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Suicide Risk Assessment

We've presented information about a continuum of care for suicide. Here we'll focus on risk assessment. 
A continuum of care includes:

 

Information About Risk Assessment

When a patient has a positive screen for increased risk for suicide, the next step is to conduct a comprehensive risk assessment.

This may be conducted by the person who does the screening, or by a different healthcare professional.

  • SAFE-T provides a framework for this type of assessment. 
    Learn More >>
  • There is a very clear clinician rating form that includes the SAFE-T combined with the Columbia Suicide Severity Rating Scale. Visit the link below and click on “SAFE-T with C-SSRS Lifetime and Recent” to download. This form walks the clinician through all parts of a risk assessment.
    Learn More >>

Risk Assessment  Should Include:

  • Suicide inquiry - This includes specific questions about the patient’s thoughts about suicide, plans for making an attempt, access to lethal means (such as firearms or pills), past
    attempts and preparatory behaviors, and intent to act on these thoughts or plans.
  • Risk factors - A patient’s stated lack of intent is insufficient to fully evaluate suicide risk. A person may deny intent but still be judged at high risk based on having thoughts about suicide, a recent history of attempts, or other risk factors. The clinician should ask about current psychiatric disorders; key symptoms such as insomnia, hopelessness, and command hallucinations; family history; interpersonal stressors including loss or humiliation; substance use; and recent changes in treatment.
  • Protective factors - Protective factors are important to understand but may not counteract significant risk. Common protective factors include the responsibility to children, grandchildren, or pets; other social supports; good relationships with healthcare providers; and religious beliefs.

Based on these three areas of inquiry, the clinician then makes an assessment of the level of risk and a disposition plan based on that level of risk. The clinician then documents their assessment and determination of risk level. They may also include treatment options they considered and chose not to recommend, along with a rationale for why they made the choices they did.

 

 

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Goals of Risk Assessment

  • As the clinician, you know that you have done the best you can do for your patient. You cannot predict who will make a suicide attempt. You can do your best to estimate their risk.
  • Your patient may feel relief at having an opportunity to speak frankly about their thoughts and feelings. As a clinician, when you meet the patient with support and concern and acknowledge their ongoing thoughts and feelings, you may paradoxically help to reduce the intensity of these thoughts and feelings. In addition, exploration of protective factors gives the patient a chance to focus on important reasons for living.
  • From a medico-legal perspective, a thorough risk assessment is considered a best practice. For more information on risk management considerations click here to learn more >>
  • For a slide set on Legal and Liability Issues in Suicide Care, please click here to learn more >>

 

Training for Healthcare Professionals

There are online trainings for healthcare professionals who want to learn more about conducting suicide risk assessments.

 

If you are a clinician or community member who needs help to decide what to do about a person who may be at risk for suicide (i.e., a risk assessment for a patient), please call The Providence Center 24-hour Behavioral Health Emergency Line:(401)-274-7111.

Let's Talk: Suicide Prevention For All

Being able to talk about suicide in a straightforward, confident way communicates to our patients and loved ones that it is okay to talk about suicide. We have gathered helpful resources that can help facilitate these conversations. 

Learn More
This information was developed by the Care New England Suicide Prevention Workgroup, which includes membership across Care New England operating units.