Table 3: Risk Categories Risk Rating
Description
Low
• No symptoms of suicidal ideation. • Non-multiple attempter with ideation that is limited in intensity and duration; no/mild plans or preparations for an attempt; and no/few risk factors. • Multiple attempter with no other risk factors. • Non-multiple attempter with moderate-severe suicidal desire/ideation, no/mild plans and preparations for an attempt, and two or more risk factors. • Non-multiple attempter with moderate-severe plans and preparations. • Multiple attempter plus one other risk factor. • Non-multiple attempter plus moderate-severe plans and preparations for an attempt, and one or more risk factors. • Multiple attempter plus two or more risk factors. • Non-multiple attempter plus severe plans and preparations for an attempt and two or more risk factors. • Multiple attempter plus severe plans and preparations for an attempt.
Moderate
Severe
Extreme
Note : Note. Adapted from “Routinized Assessment of Suicide Risk in Clinical Practice: An Empirically Informed Update,” by C. Chu, K. M. Klein, J. M. Buchman-Schmitt, M. A. Horn, C. R. Hagan, and T. E. Joiner, 2015, Journal of Clinical Psychology, 71 (12), pp. 1186-1200. Box 2: Taking Action and Documenting Rate Risk (also use decision tree) Risk is: low □ low-moderate □ moderate □ moderate-severe □ severe □ extreme □ Take Action All the following actions can be taken by assessor: • Provide client information about adjunctive treatment. • Encourage client to seek support from friends and family. • Tell the client: “If you begin to experience suicidal feelings and for any reason cannot get help, go to the closest emergency department or call 911.” • Document. Low to Middle of Risk Scale (take previous actions and also …) • Mid-week phone check-in scheduled for: ___________________________________________. • Means safety/restriction interventions (ask about removing guns, pills, ropes from the home or restricting access in other ways). • Complete safety plan form with client. • Complete a crisis card with client. • Consult supervisor within 24 hours. Above Middle of Risk Scale (take all previous actions and also …) • Frequent phone check-ins. • Arrange for client not to be alone (monitored by family member or friend). • Consult supervisor before client leaves. Severe or Extreme Risk • Voluntary or involuntary hospitalization. Consult if: unsure of risk level or actions taken, moderate to severe risk level or above, notable increase in symptoms. Suggested Documentation Low End of Risk Scale: • Regular monitoring. • Provide client with emergency numbers (1-800-273-TALK and local numbers). “Suicide risk was assessed according to Joiner et al. (1999) and determined to be [low/moderate/severe/ extreme] due to … [e.g., ideation, plans, preparations, etc.]. Action taken: [e.g., safety plan, emergency numbers, consulted with supervisor, etc.]. Risk will continue to be monitored.” Note . Adapted from “Routinized Assessment of Suicide Risk in Clinical Practice: An Empirically Informed Update,” by C. Chu, K. M. Klein, J. M. Buchman-Schmitt, M. A. Horn, C. R. Hagan, and T. E. Joiner, 2015, Journal of Clinical Psychology, 71 (12), pp. 1186-1200; and “Scientizing and Routinizing the Assessment of Suicidality in Outpatient Practice,” by T. E. Joiner, Jr., R. L. Walker, M. D. Rudd, and D. A. Jobes, 1999, Professional Psychology: Research and Practice, 30 (5), pp. 1-7. The presence or absence of a history of multiple prior
Further, according to the Joiner risk assessment model, attempt status (i.e., whether the individual has attempted once [single attempter] or more than once [multiple attempter]) should be considered along with several risk factors in order to determine an individual’s risk category. Risk factors from Joiner’s model of suicidal behavior, the Interpersonal Theory of Suicidal Behavior (IPTS; Joiner, 2005; Van Orden, et al., 2010) include: ● Capability for suicide (e.g., non-suicidal self-injury, fearlessness about death). ● Thwarted belongingness.
attempts is an important variable in the Joiner system and is emphasized with a separate categorization of risk. In a classic study, Rudd, Joiner, and Rajab (1996) explored the relationship among suicide ideators, single attempters, and multiple attempters across several categories, and they determined that “multiple attempters presented a more severe clinical picture and, accordingly, elevated suicide risk compared to [single] attempters and ideators” (p. 541).
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Book Code: SWUS1524
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