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Risk assessment and safety planning guide

Purpose

The purpose of this protocol is to identify evidence-based practices that are at the forefront of Rula guidelines, understand and meet reporting requirements, and ensure patient safety.


Recommended standard care elements for people with suicide risk

  1. Screening and identification of suicide risk
    • Assess suicide risk for all patients at each session
  2. Asking about and assessing suicide risk level
  3. Responding to suicide risk level
    • Engage patient in treatment
  4. Follow up & next steps in care

 

Suicide risk: modeling intervention after C-SSRS

The C-SSRS utilizes plain language to assess severity/immediacy of risk and to gauge level of support needed. A suicide risk assessment will be conducted at each session. The C-SSRS is currently available on all AMD templates. Below are recommended approaches to take based on the risk identified. It is up to each prescriber to determine appropriate next steps, please consider this a guide in helping inform those steps.

Risk Level Guide of Interventions based on level of Risk

High Risk


“Specific Management Interventions”
  • If appropriate Immediate contact 911 and let the patient know you are doing this (if possible)
  • Ensure patient safety by continuing visual/ and or audio observation until onsite personnel are available
  • Completion of Collaborative Safety Plan

Moderate Risk


“Enhanced Monitoring”
  • Consider referral to higher level of care
    • Eg. Weekly + visits/IOP/PHP/Hospitalization
  • Completion of Collaborative Safety Plan

Low Risk


“Routine Care”

 When appropriate consider the following needs
  • Possible referral to in-person care
  • Higher level of care
  • Changes in treatment
  • Consider a Collaborative Safety Plan 
No Risk No interventions 

 

**Overriding the recommendation of an evidenced-based tool requires strong clinical judgment and thorough documentation of reasoning.

 

Risk factors are characteristics of a person or his/her environment that increase the

likelihood that he/she will die by suicide (i.e., suicide risk).

 

Risk Factors for suicide may include, but are not limited to (modeled from CDC):

  • Family history of suicide
  • Family history of child maltreatment
  • Previous suicide attempt(s)
  • History of mental disorders, particularly clinical depression
  • Previous Suicide Attempt
  • Current or past alcohol and substance use
  • Feelings of hopelessness
  • Impulsive or aggressive tendencies
  • Isolation, a feeling of being cut off from other people
  • Barriers to accessing mental health treatment
  • Loss (relational, social, work, or financial)
  • Physical illness
  • Easy access to lethal means
  • Anniversary of a loss
  • Bullying
  • Lesbian, Gay, Bisexual, Transgender, Questioning (LGBTQ)
  • Legal Problems

 

Protective factors are characteristics of a person or his/her environment that decrease the

likelihood that he/she will die by suicide.

 

Protective Factors for suicide may include, but are not limited to (modeled from CDC):

 

  • Coping and problem-solving skills
  • Hope for future - optimism
  • Resiliency
  • Being married or a parent
  • Cultural and religious beliefs that discourage suicide
  • Connections to friends, family, and community support
  • Supportive relationships with care providers
  • Access to physical and mental health care
  • Limited access to lethal means among people at risk

 

The patient's strengths, potential barriers to safety, and collateral from colleagues provides

the context for assessing level of risk, addressing immediate safety issues, determining

probable cause, and identifying the appropriate course of action (e.g., the need for immediate

containment via a psychiatric hold or referral to higher levels of care).


Safety planning:

  • Complete safety planning through AMD safety note or through a safety tab in an initial or follow-up note if in session. 
    • Recommended to also download and send responses to patients via email. 
  • Safety planning tools

 

Evidence-based therapeutic treatment for suicidality:

  • Dialectical Behavior Therapy (DBT)
  • Cognitive Therapy for Suicide Prevention (CT-SP)
  • Collaborative Assessment and Management of Suicidality (CAMS)
  • Brief Cognitive Behavioral Therapy (BCBT).

Involuntary psychiatric holds

Each state has its own individual approaches to psychiatric holds in cases of danger to self or others. We recommend ensuring you are aware of any local laws and regulations surrounding these practices.


Additional resources 

 

Crisis Lines

 

Updated

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