MH Suicide Risk Planning

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

-- SUICIDE RISK SUMMARY -- 

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]

Risk state is [checkbox value="higher than|similar to|lower than"] the Pts usual baseline of risk.

Risk status is [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"]

[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 friends|supportive family|community involvement|involed with social institutions|problem-solving skills|coping skills|ability to adapt to change|has a sense of purpose or meaning in life|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"]

Socio-demographic Risk Factors:

[checkbox value="nil known|social isolation|unemployment|low socioeconomic status|low education|single|low income|living alone|non-religious|no children"]

Family History Factors:

[checkbox value="nil known|family Hx of mental health|suicide of family member|suicide attempt of family member"]

Clinical Factors:

[checkbox value="nil known|unspecified mental health Dx|depression|schizophrenia|bipolar disorder|substance use disorder|alcohol use disorder|anxiety disorder|dysthymia|unspecified personality disorder|borderline personality disorder|paranoid personality disorder|dependent personality disorder|avoidant personality disorder|antisocial personality disorder|Hx of psychiatric treatment|Hx of self-harm|previous suicide attempt|smoker|physical illness"]

Adverse Life Events:

[checkbox value="nil known|relationship conflict|legal problems|family-related conflict|abuse|victimization|financial problems|early separation from parents|work-related conflict|school conflict"]

Australia Specific Risk:

[checkbox value="not applicable|male|male aged 15 to 24|male aged 45 to 54|female aged 25 to 54|male aged over 85|Indigenous Australian male aged 15 to 24|rural and remote resident|diagnosis of depression|diagnosis of bipolar disorder|diagnosis of substance abuse disorder|diagnosis of anxiety disorder|diagnosis of schizophrenia|diagnosis of PTSD|chronic illness or pain|history of suicide attempts|family history of suicide|social isolation|recent traumatic events|history of abuse or trauma|LGBTQ+ identity|financial stress|unemployment|low socio-economic status|veteran"].

Shneidman's criteria:

[checkbox value="nil known|intense psychological pain that feels unbearable to the individual|self-destructive behaviours|life stressors that contribute to mental distress|high levels of emotional turmoil or agitation|the fatal potential of the method considered for suicide|a deep sense of despair about the future|subtle hints or behaviours suggesting suicidal thoughts|drug or alcohol use|previous attempts|recent losses like personal, financial, or professional|the belief that there are no solutions other than suicide"]

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="nil known|history of self-harm|history of previous suicide attempts|previous hospitalization for suicidality|previous hospitalization for self-harm"]

Time elapsed since suicide attempt:

[checkbox value="not applicable|within 1 month|within 3 months|within 6 months"][/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:

[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="stat1" value="-- Feeling Angry Strategies Provided --"] [conditional field="stat1" condition="(stat1).is('-- Feeling Angry Strategies Provided --')"] [checkbox value="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"] [/conditional]

[checkbox name="stat2" value="-- Feeling Sad Strategies Provided --"]
[conditional field="stat2" condition="(stat2).is('-- Feeling Sad Strategies Provided --')"] [checkbox value="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"]    [/conditional]

[checkbox name="stat3" value="-- Feeling Empty Strategies Provided --"] [conditional field="stat3" condition="(stat3).is('-- Feeling Empty Strategies Provided --')"] 
[checkbox value="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"] [/conditional]

[checkbox name="stat4" value="-- Focus Strategies Provided --"]
[conditional field="stat4" condition="(stat4).is('-- Focus Strategies Provided --')"] [checkbox value="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."] [/conditional]

[checkbox name="stat5" value="-- Feeling Guilty Strategies Provided --"]
[conditional field="stat5" condition="(stat5).is('-- Feeling Guilty Strategies Provided --')"] [checkbox value="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."] [/conditional]

[checkbox name="stat6" value="-- Self Expression Strategies Provided --"]   
[conditional field="stat6" condition="(stat6).is('-- Self Expression Strategies Provided --')"] [checkbox value="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"][/conditional]

[checkbox name="stat7" value="-- Keeping Busy Strategies Provided --"] [conditional field="stat7" condition="(stat7).is('-- Keeping Busy Strategies Provided --')"] [checkbox value="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."] [/conditional]

[checkbox name="stat8" value="-- Mindful Strategies Provided --"] [conditional field="stat8" condition="(stat8).is('-- Mindful Strategies Provided --')"] [checkbox value="Count down slowly from 10 to 0.|Breathe slowly, in through the nose and out through the mouth.|Focus on objects around you and think 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."]    [/conditional]

[checkbox name="stat9" value="-- Coping Statement Provided --"]    [conditional field="stat9" condition="(stat9).is('-- Coping Statement Provided --')"] [checkbox value="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]