FREE subscriptions for doctors and students... click here
You have 3 more open access pages.
The first step in managing suicidality is to make sure that the patient is safe and receives the necessary support. Healthcare professionals should urgently establish the likely physical risk, and the person's emotional and mental state, in an atmosphere of respect and understanding.
The management strategy depends on the degree of suicide risk that a person presents after assessment.
- if there is a significant risk to the individual who has self-injured or people who have self-poisoned – refer urgently to the nearest emergency department
- if urgent referral to an emergency department is not considered necessary, a risk and needs assessment should be undertaken to assess the case for urgent referral to secondary mental health services
- assessment of needs - should be comprehensive and include evaluation of the social, psychological and motivational factors specific to the act of self-harm, current suicidal intent and hopelessness, as well as a full mental health and social needs assessment.
- assessment of risk - should include identification of the main clinical and demographic features known to be associated with risk of further self-harm and/or suicide, and identification of the key psychological characteristics associated with risk, in particular depression, hopelessness and continuing suicidal intent.
- risk assessment tools and scales should not be used to
- predict future suicide or repetition of self-harm
- determine who should and should not be offered treatment or who should be discharged (1,2)
A care plan and a risk management plan should be developed according to the key areas of needs and risks identified in the assessment. This should be developed collaboratively with the person who self-harms and their family, carers or significant others if this is agreed with the person
- aims of care plan is to
- prevent escalation of self harm
- reduce harm arising from self-harm or reduce or stop self-harm
- reduce or stop other risk-related behaviour
- improve social or occupational functioning
- improve quality of life
- improve any associated mental health conditions
- a risk management plan should:
- address each of the long-term and more immediate risks identified in the risk assessment
- include a crisis plan outlining self-management strategies and how to access services during a crisis when self-management strategies fail (3)
Provide psychological, pharmacological and psychosocial interventions for any associated conditions (1)
Last reviewed 01/2018