Guidelines

Is Patient Safe to Self and/or Others?

Ensure Patient Safety First: Assess, Develop and Use Suicide Protocol to Minimize Suicide Risk/Involve Mental Health Specialists

The estimated lifetime prevalence of suicide in those ever hospitalized for suicidality is 8.6%. The lifetime risk is 4% for affective disorder patients hospitalized without specification of suicidality (Bostwick, 2000).

This section provides guidance and references on assessing suicidal tendencies, developing a clinic suicide protocol, risk factors for suicide and interventions to reduce suicide ideation.

Assess Suicidal Tendencies

Assessing suicidal tendencies is a critical but often difficult process with a depressed patient. Consider asking and documenting the following progression of questions.

1. Do you feel that life is worth living?
2. Do you wish you were dead?
3. Have you thought about ending your life?
4. If yes, have you gone so far as to think about how you would do so? Be specific, what method would you use?
5. Do you have access to a way to carry out your plan?
6. What keeps you from harming yourself?

Many patients will not answer #4 directly or will add, “But I’d never do it.” Give them positive feedback (e.g., “I’m glad to hear that”) but do not drop the subject until she/he has told you the specific methods considered (e.g., gun, medication overdose, motor vehicle accident).