MH Suicide Risk Ax
Suicide Risk Report for [text name="Name"] Date: [text name="date"]-- SUICIDE RISK SUMMARY --Pt reported they are [checkbox value="not|actively|passively"] suicidal, with [checkbox value="no|firm|vague|lethal|nonlethal|undisclosed"] plans to end their life. The patient verbally confirmed they [checkbox value="have no intention to suicide|intend to die|have ambivalent feelings about suicide"].Known triggers: [textarea default=""] Suicide ideation: [textarea default="frequency / intensity / duration"] Suicide intent: [textarea default="expectation"] Suicide plans: [textarea default="Method / Means / Lethality/ chance of rescue/ preparation"] Suicide motivation: [textarea default="stated desire / reasons"] Suicide buffers: [textarea default=""]Targets for intervention include:Psychosocial: [textarea default=""] Psychiatric: [textarea default=""] Medical: [textarea default=""] Maladaptive patterns of thought, emotion and behaviour: [textarea default=""] Problem-solving: [textarea default="improve stress management, strengthen adaptive coping and problem-solving skills, encourage self-care: healthy diet, regular exercise, good sleep hygiene, discourage alcohol and substance use, manage and control maladaptive thoughts, including suicide ideation, hopelessness and self-reproach, manage and control intense negative emotions, develop strategies to improve impulsivity and behavioural control, expand the patient’s social support network."][textarea default="As the patient is unable to gain emotional control, is unable to think rationally, and is overtly expressing suicidality, they should be considered high-risk, and I recommend immediate assessment and hospitalization"]-- RECENT HISTORY --The patient reported they [select value="do not feel|feel"] like giving up on life. Their future seems [select name="variable_1" value="hopeful|hopeless"] and their life [select name="variable_2" value="does not seem|seems"] so bad that they wish to die. They further reported [checkbox name="freq" value="no suicidal thoughts.|having suicidal thoughts"][conditional field="freq" condition="(freq).is('having suicidal thoughts')"] [checkbox value="infrequently|most days|every day"], and rated these thoughts as [checkbox value="mild|moderate|severe"] in their intensity. When asked about having suicidal plans, the patient reported [checkbox value="no plans|vague ideas about it|having a definite plan|they are unwilling to discuss it"]. When further asked about how close have they been to acting on these thoughts in the past, the patient reported [checkbox value="not close at all|very close|they did indeed attempt suicide|they do not wish to discuss it"]. When asked how certain they feel about acting on these thoughts in the future, the patient reported [checkbox value="it's unlikely|they weren't sure|they were absolutely certain|they did not wish to discuss it"] Finally, when I asked about having access to the means to suicide, the patient reported [checkbox value="no|yes possibly|yes absolutely"][/conditional][checkbox name="prosu" value="-- PROTECTIVE FACTORS --"][conditional field="prosu" condition="(prosu).is('-- PROTECTIVE FACTORS --')"][checkbox value="Pt is treatment responsive|Pt is well connectedness to individuals, family, community, and social institutions|good problem-solving skills|effective coping skills|an ability to adapt to change|Pt's sense of purpose or meaning in life|Pt has cultural, religious, or personal beliefs that discourage self-injury|good social skills|Pt has efective interpersonal skills|Pt has intact reality-testing|ability to manage feelings of anger|good health|access to mental and physical health care|healthy fear of risky behaviours and pain|hope for the future and optimism|sobriety|medical compliance|a sense of the importance of health and wellness|impulse control|Pt has a strong sense of self-worth and self-esteem|a sense of personal control or determination|access to a variety of clinical interventions and support for seeking help|resiliency|expressed reasons for living|being married|being a parent|strong relationships, particularly with family members|opportunities to participate in and contribute to school or community projects and activities|living in a reasonably safe and stable environment|having restricted access to lethal means|sense of responsibility and duty to others|Pt is employed in a job they enjoy|Pt has children who rely on them|Pt is a pet owner"][/conditional][checkbox name="stat" value="-- STATIC RISK FACTORS --"][conditional field="stat" condition="(stat).is('-- STATIC RISK FACTORS --')"][checkbox value="Genetic vulnerability|family Hx of psychiatric disorders|Hx of denying the need for service contact|Hx of avoiding of service contact|non-responsiveness to pharmacological treatment|personality disorder|non-responsiveness to psycho-social interventions|recent discharge from a psychiatric facility|chronic stressors|a history of self-harm|a history of previous suicide attempts|previous hospitalization for suicidality|previous hospitalization for self-harm|Hx of psychiatric illness|Hx of substance abuse|unstable personality structure|a background of childhood adversity|having a family history of suicide|family Hx of violence and abuse|exposure to suicide|impulsivity|rigid cognitive style|chronic anxiety|Hx of living in an impoverished environment|lack of healthy attachments|Hx of social isolation|divorced|demographic - male - single age 35-64|problem-solving difficulties|loss of a parent|Hx of trauma|Hx of abuse|Hx of impulsive behavior|Hx of reckless and self-endangering behaviors|Absolutistic thinking|Tunnel vision|Limited capacity for self-‐soothing|Perfectionism|sexual orientation rejected by family|Guns in the home|access to abundant medications|chronic medical illness|chronic pain"][/conditional][checkbox name="acute" value="-- ACUTE RISK FACTORS --"][conditional field="acute" condition="(acute).is('-- ACUTE RISK FACTORS --')"][checkbox value="current suicidal ideation|recent suicidal behaviours|current suicidal plan|plan lethality|preparation behahiours|in an unhealthy or unstable relationship|vocalising threat to suicide|rehearsal behaviours|recent suicide attempt|regrets not dying|acute mood disorder|current substance abuse|increased substance abuse|mood lability|suicide command hallucinations|insomnia|persistent nightmares|unremitting pain|persistent distress|expressed desire to suicide|expressed plan to suicide|persistent agitation|tearful|guarded|withdrawal from services|comorbid MH concerns|feelings of hopelessness|severe anhedonia|severe depression|loss of self-esteem|feelings of shame|feeling intolerably alone|feeling trapped|no reasons for living|loss of purpose and meaning|increased impulsivity|unendurable symptoms of physical health|unendurable symptoms of mental health|substance intoxication|increased recklessness|increased anger|seeking revenge|recent violent behaviours|final act behaviours|stalking|intense jealousy over ex|recent loss of relationship|loss of social support|recent discharge from MHIPU|lack of access to support services|loss of job|financial pressure|loss of status|recent loss or bereavement|recent exposure to suicide|recent social rejection|evolving psychosocial crisis|suicide of close friend|declining health|pending legal issues|pending criminal charges|being victimised|depressed|sad|irritable|loss of interest or pleasure|lack of energy|difficulty in concentration|loss of appetite|thoughts and feelings of worthlessness|guilty ruminations|pronounced sleep difficulties|highly agitated|panic attacks|psychosis"][/conditional][checkbox name="Dyna" value="-- DYNAMIC RISK FACTORS --"][conditional field="Dyna" condition="(Dyna).is('-- DYNAMIC RISK FACTORS --')"][checkbox value="untreated mental illness|suicidal thinking|homelessness|personality disorder|lack of distress tolerance skills|lack of therapeutic alliance|has access to lethal means|withdrawal from support groups|treatment compliance|abuse of substances|psycho-social stressors|problem-solving|feelings of hopelessness|feelings of anger|lack of professional skills|unmet needs"][/conditional].- RISK MANAGEMENT RECOMMENDATIONS for PATIENT--[checkbox value="hospitalization for imminent risk for suicide|immediate assessment with MH professional|removing lethal means|monitoring by family / friends|informed family of risk|recommended treatment of MH Sx|recommended D&A treatment service|help Pt improving their coping strategies|challenging negative beliefs|emphasizing behavioral control|behavioural activation|increase pleasant activities|provided suicide crisis plan: call 000 or present to ED after hours|provided suicide assessment plan: call ACS after hours or CMH during business hours|PRN medications|alerting supportive individuals|increase psycho-social supports|Encourage reality-testing with family, friends or professionals|provide interruption strategies|after hours numbers provided|Written safety plan provided"]-- SUICIDE Prevention Support for PATIENT --[checkbox value="Asked what steps the Pt can take to keep safe.|Removed / secured harmful items|Planned for Pt to attend a safe space until impulses subside|Arranged for a support person to be with Pt|Arranged hospital admission|Defused emotional stress by allowing ventilation of feelings|Allowed the patient to tell his/her story and help him/her understand their situation and reactions.|Provided practical support and reassurance.|Helped the patient identify coping strategies and skills used to get through difficult times in the past.|Helped the patient problem-solve and identify alternative solutions and ways of coping.|Mobilized family and friends to assist in providing support|referred to counsellor for problem-solving, understanding, and individual work|Helped connect the patient to available supports, services and resources in their community"]-- RISK PLAN PRINTED and GIVEN to Pt--Warning signs (thoughts, images, mood, situation, behavior) that a crisis may be developing:[textarea default=""]People that provide distraction:[textarea default=""]People whom I can ask for help:[textarea default=""]Professionals or agencies I can contact during when my risk is increasing:1 Lismore Acute Care Team 6620 2323 (4:30pm-10pm Weeknights all day Sat & Sun) 2 Mental Health Access Line 1800 011 511 3 Duty Officer or case manager 9:30am-4:30pm 6620 2300 4 https://www.healthdirect.gov.au/mental-health-helplinesSteps during a crisis:1 Go to the nearest ED if after hours 2 Present to Community Mental Health during weekday business hours 3 Request family or friend take you to ED if you're unable to get there 4 Call 000 if unable to attend ED 5 Request family or friend call 000 if unable to call yourselfThe one thing that is most important to me and worth living for is:[textarea default=""]-- DISTRACTION TECHNIQUES --Feeling angry:• Slash an empty plastic drink bottle • Rip up old clothing • Slash a piece of heavy cardboard • Squeeze ice • Do something that will give you a sharp sensation, like eating lemon • Make a soft cloth doll to represent the things you are angry at. Cut and tear it instead of yourself • Flatten aluminium cans for recycling • Hit a punching bag • Exercise and listen to angry music • Break junk up with a hammer • Rip up an old newspaper or phone book • On a sketch or photo of yourself, mark in red ink what you want to do. Cut and tear the picture. • Make clay models and cut or smash them • Throw ice against a brick wall hard enough to shatter it • Dance • Clean • Bang pots and pans • Stomp around in heavy shoes • Play sport • Play video gamesFeeling sad or depressed:• Do something slow and soothing • Take a hot bath with bath oil or bubbles • Curl up under a soft blanket with hot cocoa and a good book • Baby yourself somehow • Give yourself a present • Hug a loved one or stuffed animal • Play with a pet • Make a list of things that make you happy • Do something nice for someone else • Light sweet-smelling incense • Listen to soothing music • Smooth nice body lotion into the parts of yourself you want to hurt • Call a friend and just talk about things that you like • Make a tray of special treats • Watch TV or read • Visit a friendCraving sensation/Feeling empty or unreal:Squeeze ice • List the many uses for a random object. (For example, what are all the things you can do with a twist-tie?) • Interact with other people • Put a finger into a frozen food (like ice cream) • Bite into a hot pepper or chew a piece of ginger root • Rub vicks under your nose • Slap a tabletop hard • Take a cold shower • Stomp your feet on the ground • Focus on how it feels to breathe • Notice the way your chest and stomach move with each breathWanting focus:• Do a task that is exacting and requires focus and concentration. Eat a raisin mindfully. Notice how it looks and feels. Try to describe the texture. How does a raisin smell? Chew slowly, noticing how the texture and even the taste of the raisin change as you chew it. • Choose an object in the room. Examine it carefully and then write as detailed a description of it as you can. • Choose a random object, like a twist-tie, and try to list 30 different uses for it. • Pick a subject and research it on YouTube.Feeling guilty or like a bad person:• List as many good things about yourself as you can. • Read something good that someone has written about you. • Talk to someone that cares about you. • Do something nice for someone else. • Remember when you’ve done something good. • Think about why you feel guilty and how you might be able to change it.Express Yourself:• Write down your feelings in a diary. • Write a story • Talk to a counsellor • Draw or color. • Make yourself laugh (pull faces in the mirror and talk in a weird voice) • Dance • Start a blog – perhaps you can write about how you get through difficult times to help others going through similar experiences. • Make a playlist of songs that can help you – these can be sad, happy or uplifting songs. • Learn a new song – listen to it on repeat until you have learnt the lyrics off by heart. • Make a Hope Book or a Hope Box – see our resources for ideas on this. • Decorate your room. • Try cooking or baking a new recipe. • Play with kinetic sand – mold it, shape it or cut it up. • Make shapes using weavesilk.com – also available on iOS and Android. Other interactive distractions can be found at neave.comKeep Busy• Play a game. • Listen to music. • Read. • Take a shower. • Open a dictionary and learn new words. • Do homework. • Cook. • Dig in the garden. • Clean. • Watch a feel-good movie.Do Something Mindful• Count down slowly from 10 to 0. • Breathe slowly, in through the nose and out through the mouth. • Focus on objects around you and thinking about how they look, sound, smell, taste and feel. • Do yoga. • Meditate. • Learn some breathing exercises to aid relaxation. • Concentrate on something that makes you happy: good friends, good times, laughter, etc. • Watch ASMR videos on YouTube-- COPING STATEMENTS --"Stop, and breathe, I can do this""This will pass""I can be anxious/angry/sad and still deal with this""I have done this before, and I can do it again""Although this feels bad, it is a normal body reaction. It will pass""Although this feels bad -- feelings are not facts""These are just feelings, they will go away""This won`t last forever""Others have endured worse, and triumphed in the end""I can feel bad and still choose to take a new and healthy direction""I don`t need to rush, I can take things slowly""I have survived before, I will survive now""I feel this way because of my past experiences, but I am safe right now""I'm stronger than I think""It`s okay to feel this way, it`s a normal reaction""Right now, I am not in danger. Right now, I`m safe""My mind is not always my friend""Thoughts are just thoughts. They are not necessarily true or factual""I will learn from this experience, even if it seems hard to understand right now""This is difficult and uncomfortable, but it is only temporary""I choose to see this challenge as an opportunity""I can use my coping skills and get through this""I can learn from this and it will be easier next time""Keep calm and carry on"
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