Suicide Screening and Risk Assessment

IDENTIFY RISK
Risk factors do not cause or predict a suicide, rather they are characteristics that make it
more likely that a person will consider, attempt, or die by suicide.
a. Demographic factors (gender and age)
b. Demographic factors (marital status)
c. Geographic location
d. Socioeconomic factors: education
e. Socioeconomic factors: employment
f. Psychosocial factors
i. Lack of social support & sense of isolation
ii. Cultural beliefs that favor suicide
iii. Recent job loss or financial difficulties
iv. Failure in exam
v. Failure to adjust to new environment
vi. Legal problems
vii. Humiliating/ alienating /discriminating events
viii. Stigma associated with asking others for help

g. Family and environment

h. Physical illness
i. Psychiatric factors
j. Psychological factors
i. Proneness to negative mood (sadness/anger/anxiety)
ii. Expressing hopelessness about the future (“It’s always going to be
like this”)
iii. Visualizes dying or life after death
iv. Experiencing severe & overwhelming emotional pain/
distress(anxiety, loneliness, isolation, shame, guilt, defeated,
burdensomeness, entrapment)
v. Decreased self-esteem, poor social skills, poor problem solving skills
vi. Perfectionism (especially in context of depression)

k. Behavioural factors
i. Impulsiveness
ii. Recent increased agitation/ irritability
iii. Anger/ hostility that is out of character/ context
iv. Increased substance use
v. Changes in sleep (increased/ decreased)
vi. Reduced self care (appetite, appearance)
vii. Withdrawal from/ change in social connections/ situations
viii. History of attempts (especially with no regrets)
ix. Self-harm (clarify function)

l. Cognitive Factors
i. Thought constriction/ tunnel-vision (“Ending it seems like the only
way to make the pain stop”)
ii. Polarized thinking (“If I don’t get an A in my exams, then I’m a
failure”)
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iii. Tendency to catastrophize (“If my spouse leaves, then they will get
custody of the kids, and I’ll lose connection with them, and then I’ll
completely fall apart and die alone.”)
iv. Attitude to pain
m. Direct and Indirect verbal statements
Direct (jokingly/ seriously):
i. “I wish I were dead”
ii. “I think I may kill myself” (KMS)
iii. “What do you suppose it is like to be dead?”
iv. Those who talk about suicide are not at risk of suicide(Myth)
v. Suicidal behaviour is motivated by attention seeking(Myth)
Indirect:
vi. “What’s the point of living?” or “My life has no purpose”
vii. “Soon you won’t have to worry about me”
viii. “Who cares if I am dead anyway?”
ix. “I hope I don’t wake up tomorrow”
x. “I want everything to stop”
xi. “I’ll show him who can leave”
xii. Suicide occurs without warning(Myth)

n. Plan
i. If-then plans
ii. Highly specific & feasible
iii. High lethality
iv. Rehearsals/ preparations
o. Access to means

Interviewing Skills
1. Behavioural Incidents- questions that ask for specific facts, behavioural details or
trains of thought.
2. Gentle Assumptions- assume a potentially embarrassing or incriminating
behavior is occurring and frame question accordingly.
3. Denial of the Specific- after client has denied a generic question, ask a series of
questions about specific aspects.
4. Symptom Amplification- when the client tries or is suspected of being about to
minimize the quantity.

COMPLETE SUICIDE INQUIRY

▪ Duration of suicidal ideation

▪ Reasons for suicidal intention

▪ Current plan- accessibility, lethality, preparation

▪ Details of Previous attempts

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▪ Past Coping patterns

(Use close ended questions while assessing intent, lethality, access and means)

▪ Sometimes, people in your situation (describe the situation) lose hope; I’m
wondering if you may have lost hope, too?

▪ With all of the pain you have been having, do you sometimes wish that you could just
close your eyes and not wake up?

▪ With this much stress (or hopelessness) in your life, have you thought of hurting
yourself?

▪ Have you ever thought things would be better if you were dead?

▪ Do you ever do things that might be sort of dangerous that might be an indirect way
of killing yourself like driving recklessly, not wearing your seatbelt, having risky sex or
drinking heavily or drinking while you are driving?

Screening Questions for Suicidal thoughts

Ask either Question:

- Have you thought about killing yourself?
- Have you thought about carrying out suicide?
Follow up Question
- Can you tell me more about the suicidal thoughts?
Can you tell me more about the suicidal thoughts?
(If the client requires more direction):

▪ When did you begin having suicidal thoughts?

▪ Did any event (stressor) precipitate the suicidal thoughts?

▪ How often do you have thoughts of suicide?

▪ What brings them on?

▪ How strong are they?

▪ How long do they last?

▪ What is the worst they have ever been? What do you do when you have suicidal
thoughts?
If you do not already know)

▪ Have you made a plan (if yes- how would you do it? Where would you do it?
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▪ Do you have the (drugs, rope) that you would use? Where is it right now?

▪ Do you intend to attempt suicide?

▪ Do you have a timeline in mind for ending your life? Is there something (an event)
that would trigger the plan?
Reflected Intent

▪ How bad would things have to get for you to take your own life?

▪ What do you find to be intolerable with your life at this time?

▪ You’ve told me that you don’t have any intention of hurting or killing yourself. At the
same time, you’ve told me you’re going through a very rough time and are becoming
more and more desperate. My concern is that, in a moment of desperation, you
might impulsively take pills (shoot yourself, crash your car, etc.) without much
thought about the consequences. What do you think?”

(If you do not already know) Intent

▪ What would it accomplish if you were to end your life?

▪ Do you feel as if you’re a burden to others?

▪ How confident are you this plan would actually end your life?

▪ What have you done to carry out the plan?

▪ Have you made other preparations?

▪ What makes you feel better/ worse?

▪ How likely do you think you are to carry out your plan?

▪ What stops you from killing yourself?

Screening Questions for Suicidal Attempts

Ask either Question:

- Have you ever tried to take your own life?
- Have you ever attempted suicide?
Follow up Question
- Please tell me about the attempt
(if the client requires more direction):
What brought it on? Where were you?
(if you do not already know):
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▪ What method did you use to try to kill yourself?

▪ Did you receive emergency medical treatment?

▪ Did you want to die? How much?

▪ Afterwards, were you relieved you survived or would you rather have died?
----

▪ Did you do anything else (last night) to try to kill yourself besides taking the pills?

▪ What other methods did you consider at the time?

▪ Why did you decide to use (name of the pill)?

▪ How many pills were left behind in the bottle?

▪ How did you feel when you woke up and found that you were still alive?

▪ Were you happy or relieved that you had survived your suicide attempt?

▪ What is it that is different in your life now from twelve hours ago when you
attempted suicide?

IDENTIFY PROTECTIVE FACTORS

Individual factors:
a) Life satisfaction- sense of purpose
b) Beliefs about the meaning and value of life
c) Healthy fear of risky behaviours and pain (social disapproval)
d) Good health and access to health care
e) Compliance and sense of importance of wellness
f) Sense of competence (self worth, personal control)
g) Problem solving, decision making, conflict resolution skills
h) Interpersonal competence
i) Adaptive coping skills (impulse control, sobriety)
j) Optimistic outlook, identification of future goals
k) Cultural/ religious beliefs-discourage suicide, self preservation
l) Constructive use of leisure time activities (enjoyable activities)

Community factors:
m) Sense of belonging, sense of identity
n) Opportunities to participate & contribute
o) Affordable, accessible supportive resources
p) Community self determination & solidarity
q) Reasonably safe and stable environment
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Family factors:
a) Intact/ stable marriage
b) Pregnancy (self/ partner)
c) Sense of responsibility/duty to the family
d) Relationships characterized by warmth & belonging.
e) Positive parent- child connection
f) Active parental supervision (youth)

Work/Study factors:
a) Positive Peer support & Colleague Relationship
b) Supportive, non-punitive work environment
c) Professional Development opportunities
d) Core values are present in the workplace/school.
e) Access to Counselling/EAP (Employee Assistance Program)

Others
a) Reality testing ability
b) Positive therapeutic relationship
c) Effective clinical care for mental and substance use
d) Restricted access to highly lethal means of suicide
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Suicide Screening and Risk Assessment
Suicide Screening and Risk Assessment
Suicide Screening and Risk Assessment
Suicide Screening and Risk Assessment
Suicide Screening and Risk Assessment
Suicide Screening and Risk Assessment