Suicide Risk Assessment Guide - Ontario Hospital Association

26 I Suicide Risk Assesment Guide
• Persons concealing their true level of intent may be identified in the
risk assessment process by the incongruence between their level of
distress, agitation, and symptom severity and their stated thoughts,
intentions, and plans regarding suicide.
– In these situations a brief assessment tool that may not entirely focus
on suicide intentions but asks about plans to attempt suicide in the
future combined with other symptoms such as depression or
hopelessness may be helpful (for example, the Beck Depression
Inventory; Beck, Ward, Mendelson, 1961). Observational tools may
also be useful for providing an indication of risk to the clinician based
on combinations of prior history, current symptom severity, current
ideations and behaviours expressed by the person. See Section II for
more information on tools.
In many instances, the person may arrive at the emergency setting
accompanied by ambulance attendants, police, or family/friends. These
accompanying persons should be consulted regarding their accounts,
observations, and discussions with the person at risk. Ask anyone who may
have brought the person to the emergency department whether the person
had spoken about suicide or wanting to die, had attempted suicide in the past,
and whether any other warning signs were observed.
Mental health settings
In mental health settings, suicide risk assessment is more prevalent than in
other care settings. In both inpatient and community mental health care,
suicide risk assessment is a continual process and part of the therapeutic
process with the person. In these settings, high quality initial screening,
global assessment of care needs, and ongoing assessment are essential. The
initial screening needs to be brief but sensitive enough to detect persons
who may be experiencing warning signs, particularly at points of transition
within and between settings. A risk assessment process that involves screening,
monitoring, intervention, and follow-up needs to be completed and reviewed
on an ongoing basis to inform initial care and therapeutic opportunities,
progress in treatment, and changes to levels of care.