Suicide Risk Assessment and Intervention

Suicide Warning Signs and Risk Factors

Withdrawal: Withdrawing from friends and family can be a warning sign.
Lack of Purpose: Talking about having no sense of purpose is a risk factor.
Feelings of Worthlessness: Making comments about being worthless indicates potential suicide risk.
Recognizing these factors is critical for intervention.

Initial Question: Always ask, "Are you having thoughts of harming yourself?"
If the answer is yes, proceed to evaluate the plan's lethality using three main elements:
- Element 1: Specific Plan with Details
  - If the person admits to suicidal thoughts, ask, "What are your plans?"
- Element 2: Lethality of the Proposed Method
  - Assess whether the method is of low or high lethality.
  - High-Risk Methods: These are methods that would cause instantaneous death.
- Element 3: Access to the Planned Method
  - Determine if the individual has access to the means they plan to use.
  - If a person has a definite plan and access, they are at a higher risk.

If a patient confirms access to their planned method, the situation is more serious.
Example: A student knowing the location of their father's gun indicates a heightened risk.
Seeking help, such as therapy and medication, can lead to significant improvement.

This is a scale used in psychiatry to assess suicide risk.
Statements indicating risk include:
- "I am such a burden."
- "My loved ones would be better off without me."
- "I need an escape from these negative thoughts."
- "There is no future I want to live in."
If such statements are made, directly ask about thoughts of self-harm.

Suicide intervention is the first priority of nursing care.
Assume an authoritative role to ensure the client's safety.
- This involves helping clients feel safe when they see few alternatives.
- Example: If a client wants to be alone, insist they stay in a common area with supervision.

These contracts involve asking the patient to promise not to harm themselves and to seek help if feeling suicidal.
Limitations: These contracts are not a guarantee of safety and have been criticized.
Do not assume a client is safe based solely on this promise.

Creating a safe environment is essential.
Antidepressants and Serotonin:
- Antidepressants raise serotonin levels, which is important.
- After a few weeks on SSRIs, energy may return, but suicidal thoughts may persist.
Most Dangerous Time: When severe depression begins to lift, clients may have the energy to act on their suicide plans.
Monitor clients closely when they become cheerful after being depressed.

One-to-One Supervision: The safest intervention is continuous one-to-one observation when a client expresses suicidal thoughts and has a plan.
Fifteen-Minute Checks: Regular checks are also important.
Close Observation: Closely observe clients for any signs of distress or planning.

988 is the suicide crisis hotline number.
There were plans to remove funding for the hotline by September 2025.
This hotline is crucial for teen suicide prevention, especially within the LGBTQ community.

It is crucial to ask patients about suicide as part of their mental status examination (MSE).
If they express suicidal thoughts, always ask about their specific plan.