New Strategies for Suicide Risk Assessment: 3 Additional Reasons Why

“It is unfair for a mother to outlive her child,” she said. “This is unfair, life is unfair, why should that happen to me, and how did I not see this coming?” Eileen, Lola’s mother, said these words in an inconsolable voice.

This paragraph concluded the previous article, entitled, New Strategies for Suicide Risk Assessment: 3 Reasons Why.  In that article I outlined the three reasons why it is crucial for all of us to master the effective skills of suicide risk assessment:

1. The concept that suicide is contagious;

2. The long-term, negative ramifications of suicide; and

3. The preventability factor of suicide.

In this current article, I will describe three additional reasons.

To learn the principles of suicide risk assessment

In the previous article, I explained that we cannot pretend to be able to prevent everyone determined to carry out his or her plan for dying by suicide, but that we were able to address the preventable cases, and that suicide is, in fact, preventable.  I also explained that since about 90% of cases of suicide are related to mental health, there is, indeed, a lot that we can do, and it all starts with mastering effective skills of suicide risk assessment.  Suicide risk assessment has its principles and its set of techniques, including the steps and do’s and don’ts, which are rarely taught or practiced adequately, yet, they are essential skills for all of us as clinicians, supervisors, and leaders of agencies and health care systems to master and harness.  Some know what to ask, but may neglect to pay attention to how and when to ask.  In SWEET seminars, I often emphasize the need for all of us to strive to know what we do not know, know how to find the answer, and know how we learn best.

To mitigate chronic suicidal risks

Chronic suicidal risks are the persisting risks that need to be managed and mitigated, or else there is a risk that suicidal ideation may advance to active suicidality and suicide completion.  How often do the chronic risks get re-evaluated during the course of treatment; how do we assess for predisposition, and how do we make the distinction among baseline risk, chronic risk, and chronic high risk with acute exacerbation?  Answers to these questions can make a world of difference, and mastering the tools for an effective suicide risk assessment will help us all make that difference.

To manage acute suicidal risks

What is considered an acute suicidal risk?  How do we assess for suicidal ideation; and what steps do we take in the presence of active suicidal ideation?  In review with clinicians, the approach to any of these above scenarios varies based on multiple factors.  While care needs to be tailored, there are underlying principles for how all clinicians should assess and manage suicidal risks, hence the reason why it is crucial to master new strategies for suicide risk assessment.

“It is unfair for a mother to outlive her child,” she said. “This is unfair, life is unfair, why should that happen to me, and how did I not see this coming?” Eileen, Lola’s mother, said in an inconsolable voice. Lola’s clinician did not see this coming either, maybe because she did not know what to look for; or maybe she recognized something but did not know what the next step should have been. Regardless, as I have stated before, there are unpreventable cases of suicide. However, there are other cases that we can do something about when we arm ourselves with the right tools, and it is our duty to also do just that.

In summary, I have provided a total of six reasons why we all need to master the new strategies for suicide risk assessment,

1. Suicide is contagious;

2. Suicide has long-term, negative ramifications;

3. Suicide can be prevented;

4. To learn the principles of suicide risk assessment;

5. To mitigate chronic suicidal risks; and

6. To manage acute suicidal risks.

References:

1. Simon, Robert (2006). “Suicide risk assessment: is clinical experience enough?” Journal of the American Academy of Psychiatry and the Law. 34 (3): 276–8.

2. Beck, A.T.; Kovacs, M.; Weissman, A. (April 1979). “Assessment of suicidal ideation: The scale for suicide ideation”. Journal of Consulting and Clinical Psychology. 47(2): 343–352.

3. Harris K. M.; Lello O. D.; Willcox C. H. (2016). “Reevaluating suicidal behaviors: Comparing assessment methods to improve risk evaluations”. Journal of Psychopathology and Behavioral Assessment.

4. Fawcett J., Acute risk factors for suicide: anxiety severity as a treatment modifiable risk factor. Chapter 4 in Tatarelli et al. (eds) (2007).

5. Lambert, Michael (2003). “Suicide risk assessment and management: focus on personality disorders”. Current Opinion in Psychiatry. 16 (1): 71–76.

6. Paris, J (June 2004). “Is hospitalization useful for suicidal patients with borderline personality disorder?” Journal of personality disorders. 18 (3): 240–7.

7. Robinson, J; Hetrick, SE; Martin, C (January 2011). “Preventing suicide in young people: systematic review”. The Australian and New Zealand Journal of Psychiatry. 45(1): 3–26.

8. LeFevre, ML; U.S. Preventive Services Task Force (May 20, 2014). “Screening for suicide risk in adolescents, adults, and older adults in primary care: U.S. Preventive Services Task Force recommendation statement.” Annals of Internal Medicine. 160 (10): 719–26.

9. Haney, EM; O’Neil, ME; Carson, S; Low, A; Peterson, K; Denneson, LM; Oleksiewicz, C; Kansagara, D (March 2012). “Suicide Risk Factors and Risk Assessment Tools: A Systematic Review”.

10. Goodman, M; Roiff, T; Oakes, AH; Paris, J (February 2012). “Suicidal risk and management in borderline personality disorder”. Current psychiatry reports. 14 (1): 79–85.