- Does the client have suicidal thoughts?
- When did these begin?
- How persistent are they?
- Is the client able to control the thoughts?
- What is stopping the client from acting on the thoughts?
Sometimes a client may openly express suicidal ideation, but often the cues may be more subtle. They may speak about feeling hopeless, depressed, having trouble sleeping, or perhaps ask for a medication change. It is important that health professionals look out for risk factors or cues, and are ready to question the patient about suicidal intent.
Suicide risk factors:
Comprehensive, systematic risk assessment is a logical, structured clinical judgement.
Note: Plans or preparations for suicide (like putting affairs in order, saying goodbyes) indicate serious suicidal intent.
It can be challenging to communicate with a client who is in distress, but it is important to be persistent. Gathering the above information will allow you to estimate the risk of suicide and decide on a management plan.
One accepted method of risk assessment is to work through a hierarchy of screening questions that gently lead to directly asking about suicidal thoughts, feelings, plans or behaviour. These may include:
A comprehensive assessment and management plan for suicide risk should also consider the recognition and promotion of protective factors to reduce the client's risk of suicide. These may include:
The next step is to decide, in consultation with the client, on how to manage the risk of suicide and maintain safety. This may include referrals to other health professionals or services, contacting the client's family or support network, or the development of a safety contract. For more information about the support options for clients at risk of suicide, refer to Assessing support for clients at risk.