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.

Evaluating Lethality of a Suicide Plan

• 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.

Importance of Access to Means

• 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.

Columbia Suicide Severity Rating Scale

• 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.

Intervention and Nursing Care

• 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.

No-Suicide Contracts

• 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

• 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.

Intervention Strategies

• 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.

Suicide Crisis Hotline

• 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.

Importance of Asking About Suicide

• 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.