Suicide Assessment Outline

Front 1

1. Assessing Suicidal Ideation

Back 1

a. Ask directly if they have thoughts of suicide (asking will not “plant an idea”)
b. Are the thoughts pervasive or intermittent with a definite relationship to a given situation
c. Suicidal ideation: new or old idea?
d. Do they have a plan; if so, how extensive is their plan (how and when?)
e. Lethality of the means/method defined.
f. Is there access to the identified means?
g. Testing: Beck Depression Scale/Beck’s Hopelessness Scale or Suicide Assessment Checklist.
h. Presence or absence of support network.

Front 2

2. Suicide Attempt

Back 2

a. Immediate referral for a medical evaluation for medical stability if method of attempt warrants it
i. Means, location, collaborator, rescuer, number of attempts
ii. Thoroughness of plan and its implementation
iii. Note signs of impairment and physical harm
iv. Level of treatment required

* Intention, plan method, means, lethality, and prior attempts

Front 3

3. Risk Factors
a. Intention and History

Back 3

i. Recent/prior attempts or gestures
ii. Direct or indirect communication of intent
iii. Extensiveness of plan
iv. Lethality of means
v. Access to means
vi. Family history of suicidal behaviors

Front 4

3. Risk Factors
b. Demographics

Back 4

i. Age (Teens, middle age, and elderly are at higher risk)
ii. Gender (Males more often succeed at suicide attempts because of lethality of means, but females make more attempts)
iii. Homosexuals (Additional stressors/lack of social supports)
iv. Race (White)
v. Marital Status (Separated, widowed, divorced)
vi. Social support (Lack of support system, living alone)
vii. Employment Status (unemployed, unstable job performance, change in status or performance)

Front 5

3. Risk Factors
c. Emotional Functioning

Back 5

i. Diagnosis (Major depression, recovery from recent depression, schizophrenia, alcoholism, bipolar disorder, borderline personality disorder)
ii. Auditory Hallucination Commanding Death (Bizarre methods may also indicate psychosis)
iii. Recent loss or anniversary of a loss
iv. Fantasy to reunite with a dead loved one
v. Stresses (Chronic or associated with recent changes)
vi. Poor coping ability
vii. Degree of hopelessness or despair

Front 6

3. Risk Factors
d. Behavioral Patterns

Back 6

i. Isolation
ii. Impulsivity
iii. Rigid

Front 7

3. Risk Factors
e. Physical Condition

Back 7

i. Chronic Insomnia
ii. Chronic Pain
iii. Progressive Illness
iv. Recent Childbirth

Front 8

3. Risk Factors

Back 8

While many of these factors appear to be of a general nature it is the clustering of these factors which contribute to the persons mood, belief system, and coping ability that may lead to the risk of suicide.

Front 9

ADOLESCENT SUICIDE
Behavioral and Social Clues
1-10

Back 9

1. Heavy drug use
2. Change in academic performance
3. Recent loss of a love object, or impending loss
4. Pregnancy
5. Homosexuality (additional stressors/lack of social support)
6. Running Away
7. Prior suicide attempts or family history of suicide
8. Intense anger
9. Preoccupation with the violent death of another person
10. Impulsivity learning disability

Front 10

ADOLESCENT SUICIDE
Behavioral and Social Clues
11-20

Back 10

11. Ineffective coping
12. Ineffective coping
13. Lack of resources and feelings of alienation
14. Hopelessness, depression
15. Risk-taking behaviors (playing in traffic, intentional reckless driving, etc.)
16. Loss of support system
17. Recent move, change in school
18. Loss of family status (family member leaves or is removed from the home, change in economic level of family)
19. Feeling anonymous and unimportant
20. Peer group activity associated with issues of death

Front 11

In assessing adolescents, the symptoms of depression may not be indicated as directly as when assessing an adult. This is referred to as masked depression. Masked depression can be described in two ways:

Back 11

1. Classic: Somatic complaints take the place of the general criteria of depression. There are chronic complaints of headaches, backaches, and stomachache.
2. Behavioral: Evidenced by acting out behaviors such as substance abuse, promiscuity, and shoplifting. These are all representations of ways of converting affective state interpreted as boredom into something exciting. Young people are sometimes ineffective in expression depression. Therefore, they translate it into something else and project it outward, finding boredom in school, peers, and family. The use of substances may be an attempt to cope with emotional distress, lack of identity, or boredom. They may see the world as boring and unfulfilling. Males tend to act out more aggressively in their environments.

Front 12

MANAGEMENT/TREATMENT OF SUICIDAL BEHAVIOR
Document:

Back 12

1. Statements about suicidal thoughts, plans, and intent.
2. Past suicide attempts.
3. Degree of hopelessness.
4. Acute risk factors (family history of suicide, alcohol or substance use, precipitating stressors, support system).
5. Your judgment about lethality.
6. Action taken, including consultation with experienced professional.
7. Results of actions
8. Periodical inquiry about suicidal thoughts.
9. Reasons to discontinue suicide checks.

Front 13

TREATMENT FOCUS AND OBJECTIVES
1.

Back 13

1. Outpatient Therapy and Management: Utilized when the risk of suicide is low, the precipitating crisis is no longer present, there is an adequate support system, and the person contracts that they will contact the therapist if they are unable to cope. Least restrictive and appropriate means of intervention are always utilized.

Front 14

TREATMENT FOCUS AND OBJECTIVES
2

Back 14

2. Hospitalization: Utilized if the person is at high risk for suicide, lacks adequate social supports, lacks adequate impulse control, is intoxicated or psychotic. For the benefit of the person, initially pursue the least restrictive course of a voluntary admission is warranted which will necessitate an evaluation by the appropriately designated persons/facility in your area.

Front 15

TREATMENT FOCUS AND OBJECTIVES
3

Back 15

3. Techniques

a. Activate clients support system (consider 24 hour watch) - Alleviate the person’s isolation by recommending that they stay with family or friends
b. Try to eliminate means - Facilitate the removal of weapons or other means of a suicide attempt from their environment. Deal with issues of substances (abuse) if necessary
c. Increase frequency of therapeutic office visits.
d. Have the client check in by telephone periodically between sessions.
e. Obtain releases to talk to others.
f. Contract with client not to commit suicide.
g. Give client local emergency number/suicide hotline number.
h. Support the development and utilization of a support system, or the re-establishment of their support system
i. Facilitate the appropriate expression of anger or other feelings which are contributing to self-destructive impulses
j. Validate the person’s experience of the crisis, but also identify their ambivalence and the fact that suicide is a permanent solution to a temporary problem
k. Refer for medication evaluation making sure that the physician is aware of the person’s suicidal ideation/impulses (make sure to obtain a release).
l. Educate the person regarding the impact that a lack of sleep has on effectively coping, and reassure them that the depression can be managed or eliminated
m. Identify irrational, negative beliefs. Help the person recognize that the associated negative self-talk contributes to keeping them in a state of hopelessness. Facilitate the identification of alternatives to the difficulties that they are currently experiencing
n. Remain calm, matter-of-fact, non-judgmental
o. Do not emphasize how much they have upset other people
p. Do not offer psychological or moral edicts of suicide
q. Explore with person what they hoped to accomplish by suicide
r. Identify life issues which have contributed to person’s emotional state
s. Discuss the fact that suicide is a permanent solution
t. Review resources and relationships (family, friends, family physician, clergy, employer, police, emergency response team, therapist, community support groups, 12-step groups, emergency room, psychiatric hospital)
u. Be reassuring and supportive
v. Facilitate improved problem solving and coping
w. Facilitate development of a self-care program
i. Daily structure
ii. Inclusion of pleasurable activities
iii. Resources/support system (including therapy and medication compliance)
iv. Identify crisis/potential crisis situations and plausible choice for coping
v. Identify warning signs (self-monitoring) that indicate that the person is not utilizing their self-care plan, medication difficulties, etc.
vi. Regular aerobic exercise and good nutrition