Suicide Risk Assessment

Thoughts, myths, questions about suicide

1. Is suicide a form of manipulation?

2. Will asking about suicide lead to suicidality?

3. When a person talks about suicide are they “just” seeking attention?

Assessment of Suicide Risk

1. Client’s current state: IS PATH WARM

ideationsubstance abuse  purposelessnessanxietytrappedhopelessness  withdrawalangerrecklessnessmood changes

2. Mental disorders with very high rates of suicide

• 90% have a diagnosable mental disorder

• Eating disorders: 258/100,000

• Bipolar: as high as 20%

• Schizophrenia: 15%

• Antisocial personality: 5%; 46% attempt

• Borderline personality: 5-10%

• Major depression: 6%

3. Risk Continuum

• No indications

• Suicidal ideation

• Suicidal plan

• Access to plan

• History of attempt

Watch dvd for example

Role Play to Assess Risk

• In triads, rotate the three roles.• Counselor-

– What brings you in today?– Use observational skills and watch for risk factors– Ask questions intentionally

• Observer-– Observe the client for incongruities, nonverbals, etc.– Watch how client responds to questions asked.

• Client-– Use the scenario given

Problem Solving and Crisis Management

Respond according to risk level

• Low level of risk• Talk about it• Address particular triggers• Contract• Obtain support from friends/family• Identify and plan use of crisis services• Explore reasons for not killing self• Refer for psychiatric evaluation

Responses, cont.

• Higher level of risk• Schedule additional appointments• Eliminate potential methods, e.g. weapons, meds,

etc.• Develop a safety plan• Explore option of voluntary hospitalization• Contact CDMHPs for involuntary outpatient or

commitment evaluation-206-461-3222• 72 hours, 14 days, 90 days inpatient• 90 (adult) or 180 (youth) days of outpatient

Risk factors for suicidality-American Association of Suicidology

• Hopelessness• Rage, uncontrolled anger• Vengeful• Reckless, impulsive or risky bx.• Feeling trapped• Increased use of alcohol/drugs• Dramatic mood change• Anxiety or agitation• Sleep disturbance…too much or too little• No reason to live

Some stats-2005

• National rate=11/100,000• Washington rate=14.6/100,000• Varies by age:

– 75+=16.9/100,000– 5-14=.7/100,000

• Varies by ethnicity and gender– Highest: white male=19.7– Lowest: black females=1.8– The rate of suicide for black teen females has

increased in recent years. Recent study: 7% will attempt.