Information for assessing suicide risk

Introduction

These notes provide a checklist for some of the information which needs to be considered when making a judgement about a patient's risk of committing suicide.

Suicide, attempted suicide and deliberate self-harm

When thinking about suicide risk, it can be helpful to use objective language when describing what has happened. If you say that a patient "tried to kill themself" or "attempted suicide" then you are implying that you know that this was the patient's real intent. It may be better to avoid such language and instead to say what the patient actually did rather than presume to know what they were trying to achieve.

Mental health problems

Be aware of the patient's actual psychiatric diagnosis (or diagnoses). You cannot manage a patient effectively without thinking about their diagnosis.

Physical health problems

Be aware of physical illnesses, especially if chronic, painful, deteriorating, terminal.

Demographics

Age, gender, marital status, occupation, etc. There are some epidemiological associations with suicide risk but usually factors specific to the individual will be more relevant.

Substances

Prescribed medication (consider side effects and compliance), alcohol, recreational drugs.

Social situation

Domestic situation, financial situation.

Stressors

For example bereavement, job loss, relationship problems, accommodation problems.

Protective factors

Anything making it less likely that the patient will commit suicide - e.g. children, religious beliefs.

Previous attempts

Obtain the following information about recent and past episodes of deliberate self-harm and suicide attempts.

Events leading up to attempt

Time course of deterioration, precipitants, planned, impulsive? Intoxicated?

Subjective risk as judged by patient

Did the patient really believe that their actions would lead to death?

Objective risk

How dangerous in fact were the patient's actions?

Details of actions taken

What did the patient actually do?

Actions taken to make the attempt more or less likely to be successful

Extent of planning. Steps taken to avoid discovery. How did the patient end up in contact with services? Did they phone anybody? Or were they discovered accidentally?

Consequences of attempt

Did they require medical treatment? Admission to hospital?

Current intent

What is the patient's current expressed attitude towards killing themselves? If they have a method in mind, what is the subjective and objective risk? Is their intent conditional on other factors such as whether they are admitted, whether they are rehoused, etc.? What is the extent of their hopelessness? Do they have psychotic symptoms which affect their risk of suicide?

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Dave Curtis (http://www.davecurtis.net/dcurtis.html)

Copyright Dave Curtis 2011. You can distribute this material freely provided my copyright remains acknowledged.