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

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