General Guidelines

• If, at any time, Pt is threatening suicide, get help. Call 911.
• Provide safe environment.
• Always take overt or covert suicide threats or attempts seriously.
• Observe Pt closely.
• Encourage expression of feelings.
• Assign tasks to increase feelings of usefulness.
• Provide full schedule of activities.
• Show acceptance, respect, and appreciation.
• Do not argue with Pt.
• Remind Pt that there are alternatives to suicide.

Groups at Increased Risk for Suicide

• Adolescent and young adult Pts (ages 15-24).
• Elderly Pts.
• Terminally ill Pts.
• Pts who have experienced stress or loss.
• Survivors of persons who have committed suicide.
• Individuals with bipolar disorder or schizophrenia.
• Pts coming out of depression.
• People who abuse alcohol or other drugs.
• Pts who have previously attempted suicide.
• More women attempt suicide; more men complete suicide.

Lethality Assessment

• Intention: Ask Pt if he or she thinks about and/or intends to harm self.
• Plan: Ask Pt if he or she has formulated a plan. What are the details: where, when, and how will plan be carried out?
• Means: Check availability of method: access to gun, knife, pills, etc.?
• Lethality of Means: Pills vs. gun; jumping vs. slitting wrist.
• Rescue: Possibility of rescue.
• Support or lack of support.
• Anxiety or hostility level.
• Disorganized thinking.
• Preoccupation with thoughts of suicide plan.
• Prior suicide attempts.