Management of Patients With Suicide Risk
Management of Patients With Suicide Risk
Management of Patients With Suicide Risk
Management of Patients
with Suicide Risk
DR LUKE WOON SY- CHE R NG
P SYCHI ATRY & ME N TAL HEALTH UN I T
HOS P I TAL BE N TONG
Triaging of Patients
Low Risk
Medium Risk
High Risk
Continued
Suicide Caution Procedure
The procedure is carried out by paramedic staff in the ward
Environmental manipulation
Regular review of patient
Is the reason for taking the patient off the unit urgently
needed or required?
- The increased risk associated with the transport should be
balanced by the benefit of the procedure
Transferring Patient
#2
Those with moderate and low risk, with good social support – should be given
the option of an outpatient treatment.
Discharge
The psychiatric team has been consulted
Comprehensive suicide risk management has been conducted
Harmful items and lethal medications have been removed
Discharge
Identify and, if appropriate, contact outpatient support system; family/ friends
A supportive person is available and instructed in follow up observation and
communication regarding signs of escalating problems or acute risk.
If the patient does not wish to permit contact with family, this should be
documented
Discharge
Provide the patient and the family/carer with discharge instructions
Explain the uneven recovery path from their illness, especially depression. e.g.,
“There are likely to be times when you feel
worse – that doesn’t mean that the medications
have stopped working. Contact your healthcare
clinician if this happens.”
Inform patient and/or family/friends (if indicated) about the signs of increased
suicide risk; especially sleep disturbance, anxiety, agitation, and suicidal
expressions and behaviours
Discharge
Patient understands the conditions that warrant a return to the ED.
Provide information for follow-up appointment, which may include contacting
and/or scheduling an appointment with a psychiatrist and/or psychologist.
Provide prescriptions that allows for a reasonable supply of medication to last
until the first follow-up appointment.
Provide information about local resources available, such as emergency contact
numbers and instructions
Suicide risk increases following discharge across diagnostic categories
Suicide attempts are also more frequent in the time period following discharge
Management
Flowchart
Documentation
WHEN TO DOCUMENT SUICIDE RISK ASSESSMENTS
At the time of hospital admission
Before discharge
Documentation
WHAT TO DOCUMENT IN A SUICIDE ASSESSMENT
Basis for the risk level (including presence and characteristics of any
suicidal or non-suicidal self-injury thoughts or behaviours)
Treatment plan for reducing the risk, including observations and other
restrictions