Suicide Risk Assessment Guide - Ontario Hospital Association

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10 I Suicide Risk Assesment Guide Protective factors Protective factors are those that may mitigate risk of suicide (Nelson, Johnston, & Shrivastava, 2010; Sanchez, 2001); see Box 1 below. Box 1. Examples of Protective Factors (Sanchez, 2001; United States Public Health Service, 1999) • Strong connections to family and community support • Skills in problem solving, coping and conflict resolution • Sense of belonging, sense of identity, and good self-esteem • Cultural, spiritual, and religious connections and beliefs • Identification of future goals • Constructive use of leisure time (enjoyable activities) • Support through ongoing medical and mental health care relationships • Effective clinical care for mental, physical and substance use disorders • Easy access to a variety of clinical interventions and support for seeking help • Restricted access to highly lethal means of suicide The identification of protective factors is a necessary component of suicide risk assessment in order to identify potential strengths and resiliency that can be used to buffer suicide risk. Recognizing protective factors can be a means to encourage hope among persons at risk. Responsibility and love for one’s family or children, strong ties to friends or the community, or personal hobbies or interests may foster a sense of self-worth and should be considered during suicide risk assessment. However, the protective nature of some factors may be temporary (e.g., a person may not attempt suicide while their children are still living at home). Protective factors should never supersede evidence of warning signs when assessing risk. The presence of protective factors does not reduce the risk associated with the presence of severe warning signs. Instead, these factors should be used in the care process with the person to attempt to alter risk.
The mere absence of warning signs and potentiating risk factors can also be thought of as a protective factor It is important to recognize that the absence of these factors can be strengths which may assist in coping with other risk factors or warning signs. In fact, several experts interviewed emphasized the use and leverage of protective factors in a strengths-based approach to assessing and monitoring risk of suicide, particularly for persons receiving community-based care (See Reason for Living Inventory in Section II for an example of a tool that can help gather information on protective factors). Further, it is important to discuss both the available internal (e.g., person’s skills, coping mechanisms) and external (e.g., strong family or community supports, cultural or religions networks; Grotberg, 2002) supports. Asking the person to identify with positively worded statements (e.g., “I can take care of myself”, “I have people I can talk to”, etc.) might also help to shift the focus from the person’s distress and suicidal ideation to areas of strength and support. 2. The Principles that Guide the Assessment Process Providers need to recognize, organize and act on potentiating risk factors and warning signs. This process is complicated by the context and complexity of providing care to persons at risk of suicide. For example, in almost all health care settings, care providers are faced with numerous challenges including: • time available to appropriately assess a person; • the availability, experience, and support of other care providers or clinical team members; • the sophistication of health information systems; • the availability of appropriate services for high-risk persons; • ongoing management of admissions and discharges; and • staff shift changes and internal transitions in care. These challenges are compounded by the urgency and consequences associated with the person’s condition. Timely, informed decisions need to be made regarding a person’s safety and the risk that the person may pose to himself or herself while in the care environment as well as when outside of that environment. Section I: Overview of Suicide Risk Assessment Principles, Processes, and Considerations Suicide Risk Assesment Guide I 11
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Page 9 and 10: Executive Summary BACKGROUND Suicid
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Scale Main Author Contact Info Copy
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There is no consensus on which is
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64 I Suicide Risk Assesment Guide r
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Section III: A Framework for Suicid
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Below is a framework for suicide ri
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For persons not already in mental h
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protective factors. Tools that may
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3. Measuring the Quality of the Sui
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documentation of all 19 indicators
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provider (e.g., admitted to a hospi
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SUMMARY AND RECOMMENDATIONS This re
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Section IV References and Resources
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82 I Suicide Risk Assesment Guide A
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Appendix B: List of Interview Parti
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Appendix C: Illustration of the Acc
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Appendix H: Characteristics of Suic
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Appendix J: References Aboriginal H
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Bostwick, M. (2009). Editorial on
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Denneson, L. M., Basham, C., Dickin
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Hirdes, J. P., Marhaba, M, Smith, T
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Maltsberger, J. T. (1994). Calculat
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O’Carroll, P. W., & Mercy, J. A.
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Steed, L. (2001). Further validity
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Suicide Risk Assessment Guide - Ontario Hospital Association

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