Suicide Risk Assessment

Description

General Measures

Referral

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ICD-10 code: R45.8/X60-X84/Z91.5 + (Z81.8)

Description

Suicide is the act of deliberately killing oneself. Self-harm refers to intentionally self-inflicting injury or poisoning, which may or may not have a fatal intent or outcome. Suicide risk assessment is a process of estimating the probability for a person to commit suicide. There are 5 important components when assessing suicide: ideation (thoughts), intent, plan, access to lethal means, and history of past suicide attempts. Key risk factors for suicide include previous suicide attempt, current suicidal plan or ideation, and history of mental illness and/or substance abuse, access to lethal means, history of childhood sexual/physical abuse, family history of suicide and suicidality in males, adolescents, elderly patients, and patients with alternative sexual orientations - lesbian, gay, bisexual, and transgender (LGBT) patients (See: Special considerations - Sexual health and sexuality).

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WARNING
Suicide risk assessment tools and guidelines should not replace clinical judgment.

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General Measures

Any of the following factors may indicate a high risk of suicide:

• Extreme hopelessness and despair
• Current thoughts/plan/act of self-harm/suicide
• History of self-harm/suicide
• Mental health condition: depression, bipolar disorder, substance use disorders, psychoses, dementia
• Chronic condition: chronic pain, disability
• Extreme emotional distress
• Key population groups (LGBTQIA+) and adolescents

1. Reduce immediate risk
   • Manage the patient who has attempted a medically serious act of self-harm: See: Trauma and injuries.
   • If medically stable, assess for imminent risk of self-harm/suicide: imminent risk of suicide is likely in a patient who is extremely agitated, violent, distressed or has difficulty communicating and has any of the following:
     • Current thoughts or plan of self-harm/suicide
     • History of thoughts or plan of self-harm in the past month
     • Act of self-harm
2. Manage underlying factors
   • Ensure optimal treatment and support of other conditions like chronic pain and mental health conditions (depression, mood disorders, substance use disorders, psychosis, dementia).
   • Identify psychosocial stressors like bereavement, intimate partner violence, financial or relationship problems, bullying, divorce, or separation.
3. Monitoring and follow-up

For all cases of medically serious acts of self-harm/suicide, or where there is an imminent risk of self-harm/suicide:

• Remove access to means of self-harm/suicide (bleach, pesticides, firearms, medications) and medicines known to be toxic in overdose, including paracetamol, amitriptyline, theophylline.
• Maintain regular contact if possible – suggested weekly contact for the first 2 months. Follow-up for as long as the risk of self-harm/suicide persists. At every contact, reassess for suicidal thoughts and plans.
• Educate patient and family:
  • To seek help from a trusted family member, friend, or health worker if they have any thoughts of self-harm/suicide.
  • That family/carers may also need psychosocial support – provide patient with resources (e.g., brochures if available, SA Depression and Anxiety Group details https://www.sadag.org/)
• Educate family/friend/carer:
  • Talking about suicide does not trigger the act of suicide and may lower the risk of following through on suicidal ideation.
  • Where they may get support for their own mental health and to better support the patient.
• Refer to social worker, registered counsellor, mental health services if available, or to community resources such as NGO or faith-based organisation crisis centres or support groups.

Referral

• All patients who have attempted a medically serious act of self-harm/ suicide
• All patients where there is an imminent risk of self-harm/ suicide
• All patients with a high index of suspicion

Click here for the pdf

Click here for the circular

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Standard Treatment Guidelines and Essential Medicines List for South Africa Primary Healthcare Level_Chapter 16: Mental Health Conditions_NEMLC Recommendations for Medicine Amendments 2020_2023