11/13/24, 8\:13 PM Guide | Suicide risk assessment

Suicide risk assessment

Table of contents

Opening the consultation

Wash your hands and don PPE if appropriate.
It's important to try and establish rapport with the patient early in the consultation to allow you to perform an accurate
assessment of their mental health.
Introduce yourself and explain why you are reviewing the patient\:
“ D r Y f r o m A & E h a s a s k e d m e t o s e e y o u . M y n a m e i s D r
S m i t h a n d I' m a p s y c h i a t r i s t . I' m h e r e t o t a l k a b o u t t h e e v e n t s t h a t h a v e l e d y o u t o b e a d m i t t e d t o h o s p i t a l .
"
Explain that some of the questions you ask may be di
kept con
" A n y t h i n g t h a t’ s s a i d h e r e t o d a y w i l l b e c o n
t o s h a r e s o m e i n f o r m a t i o n . I a p p r e c i a t e t h a t s o m e q u e s t i o n s m a y b e d i
a n s w e r r i g h t n o w , w e c a n c o m e b a c k t o i t a n o t h e r t i m e . D o e s t h a t a l l s o u n d o k ?"
The purpose of a suicide risk assessment is to\:
Establish the patient's intent
Assess the seriousness and perceived seriousness of their attempt
Assess how they feel about the attempt at the time of assessment
Covering these points will allow you to make an adequate assessment of risk.
In order to try and establish intent, it can be useful to start o
timeline of what happened. It’s best to start with open questions, and then later use closed questions for clari
“ T e l l m e a b o u t w h a t h a p p e n e d”
“ W h a t h a p p e n e d n e x t ?”

Current episode of self-harm

Although the exact details of the method of self-harm can di
hanging), there are key questions and themes that need to be covered in all scenarios to assess suicide risk.
Key questions to ask about the current episode of self-harm
It’s best to think about this in terms of before, during, and after...
Before
Was there a precipitant?
Examples may include an argument with a spouse or a recent bereavement.
You may establish psychological, physical or social problems here, but you also need to screen for these later.
Was the self-harm planned, or impulsive?
Did the patient carry out any
Write a suicide note
Leaving a will
Terminating contracts (e.g. mobile phone, gas and electricity)
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Were any precautions taken against discovery?
Closing curtains
Locking doors
Waiting until they knew everyone would be out of the house and not be back for several hours
Going somewhere very remote
Was alcohol used?
Ask about the amount and type used
Ask about previous alcohol use
During
What method of self-harm was involved?
Was the patient alone?
Where were they when they self-harmed?
What was going through their mind at the time?
Did they think their self-harm would end their life?
What did they do straight after the self-harm?
After
Did the patient call anyone? How did they get to A&E? Who were they found by?
How did they feel when help arrived?
How does the patient feel about the attempt now? Do they regret it?
What is the patient's current mood?
Does the patient still feel suicidal?
If the patient were to go home today, what would they do? (make sure you cover the next few days)
If the patient were to feel like this again, what might they do di
What does the patient think might prevent them from doing this again in the future?
Does the patient feel there is anything to live for? (i.e. protective factors)
Will the patient accept treatment?
Speci
What medication or medications did the patient take?
Where did the patient get the medication from?
How much of the medication did the patient take?
What did the patient take the medication with?
What did the patient think that amount of medication would do?
What made the patient decide to take the medication/how long had they been thinking about taking an overdose for?
What did the patient do after taking the medication?
How did the patient get to the hospital?
Speci
Where are the cuts?
How many cuts are there?
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How deep are the cuts?
How did the patient feel whilst they were cutting?
How did the patient feel when they saw blood?
What was the patient hoping the cutting would do?
Screen for other mental health disorders which increase the risk of suicide
Depression
Anhedonia\: "Do you feel that you no longer enjoy activities that you previously used to?"
Low mood\: "How has your mood been recently?"
Fatigue\: "What have your energy levels been like recently?"
Psychosis
Thought insertion\: "Are the thoughts to harm ever not your own?"
Auditory hallucinations\: "Do you ever feel like there are voices that you can hear telling you to harm yourself, that no one else
can hear?" "How do you know these are other peoples voices and not your own worries in your head?"
Anorexia
"How would you describe your eating habits?"
"Do you feel you're eating enough at the moment?"
"What's your appetite like at the moment?"
"Have you lost weight recently?"
"Are you satis

Previous episodes of self-harm

Has the patient ever carried out self-harm in the past?
What methods of self-harm were involved?
Did they get any help from their support network or other agencies as a result of their self-harm?

Past psychiatric diagnoses

Does the patient have any psychiatric diagnoses?
Has the patient had any previous admissions to a psychiatric hospital?

Past medical history

It is important to ask about a patient's past medical history as this may be relevant to their current episode of self-harm (e.g.
bleeding disorder/liver dysfunction).
Chronic pain and chronic illness are also risk factors for suicide.

Drug history

It's important to take a thorough drug history as this may be relevant to the current episode of self-harm (e.g.
anticoagulants/overdose/interactions).

Family history

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Have any of the patient's family members ever attempted or completed suicide?
Are there any psychiatric conditions present in close family members?

Taking a thorough social history allows identi
Living situation
Who does the patient live with?
Where does the patient live?
Does the patient have a good support network?
Is the patient able to manage all their activities of daily living independently?
If the patient has children you also need to consider if the children are being neglected and if the patient has thoughts of
harm towards the children.
Note\: if you do elicit risks then it is important to do something about it (e.g. if there is a child safeguarding concern this needs to
be shared with a senior nurse or your consultant to allow the safeguarding concerns to be addressed).
Occupation
What job does the patient have?
If none, ask if coping
Does the patient have any debt?
Alcohol
Particularly important to ask about if used during the episode of self-harm.
Does the patient drink alcohol?
How much does the patient drink in an average week?
What is the pattern of drinking? (e.g. every day vs binge drinking)
Recreational drugs
Does the patient use recreational drugs?
What drugs does the patient use?
How often and how much of the drugs does the patient use?

Closing the consultation

Thank the patient for taking the time to speak with you.
Tell the patient how you see their di
In most cases, you will have a conversation to agree on a management plan. In some cases, however, this may not be
appropriate.
Dispose of PPE appropriately and wash your hands.
If the patient is not suicidal and you intend to send them home with no follow-up
If a patient is felt to be low risk, you may be discharging them home with no follow up with mental health services. In these
cases, it's essential to formulate a safety plan with the patient and also signpost to appropriate agencies.
Safety plan
Seek the support of their family and friends (clarify who they have already told ).
Recognise stressors and address them where possible.
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Avoid harmful alcohol use when stressed.
Ask the patient who they could tell if they felt like this again.
Suggest that if the patient feels like this again, they can seek help from a number of places including\:
Personal support network
GP
Local support line (e.g. Samaritans)
A&E
Local mental health services that see people who self-refer (provide them with the number)
Signpost the patient to appropriate agencies
Signpost the patient to agencies which may be able to address some of their sources of stress/risk factors\:
GP
Housing services
Citizen’s Advice Bureau
Alcohol and drugs services
Domestic violence services
Counselling services
If the patient requires support from a mental health team
Some patients may require support from the local mental health team. Have a discussion about whether the patient could
manage safely at home with the support of an intensive home treatment team or will accept voluntary admission to a
psychiatric hospital.
If the patient is unsafe to send home
For some patients, it may be clear that they are at high risk of completing suicide or further self-harm and lack insight. In
these cases, a Mental Health Act assessment will need to be carried out.

Factors that increase suicide risk

Demographics
Male
Older
Widowed/separated/single
Living alone/social isolation
Low income/unemployed
Certain occupation (e.g. doctor, farmer)
Family history of suicide
Diagnoses
A previous suicide attempt (risk x 40)
Severe depression (risk x 20)
Anorexia (risk x 25)
Haemodialysis (risk x 14)
Recreational opiate use/dependence (risk x 14)
Alcohol dependence (risk x 6)
The act itself
The patient carried out
The patient has researched methods and prepared for the act (e.g. stockpiling tablets)
The patient perceived the act to have a high lethality
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The patient took precautions against being found
The patient used a violent method of suicide (e.g.
The patient's attempt is discovered by chance
The patient resists/tries to evade medical intervention
The patient downplays the seriousness of the attempt
Source\: geekymedics.com
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