Suicide/Self Harm Risk Assessment

Intro

• Wash hands; Introduce self; Check patient name and DOB/CHI; Explain and gain consent

The Event (PC/HPC)

• Before
  • Events leading up to attempt e.g. triggering life events, chronic depression
  • Planning
    • How long have you felt like this?
    • Did you think about how, where, when?
    • Did you tell anybody? Leave a note?
    • Precautions e.g. where were they (and would they be found)?; Were other aspects of life accounted for e.g. childcare, job, money etc?
• During
  • How?
    • e.g. how many tablets, what tablets, where were they got,
    • What did they expect?
    • When/where?
    • How they came to be in hospital?  Were they discovered or brought themselves?
    • Associated alcohol/drug use?
• After
  • Feelings now
    • Angry (either that they attempted or they attempted and failed)
    • Regretful
  • Feelings of the future
    • If you went home now, what would you do?
    • If changed mind, why? what changed?
    • It can be useful to be blunt- would you try this again? / Have you made any plans if the attempt failed (positive or negative)?

Assessing risk

• Depression screen
• Past medical history including full psychiatric history and past suicide attempts/self harm
• Social History
  • Drug/Alcohol
  • Employment
  • Family/Household/Relationships
  • Social factors e.g. money, housing etc
• Family history (included in full psych history)
• Ask about willingness to seek help

Finish

• Thank patient, wash hands
• Record summary in notes and note any suggestions or take for further action as appropriate
  • (the majority will be ok to go home with follow-up in the community)

Risk factors

• Male; old or young
• Unemployed, depressed, lack of or breakdown of social support (including relationships)
• Chronic illness, previous attempts; alcohol/drug abuse