Current suicidal thoughts
- Are suicidal thoughts present?
- When did these thoughts begin?
- How persistent are they?
- Can they control them?
- What has stopped the person acting on their thoughts so far?
Sometimes a person will clearly articulate suicidal ideation, other times the cues will be more subtle – a person may describe feelings of hopelessness, depression, insomnia or express a desire for medication change. Health professionals must be alert for the cues, and be ready to ask the patient directly about suicide intent.
Risk factors for suicide
When a thorough risk assessment is undertaken in a systematic way it is more than a guess or intuition – it is a reasoned and structured clinical judgement.
Important Note: If a person has developed a potentially fatal or effective plan and has the means and knowledge to carry it out, the chances of dying from suicide are much higher.
Important note: A suicide plan or preparation for death, such as saying goodbyes and putting affairs in order, indicates serious suicidal intent.
Communicating with an emotionally distressed person can be difficult, but it is important to persist and gather the information required to estimate the risk, identify protective factors and determine the appropriate management.
A hierarchy of screening questions that gently leads to asking about suicidal intent is an accepted method of risk assessment. Ask specific questions about self-harm, suicidal thoughts, plans, attitudes towards suicide, history of suicidal behaviour, thoughts of death, and feelings of hopelessness.
In addition to an assessment of the risk, a comprehensive approach to management of suicide focuses on the identification and fostering of protective factors, which reduce the risk of suicide. Protective factors to consider when creating a management plan include:
In consultation with the client, decide the next steps to be taken to maintain safety. This could involve contacting the client’s supports, referral to an appropriate mental health service or developing a safety contract. For more information about support options for someone at risk, please refer to Assessing support for clients at risk.