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]
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