MH Suicide Risk Planning

Suicide Risk Report for [text name="Name"]
Assessment date and time: [text name="date"]

-- SUICIDE RISK SUMMARY -- 

Risk State (risk compared to Pts usual baseline): [checkbox value="higher than|similar to|lower than"] the Pts usual baseline of risk.

Risk Status (risk relative to a specified subpopulation): [checkbox value="higher than|similar to|lower than"] the general population, and [checkbox value="higher than|similar to|lower than"] other Pts in the current service setting.

Foreseeable changes in risk: 

[textarea default=""]

Available resources immediately accessible to the Pt: 

[textarea default="Help line numbers, Acute Care Team, PRN meds, Friends, Family, Counsellor, Community Mental Health Clinician, Disability Support Worker, NGO Caseworker"]

-- PATIENT REPORT --

Pt confirmed having [checkbox name="freq" value="no suicidal thoughts.|suicidal thoughts"][conditional field="freq" condition="(freq).is('suicidal thoughts')"] [checkbox value="every now and then|every other day|every day"], and rated these thoughts as [checkbox value="mild|moderate|severe"] in their intensity. 

When asked about having suicide plans, the patient reported: [checkbox value="no current plans|vague plans|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="stat" value="-- ENDURING RISK FACTORS --"][conditional field="stat" condition="(stat).is('-- ENDURING RISK FACTORS --')"] 

Strengths and Protective Factors

[checkbox value="treatment responsiveness|connectedness to individuals, family, community, and social institutions|problem-solving skills|coping skills|ability to adapt to change|they sense of purpose or meaning in life Cultural, religious, or personal beliefs that discourage self-injury|good social skills|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|they strong sense of self-worth or 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|being a pet owner"]

Long-term Risk Factors

[checkbox value="Hx of denying the need for service contact|Hx of avoiding service contact|Dx of eating disorder|Dx neurological disorder|persistent psychotic illness|non-responsiveness to pharmacological treatment|non-responsiveness to psycho-social interventions|chronic stressors|Hx of psychiatric illness|long-standing fascination with death|social isolation|romantises death and dying|Hx of discrimination|a background of childhood adversity|having a family history of suicide|a disruptive and unsupportive family background|Dx of PTSD|combat veteran|background of being a first responder|Hx of relationship conflicts|divorced|complex family dynamics|unsupportive family|demographic - male - single age 35-64|substance misuse|absolutistic thinking|tunnel vision|perfectionism|sexual orientation rejected by family|guns in the home|access to abundant medications|chronic medical illness|chronic pain"]

Impulsivity/Self Control

[checkbox value="Hx of impulsive behaviour|problem-solving difficulties|unstable personality structure|Hx of substance abuse|low threshold for boredom|Hx of provocative behaviours|Dx with ABI|Dx with intellectual disability|Dx with developmental delay|Pt struggles with decision-making|Hx of sensation seeking behaviours|Pt struggles to delay gratification|Pt struggles to self-regulate emotions|low threshold for emotional arousal|Pt struggles to maintain goal focus|external locus of control|Hx of reckless self-endangerment|Pt struggles to inhibit aggression|limited capacity for self-soothing|low expecations for positive future|Dx with ADHD|Pt remains pre-occupied with suicide"]

Past Suicidal Behaviour

[checkbox value="history of self-harm|history of previous suicide attempts|previous hospitalization for suicidality|previous hospitalization for self-harm"][/conditional]

[checkbox name="Dyna" value="-- DYNAMIC RISK FACTORS --"][conditional field="Dyna" condition="(Dyna).is('-- DYNAMIC RISK FACTORS --')"] 

Recent/present suicide ideation or behaviour

[checkbox value="current suicidal ideation|has a suicide plan|suicide plan has high lethality|preparation behahiours|vocalising threat to suicide|rehearsal behaviours|access to lethal means|recent suicide attempt|Pt regrets not dying|mood lability|persistent agitation|tearful|guarded|withdrawal from services|increased impulsivity|increased recklessness|increased anger|seeking revenge|recent violent behaviours|final act behaviours"]

Stressors / precipitants

[checkbox value="financial loss|poor health|pending incarceration|detention|stressful loss|rejection|sense of being a burden|feeling alone|feeling isolated|suicide contagion in community|feeling trapped|recent humiliation|recent assualt|social rejection|anniversary of loss|suicide command hallucinations|argument with intimate|relationship conflict|loss of status|loss of self-esteem|loss of purpose and meaning|loss of social support|recent loss of job|suicide of an intimate"]

[textarea default=""]

Symptoms, suffering and recent changes

[checkbox value="increased depressive symptoms|reports inner torment|persistent negative thoughts about self|reports self-hatred|social media posts about suicide|persistent crying|final act behaviours|mental illness Sx|unremitting pain|recent discharge from MHIPU|feeling trapped|increased substance abuse|persistent self-devaluation|no reasons for living|stalking|comorbid MH concerns|increasing impulsivity|being victimised|pending unemployment|increasing financial pressures|persistent nightmares|increasing financial pressure|recklessness|feeling out of control|feeling intolerably alone|withdrawal|feeling anger|icreased anxiety|panic|fear|agitation|hopelesness|pending legal issues|negative appraisals of self|insomnia|intense jealousy over ex|low expectation for recovery|pending criminal charges|declining health|feelings of shame|change in sleep patterns|change in appetite|access to lethal means|unmet needs|feelings of anger"]

[textarea default=""][/conditional]

-- RESPONSE --

[checkbox value="No action taken|provided brief supportive counselling|actively listened and validated Pt concerns|referred Pt to suicide prevention service|hospitalization recommended|immediate assessment with MH professional recommended|discussed Pt with supervisor|discussed Pt with MDT|supported Pt to remove lethal means|arranged monitoring by supportive person|informed family of risk|advised primary health provider of risk|recommended Pt seek treatment of MH Sx|recommended D&A treatment service|recommended counselling|helped Pt improve coping strategies|challenged Pts negative beliefs|emphasized behavioural control|encouranged behavioural activation to enhance mood|recommended pleasant activities|recommended to call 000 or present to ED after hours if needed|recommended Pt to call Acute Care Team after hours or Community Mental Health outpatients during business hours if Sx worsen|recommended use of PRN medications|alerted supportive individuals|recommended increasing psychosocial supports|encouraged reality-testing with family, friends or professionals|provided interruption strategies for troubling thoughts|after hours numbers provided|written safety plan provided"]

[textarea default="Supported Pt to modify risk factors:"]

[textarea default="Will follow-up with Pt in X hours/days/weeks"]

[checkbox name="Safe" value="-- SAFETY PLAN --"][conditional field="Safe" condition="(Safe).is('-- SAFETY PLAN --')"] 

Encouraged Pt to make the environment safe by suggesting:
  
- remove or secure harmful items
- going to another location until the urges have passed
- getting another person involved to help

Warning signs (thoughts, images, mood, situation, behaviour) that a crisis may be developing:

[textarea default=""]

People who can provide distraction

[textarea default=""]

People to ask for help

[textarea default=""]

Professionals or agencies to contact when feeling unsafe:

1 Acute Care Team (after hours)
2 Mental Health Support Lines
3 Community Mental Health (business hours)

[textarea default=""]

Steps during a crisis:

1 Go to the hospital emergency room if possible
2 Request family or friend drive them to ED if unable to get there
3 Call an ambulance if unable to attend ED
4 Request family or friend call an ambulance if unable to call

The one thing that is most important to me and worth living for is

[textarea default=""][/conditional]

[checkbox name="DIST" value="-- Recommended Distraction Techniques --"][conditional field="DIST" condition="(DIST).is('-- Recommended 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 games

Feeling 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 friend

Craving sensation OR 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 breath

Wanting 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 the web.

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 – mould 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.com

Keep 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 FOR PATIENT --

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

This feels bad, it is a normal body reaction.  It will pass

This feels bad, and feelings are very often wrong

These are just feelings, they will go away

This won`t last forever

Short term pain for long term gain

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[/conditional]