Suicide
Intervention
Plans
• Suicidal ideation
• Personal suicide intervention plan
• Suicide intervention plan for someone you care about.
“I haven’t walked in your footsteps, nor felt your pain; however, your burden is my burden, I am here.”
What is Suicidal Ideation?
SUICIDAL IDEATION RISK ASSESSMENT STEPS:
Suicidal ideation risk assessment is a process of determining how seriously someone is thinking about and/or planning for a suicide.
1. Identify Risk Factors
2. Identify Protective Factors
3. Conduct Suicide Inquiry
4. Determine Risk Level
5. Determine Intervention
Every Veteran and community needs access to the best available care in the least restrictive setting.
Treatment should focus on reducing the immediate suicide risk and exploring the underlying mental health and/or substance use disorder.
A thorough suicidal ideation risk assessment should be:
- Culturally Sensitive
- Preventive
- Explorative
- Fluid
- Collaborative & Strengths Based
- Engaging
1. Identify Risk Factors
Factors that may increase the risk of suicide:
▪ Trauma
▪ Triggering Events
▪ Ideation
▪ Medical Health
▪ Mental Health
▪ Chemical Health
▪ Substance Use
▪ Past Suicidal Behavior
▪ Self-Injurious Behavior
▪ Trapped
▪ Purposelessness
▪ Hopelessness
▪ Withdrawal
▪ Anger
▪ Recklessness
▪ Mood
2. Identify Protective Factors
Protective factors buffer individuals from suicidal thoughts and behavior. Protective factors have not been studied as much as risk factors.
▪ Effective clinical care for mental, medical, and chemical health.
▪ Access to a variety of interventions and support, at the least restrictive environment.
▪ Connectedness to other people such as family, neighbors, community, and even culture.
▪ Support from ongoing medical, mental and chemical health care relationships.
▪ Skills in problem solving, conflict resolution, coping, and healing.
▪ Cultural and religious beliefs that discourage suicide and support instincts for selfpreservation.
3. Conduct a Suicide Inquiry
- Ideation:
Frequency, Intensity and Duration - Plan:
Timing, Location, Lethality, Availability/Means - Behavior:
Past attempts, aborted attempts, rehearsals - Intent:
Extent to which they expect to carry out the plan and believe the plan to be
lethal versus harmful. - Notes: When working with youth, collect information from a parent, guardian or service provider on the youth’s suicidal thoughts, plans, behaviors, and changes in mood, behavior or disposition. If the person has thoughts or plans to harm someone else, conduct a homicide inquiry using the same questions (replace “hurt or kill yourself” with “hurt or kill someone else”).
4. DETERMINE RISK LEVEL:
The risk level is determined with the previous three steps.
Click on image to enlarge
5. DETERMINE INTERVENTION:
Interventions are based on the scope or role of the person conducting the suicidal ideation risk assessment, available resources and supports, and the agency’s policies and procedures.
Scope and Role
Is it your role to use clinical judgment to determine the course of action?
▪ Do you consult with a supervisor or clinical lead before making decisions?
▪ Does your agency have an outside organization to contact during mental health crises?
Available Resources and Referrals
Your region may or may not have lots of mental health and/or chemical health supports.
▪ The person experiencing suicidal thoughts may be engaged, or not in medical, mental, or chemical health services.
Policies and Procedures
Your agency may have a particular code, protocol, policy, or procedure specific to suicial thoughts or mental health crises.
- Call 911 and ask the operator if there are mental health specialists available.
Make it clear to the police that this is a mental health emergency. Be clear if there are other threats (e.g., physical aggression, weapons) present or if it is a non-life-threatening mental health emergency.
Individual responses will differ and may include any or all of the following:
Confirm contact information and emergency contacts.
▪ Discuss a plan for acting on or enhancing protective factors.
▪ Discuss suicide precautions (e.g., observation, means reduction).
▪ Assist the person in developing a safety plan.
▪ Consider what harm reduction strategies can be used to reduce the harms of drug use (e.g., carry naloxone, have a safety plan for every use, do not use alone, train those around you to use and carry naloxone).
▪ Save mental health crisis numbers in phone.
▪ Identify current care team members and/or services.
▪ Get a Release of Information (ROI) for other care team members or loved ones for additional information.
▪ Consult with any/all of current care team members and/or services.
▪ Schedule follow-up visits with medical, mental, or chemical health providers.
▪ Make referral(s) to additional service(s).
▪ Consult with mental health crisis team.
▪ Call mobile mental health crisis services.
DOCUMENT
Your agency/organization may have a particular code, protocol, policy, or procedure specific to suicial thoughts or mental health crises.
RISK LEVEL AND RATIONALE
What is the level of risk and how was this decision made? Is risk level low, moderate, or high? How can you tell?
-
- Ex., “The person is at low level of risk for suicide evidenced by strong protective factors and modifiable risk factors; person states that ‘I could never do that [end my life] to my sister’. Person is currently experiencing feelings of hopelessness,
isolation, and feeling trapped; person states ‘It might get better after my neighbor comes back’. The person has thoughts about death, but no plan, intent or behavior.”
- Ex., “The person is at low level of risk for suicide evidenced by strong protective factors and modifiable risk factors; person states that ‘I could never do that [end my life] to my sister’. Person is currently experiencing feelings of hopelessness,
CONSULTATION
Who was consulted and/or what contact was made with additional people?
▪ E.g., “(Person) signed a release of information (ROI) for their neighbor and sister in case of an emergency. In addition, we consulted with the (county) mental health crisis line, they advised an outpatient referral.”
INTERVENTION
- What is being done to address or reduce the current risk such as a scheduled follow-up visit, mental health referral, reviewed crisis line, and developed a safety plan?
▪ E.g., “(Person) is already engaged in mental health care at (facility) with (provider); release of information in place and scheduled follow-up visit. Reviewed mental health crisis lines and saved numbers in phone. Discussed harm reduction strategies for substance use. “
NEXT STEPS
- What are the next steps, if any, to ensure the person’s safety? What are you/agency/provider going to do? What is the person going to do?
▪ E.g., “(Person) is aware they can return to (agency) at any time during regular
office hours for services or to check-in. Person agreed to call sister if/when they
are fearful for their own safety in next two days; sister is aware of the plan.”
“Isolation is the root to all suicides, the feeling no one cares, but they do, I do!”
Suicide Risk Assessment Tools
Risk Factors & Warning Signs
While there is no definitive list of suicidal behaviors, some characteristics are more likely to appear in someone planning on attempting suicide. These resources were compiled with the idea that, if individuals were more aware of some of the factors and warning signs, then we all might stand a better chance at preventing the next suicide.
Click Link Below To View PDF:
I’m Suicidal
If you are contemplating suicide, please call the National Suicide Prevention Lifeline at 988.
ASPARC has compiled these resources in an attempt to provide reassurance and general information to those who feel that they are in crisis.
Suicide Safety Plans
Suicide safety plans are an integral part of ensuring that a suicidal individual has a support system in place to prevent them from completing. The following resources have been compiled to educate those contemplating suicide and outside support on how best to make a safety plan and what needs to be included in any good safety plan.
Click Link Below To View PDF:
The National Suicide Prevention Lifeline is a United States-based suicide prevention network of over 160 crisis centers that provides 24/7 service. Call, Text, or Chat: 988. It is available to anyone in suicidal crisis or emotional distress. The caller is routed to their nearest crisis center to receive immediate counseling and local mental health referrals.
CALL, TEXT, OR CHAT 988
Veterans Crisis Line
Are you a Veteran in crisis or concerned about one?
Connect with the Veterans Crisis Line to reach caring, qualified responders with the Department of Veterans Affairs. Many of them are Veterans themselves.
988 (then press 1)
Text HOME to 741741 to connect with a Crisis Counselor
Free 24/7 support at your fingertips.
- US and Canada: text 741741
- Message us on WhatsApp at 443-SUPPORT
- For international support, click here.
- Text Us
- Or, message us on Facebook.
If you feel you are at risk for taking your own life seek help right away.
There are many ways to
get help
- Call 911 or go to your local emergency room.
- Call the National Suicide Prevention Lifeline at 988. Veterans can call and then press 1 to reach the Veterans Crisis Line.
- Text the Crisis Text Line (text HOME to 911).
- Text the Veterans Crisis Line at 988.
- Call your health care or mental health provider
- Reach out to a loved one or close friend
- If you are worried that a loved one is at risk for suicide, don't leave them alone. You should also:
- Encourage them to seek help. Assist them in finding help if needed.
- Let them know you care. Listen without judgement, and provide encouragement and support.
- Restrict access to weapons, pills, and other items that could cause harm.
You may also want to call the National Suicide Prevention Lifeline at 988 for advice and support.
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