Table 3. Levels of Suicide Risk Acute
Chronic
High risk : Patients have suicidal ideation with the intent to die by suicide. They are unable to maintain safety without external support. Intermediate risk : Patients have suicidal ideation but no intent based on identified reasons for living (i.e., children) and ability to follow a safety plan and maintain safety. Preparatory behaviors are likely absent.
High risk : Patients have chronic suicidal ideation and an increase or change in baseline mood, behavior, or talk about suicide/ dying. Intermediate risk : Patients have chronic suicidal ideation but have protective factors, coping skills, reasons for living, and psychosocial stability that suggest the ability to endure future crisis without resorting to suicide.
Low risk : Patients have suicidal ideation but do not currently have a plan for suicide or suicidal behaviors. Another feature is collective high confidence (from patient, care provider, family member) in the ability of the patient to maintain safety independently. Low risk : Patients have chronic suicidal ideation but have abundant strengths and resources. The following are generally not present: History of self-directed violence, chronic suicidal ideation, high impulsivity, risky behaviors, marginal psychosocial functioning. Note : Adapted from Zero Suicide. (2019). Therapeutic risk management: Risk stratification table . https://zerosuicide.edc.org/sites/default/ files/Risk%20Stratification%20Table%20MCHGM.pdf Appropriate actions for different levels of risk Zero Suicide (2019) offers the guidelines found in Table 4 for specific actions according to their respective levels of risk. Table 4. Actions According to Level of Suicide Risk Acute Chronic High risk :
High risk : These individuals require a calculated risk assessment, routine mental health follow-ups, a safety plan, routine suicide risk screening, building coping skills, management of co-occurring psychiatric disorders, and evidence-based treatment for suicide. Intermediate risk : These individuals require routine mental healthcare to maintain or enhance coping skills and protective factors, a safety plan, management of co-occurring psychiatric disorders, and evidence-based treatment for suicide.
Requires psychiatric hospitalization to maintain safety. These patients need to be observed on a secure unit and kept in an environment with limited access to lethal means.
Intermediate risk : Consider psychiatric hospitalization if related risk factors are responsive to inpatient treatment (e.g., psychosis). If treated in an outpatient setting, there should be increased contact, regular reassessment of risk, a safety plan in place. Low risk : Outpatient treatment should include behavioral health services and a well-articulated safety plan.
Low risk : These individuals may seek treatment on a regular or an as-needed basis. Some may be managed in primary care. Note : Adapted from Zero Suicide. (2019). Therapeutic risk management: Risk stratification table . https://zerosuicide.edc.org/sites/default/ files/Risk%20Stratification%20Table%20MCHGM.pdf Case study Ella is a 16-year-old, female high school student. She
Self-Assessment Quiz Question #1 What was the trigger that led to the death by suicide in this case? a. Ella’s mom not listening. b. Romantic Breakup. c. Ella’s tendency to experience suicidal ideations. d. School counselor’s confrontation. Self-Assessment Quiz Question #2 Based on the information regarding restricting access to lethal means, which action could have been taken by an individual in the scenario to reduce the risk of suicide? a. Notify the pediatrician. b. Meet with the parents and Ella together. c. Ask Ella to meet with the counselor regularly. d. Remove access to the Tylenol.
requests to see a school counselor after a difficult breakup with her boyfriend of three months. During the consultation the counselor learns that Ella has been experiencing suicidal ideations. Further assessment indicated that she also had a plan with intent. Specifically, she reports that she has a plan to “swallow a bottle of Tylenol” to “make the pain go away.” When asked if she had access to Tylenol, she reported that she bought a bottle a few days ago and was “just waiting to find the right time”. The school counselor promptly contacts Ella’s parents, who came in to meet with her. Ella’s mom reports that Ella “tended to be dramatic” and that she had made such threats after her previous three breakups, and all Ella needed to do was “focus on her future and stop being so distracted by those boys”. At the counselor’s insistence, the mother promised to report the counselor’s findings to her pediatrician. The following week, Ella’s best friend found her dead on the bathroom floor.
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Book Code: SWPA1525
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