Understanding Suicide: Assessment & Prevention

Assessing & Prevention: Assessing for suicide can include the use of any of the Ideation to action models for quick determinations of an individual’s status and level of true ideation. You can further assess by exploring and monitoring an individual’s symptoms of depression, feelings of connectedness,  and recent or abrupt changes in jobs, relationships, or other events. You must also assess an individual's current self-perception, level of ideation, planning, and means. 

When you have concerns that a person is potentially at risk for suicide, it is important to directly ask aloud to avoid missing the ideation and the individual’s true state of heart and mind. When you do this you must be verbally direct, such as: “Are you planning to kill yourself?” *It is imperative to be empathetic and sympathetic as you convey your tone. Remember to never be accusatory or speak in a way that conveys shaming, anger, fear, or resentment as this can provoke guilt and further exacerbate the situation.

If the answer is yes, next determine if there is a plan, determine exactly what this plan is, and observe how detailed the plan is. More detailed plans indicate a higher likelihood of an attempt since it’s clear that the individual has given thorough thought to carrying out the act. 

Ask aloud: “Do you have a plan to take your life? 

If yes, follow with: What is that plan?” *Remember to ask with empathy in your tone and delivery!

If there is a plan, detailed or otherwise, determine if there is a means to carry it out. 

Ask: Do you have a way to do this now? 

If the answer is NO, be sure to also ask: Are you currently in the process of achieving/attaining a way to kill yourself?

If a person has:

Ideation + Plan + Means= Hospitalization may be required in order to engage prevention. Some people may voluntarily agree to go to the hospital when they recognize the severity of their suicidal mindset or if it is presented to them through the observation and encouragement of a therapist or loved one, and this is preferred. 

It is important to understand that if hospitalization is necessary, you will need to involve the family of the individual including any emergency contacts. For clinicians utilizing family or other emergency contacts, it is necessary to provide specific directives to immediately escort or accompany the suicidal person to the hospital for treatment. Once this has been verbally communicated and confirmed, clinicians should also provide the professional directive in writing as they were provided, confirmed, and agreed upon. Clinicians should also be clear in verbally explaining and detailing in this same written communication, the risk that a potential suicide attempt may occur in the event that the individual is not taken to get hospital treatment.

Once again, for anyone, broaching the topic of suicide and having such a severe and serious conversation about it with someone you either love or are clinically treating, is daunting, scary, and anxiety-inducing, even for those who have done so more than once. 

Clinicians who need support should communicate with supervisors about their own thoughts, feelings, and emotions relating to the event. Clinicians must also be certain to physically document every detail of the situation and all actions taken. This will also require an incident report or other documentation as declared by the agency safety officer if employed or working for a mental health practice.

Family members can always call 988 for crisis help right away 24/7. Families and clinicians should call 911 if the need is escalated, such as with a loved one or client who has in some way already attempted suicide.

Less Emergent Prevention

For clinicians with concerns about a client who is expressing less urgent ideation without a means or a plan, there are assessment tools available, such as the Columbia Suicide Severity Rating Scale (C-SSRS) and the Kessler Psychological Distress Scale or K10. These assessments can help to determine what stage of ideation and relevant coordination of treatment is necessary. 

If the client is only expressing ideation and has not considered a plan, or has a vague plan, two things must occur. First, you may need to develop a safety plan with the client that is realistic and useful to the client. You want to work with the client or individual to determine emergency contact information and steps for recognizing how the signs and symptoms may present that indicate suicidality is prevalent. Safety planning should also include useful resources and agencies to call during a crisis, coping techniques, and safe friends or locations that can help to de-escalate the situation.

Prevention starts by working with suicidal individuals to provide adequate coping skills and techniques when faced with triggers or life stressors. Clients and individuals who have suicidal thoughts can be urged to consider developing a support group to foster connection and ongoing support. Prevention also involves working with these individuals to learn about impulse control, cognitive challenging for all-or-nothing thinking, and catastrophizing so that they can remain in control of big and powerful emotions and counter the kind of thinking that leads to suicidal ideation.

Suicide is a complex and scary topic but the more you know and prepare, the better the chances for a safe outcome for all involved. It is important to remember that you aren’t ever alone in the fight against suicide. There is support available always without judgment or blame.

Remember, If you or a loved one is considering suicide, you are NOT alone. Please get help today! Help IS available and your life is worth it. 

Suicide & Crisis Prevention Lifeline: Call or text 988, 24 hours a day, 7 days a week. https://988lifeline.org/