REFERRAL

  • All patients who have attempted a medically serious act of self-harm/suicide.
  • All patients where there is an imminent risk of self-harm/suicide.
  • All patients with a high index of suspicion.