Assessment of suicidal behavior
A comprehensive assessment of suicidal behaviour is fundamental to effective counselling intervention and prevention activities. The primary goal of suicide assessment is to provide
information for prevention and counselling. Assessment subsequently guides clinical judgement, counselling intervention, prevention and post-vention. All suicide assessment should include:
- A review of relevant risk factors.
- Any history of suicidal behaviour.
- Unchangeable biological, psychosocial, mental, situational or medical conditions.
- The extent of current suicidal symptoms including the degree of hopelessness.
- Precipitant stressors.
Level of impulsivity and personal control.
- Other mitigating information.
- Protective factors.
Suicide assessment requires an evaluation of the behaviours and risk factors, the underlying diagnosis of mental disorders, and a determination of the risk for death. Once an assessment is completed, it is important to rate the overall suicide risk in terms of severity. The scale below, based on a 5-point continuum from nonexistent to extreme suicide risk, could serve as general guidance for such a rating:
I. Nonexistent: Essentially, no risk of harm to self.
II. Mild: Suicidal ideation is limited, there are no resolved plans or preparations for harming oneself, and there are few known risk factors. The intent to commit suicide is not apparent, but suicidal ideation is present; the individual does not have a concrete plan and has not attempted suicide in the past.
III. Moderate: Resolved plans and preparation are evident with noticeable suicidal ideation, possible history of previous attempts, and at least two additional risk factors. Or, more than one risk factor for suicide is present, suicidal ideation as well as intent are present, but a clear plan is denied; the individual is motivated to improve his or her current emotional and psychological state, if possible.
IV. Severe: Clearly resolved plans and preparation to inflict self-harm or the person is known as a multiple attempter with two or more risk factors. Suicidal ideation and intent are verbalized along with a well-though out plan and the means to carry it out. This individual demonstrates cognitive inflexibility and hopelessness about the future and denies available social support; there have been previous suicide attempts.
V. Extreme: A multiple attempter with several significant multiple risk factors. Immediate attention and action is a must.
Ultimately, the counsellor’s responsibility is to make a judgment and locate a point on the suicide lethality scale that helps identify the individual’s potential for fatal self-harm.
It is often best to make a false-positive than a false-negative error in judgement. Assessment data also can be useful in comparing an individual’s pre- and post-counselling
level of functioning for intervention and prevention purposes.
Assessment for suicide risk includes a clinical interview, information from formal evaluation procedures, and a gathering of valuable collateral data from third-parties.
The reasons for living, or continuing with life, are important cognitive factors in suicidal
assessment and should be incorporated into screening and treatment planning. Finally, suicide assessment needs to be multidimensional and done within the context of normal human development and gender differences, family history, substance abuse, level of isolation, psychiatric diagnosis, level of helplessness/hopelessness, and demographic patterns.
In general, adolescent and child assessment must minimally include:
- Clinical interview;
- Behavioral observations;
- Collateral information from parents, teachers, relatives, and friends;
- Assessment of risk and situational factors;
- Assessment of ideation, plan, and intent and reasons for living;
- Availability and quality of family and peer support.
Signs of suicide
People show their suicidal feelings by:
- being withdrawn and unable to relate.
- having definite ideas of how to commit suicide and maybe speaking of tidying up
- or giving other indications of planning suicide.
- talking about feeling isolated and lonely.
- expressing feelings of failure, uselessness, dispiritedness, lack of hope’ or loss of
- constantly dwelling on problems for which there seems to be no solution.
Suicide risk is greater where there is
- recent loss or the breakup of a close relationship
- current or unanticipated unhappy change in health or circumstances such as
retirement or financial problems.
- painful and/or disabling physical illness.
- heavy use of or dependency on alcohol or other drugs.
- history of suicide in the family
- within the period of the rise and fall in mood, the most dangerous time is often
when the caller appears better. Now he has enough energy to kill himself.