Information for assessing suicide risk
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.
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.
Prescribed medication (consider side effects and compliance), alcohol, recreational drugs.
Domestic situation, financial situation.
For example bereavement, job loss, relationship problems, accommodation problems.
Anything making it less likely that the patient will commit suicide - e.g. children, religious beliefs.
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?
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?
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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Copyright Dave Curtis 2011. You can distribute this material freely provided my copyright remains acknowledged.