Suicide Assessment
• When evaluating the patient's risk of suicide or the intent, asses for
The specificity and the lethality of the suicide plan
The consideration of the method to be used
The patient's social network
• When looking at the specificity of the plan, the practitioner should consider the following
questions
o How detailed is the plan?
o Has the patient thought through all the steps and details in how to execute the plan?
Lethality of the Plan
• Refers to how quickly the plan produces death.
• Since lethality is directly related to the method used, practitioners need to ask about the
patient's method (i.e., use of razors, gun, overdose) as well as availability and the way the
method will be employed.
• For example, does the patient plan to use a razor on his/her wrist or on his/her thigh?
• Does he/she plan to overdose on aspirin or cyanide?
• Individuals vary in their views about the methods used for suicide.
• Asses the patient's social network and the proximity of the network
• Does the patient have family, friends, and/or neighbors?
• What is the proximity of these various forms of social networks?
• Is the patient socially isolated? The more isolated the greater the risk.
• Listening and hearing a patient is the key ingredient in suicide assessment.
• Ask family members and friends if they have heard the patient express comments such as
o Soon you won't have to worry about me
o I would be better off dead or
o I don't want to be a burden to others
o Has the patient expressed feelings of hopelessness, commented about how life is
unbearable, or talked about how life is worthless?
Non-Verbal Cues Offer another Window to Assessing Suicide
• Practitioners can ask friends and/or family members question about whether the patient
has done things like
o Preparing a will and/or funeral arrangements
o Giving possessions away
o Accumulating and using prescription drugs or substances
o Use of alcohol excessively
o Visiting a physician or nurse practitioner frequently, and/or
o Withdrawing from others
• It is important to listen to the patient's verbal cues and observe nonverbal cues
• Practitioners need to directly ask the patient about their suicidal intent such as
o How often does suicide come to mind?
o How hopeless do you feel?
o Do you think about killing yourself or to deal with your problems?
CMT 05211 Internal Medicine II NTA Level 5 Semester 2 Student Manual
Session 13: Non-Organic (Functional) Psychiatric Disorders 162
• The patient's history needs to be taken into account
o Have suicidal behaviors occurred in the past?
o Has the patient engaged in self-mutilating behaviors?
• Risk of suicide increases if a history of suicidal attempts or ideations is present.
• The patient's subjective meanings of suicide need to be explored.
• In other words, what does suicide mean to the patient?
• When examining the meaning of suicide, religion and ethnicity should be taken into
account since attitudes toward death are impacted by these variables.
• For example, some groups consider suicide shameful or a moral offense, while others
may perceive it as honorable.
• Catholicism teaches that taking one's life is unacceptable.
• The practitioner needs to assess other psychosocial issues that are current and relevant in
the life of the patient such as
o What are recent stresses in the patient's life?
o Has the patient lost or anticipates losing a primary relationship?
o What is the patient's physiological state (i.e. physical illness, organic impairment)
All patients with mental health issues should be screened for HIV and syphilis as these are
more treatable causes of disorder.
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