suicide risk

Suicide Risk Assessment:

I am updating patient name's suicide risk assessment [checkbox value="as part of their 13-week risk reassessment|due to a change in circumstances surrounding they risk of suicide."] 

When asked about thoughts of suicide, patient name identified having [checkbox name="sucon" value="nil current concerns about suicide|current thoughts about suicide|and has plans and / or intent to suicide"][conditional field="sucon" condition="(sucon).is('current thoughts about suicide')||(sucon).is('and has plans and / or intent to suicide')"]. When asked what might have contributed to this recent change in risk, patient name identified [checkbox value="a relationship break-up|a loss of friendship|a relationship conflict|a legal problem|a disciplinary issue|an anniversary of someone else's suicide|a pregnancy|a fear of being pregnant|a loss of freedom|physical abuse|sexual abuse|bullying from peers|bullying|humiliation|loss of self-esteem|parental disappointment|parental disapproval|false accusations|loss of social status|threats to loss of children|loss of employment|an increase in mental health symptoms|symptoms associated with a medical problem|worrying about academic failure|worrying about disappointing others|nothing in particular, just an overwhelming feeling of wanting to end their life|such that suicide seems like a viable solution."][/conditional]. 

[textarea cols=90 rows=20 default="other notes about recent risk"].

There were [checkbox name="warning" value="no warning signs of an increased suicide risk identified during this assessment|some warning signs that patient name may be at an increased risk of suicide because of"][conditional field="warning" condition="(warning).is('some warning signs that patient name may be at an increased risk of suicide because of')"] [checkbox value="they openly expressing threats of suicide|they threatening to self-harm|they seeking access to lethal means|they having recently acquired lethal means|they talking about death and suicide|they writing about death and suicide|they increased they substance abuse|they having recently lost a reason for living|they having recently lost of sense of purpose for living|they being in an 'at risk' mental state (hopelessness, despair, agitation, shame, guilt, anger, psychosis, psychotic thought processes)|they recently experiencing an interpersonal rejection / humiliation|they recently experience of a major loss|they recently experiencing the anniversary of a major loss|they being presently intoxicated|they being presently in a drug-withdrawal state|they experiencing chronic pain|they experiencing a medical illness|they recent experience of a major financial difficulty|they recently being made unemployed|they impending legal prosecution|they recently experiencing a major family breakdown|they experiencing child custody difficulties|they feeling trapped|they experiencing increased anxiety|they appearing to be agitated|they being unable to sleep|they expressing new feelings of hopelessness|they recent social withdrawl|they being uncharacteristically happy after a period of depression|they reporting significant neuro-vegetative changes|they settling practical affairs (making a will, giving away possessions etc.)"][/conditional].

There were [checkbox name="statsu" value="no static factors identified that predispose patient name to an elevated risk of suicide, relative to a non-clinical population|static factors identified that predispose patient name to an elevated risk of suicide, relative a non-clinical population"][conditional field="statsu" condition="(statsu).is('static factors identified that predispose patient name to an elevated risk of suicide, relative a non-clinical population')"] such as: [checkbox value="they denying the need for service contact|they avoidance of service contact|they non-responsiveness to pharmacological treatment|they non-responsiveness to psycho-social interventions|having chronic stressors|having a history of self-harm|having a history of previous suicide attempts|they previous hospitalization for suicidality|they previous hospitalization for self-harm|they history of psychiatric illness|they history of substance abuse|they having a diagnosed personality disorder|they having a background of childhood adversity|they having a family history of suicide|they belonging to a higher risk demographic group (age, gender, marital status) for suicide|they having problem-solving difficulties"][/conditional]. 

There were [checkbox name="dysu" value="no dynamic factors identified that predispose patient name to an elevated risk of suicide, relative to a non-clinical population|dynamic factors identified that predispose patient name to an elevated risk of suicide, relative a non-clinical population"][conditional field="dysu" condition="(dysu).is('dynamic factors identified that predispose patient name to an elevated risk of suicide, relative a non-clinical population')"] such as [checkbox value="expressing suicidal intent|articulating feelings of hopelessness|the psychological symptoms associated with they mental health diagnosis|they treatment compliance|they abuse of substances|they recent discharge from a psychiatric unit|psycho-social stressors"][/conditional].

There were [checkbox name="prosu" value="no protective factors identified to buffer patient names risk of suicide|protective factors identified that may buffer patient name against the risk of suicide"][conditional field="prosu" condition="(prosu).is('protective factors identified that may buffer patient name against the risk of suicide')"] which include [checkbox value="treatment responsiveness|they connectedness to individuals, family, community, and social institutions|they problem-solving skills|they coping skills|they ability to adapt to change|they sense of purpose or meaning in life Cultural, religious, or personal beliefs that discourage self-injury|they good social skills|they ability to manage feelings of anger|they good health|they access to mental and physical health care|they healthy fear of risky behaviours and pain|they hope for the future and optimism|they sobriety|they medical compliance|they sense of the importance of health and wellness|they impulse control|they strong sense of self-worth or self-esteem|they sense of personal control or determination|they access to a variety of clinical interventions and support for seeking help|they resiliency|they expressed reasons for living|they being married|they being a parent|they strong relationships, particularly with family members|they opportunities to participate in and contribute to school or community projects and activities|they living in a reasonably safe and stable environment|they having restricted access to lethal means|they sense of responsibility and duty to others|they being a pet owner"][/conditional].

[comment memo="Use the 4P's (Predisposing, Precipitating, Perpetuating, Protective) within a biological, psychological, and social framework."]

[comment memo="For example: Jenny is a 30-year-old temp worker, living with her de-facto partner in a tenuous relationship. She was admitted 12 days ago following a manic relapse on the background of severe bipolar disorder and alcohol abuse. 

Jenny has a genetic vulnerability to bipolar disorder (aunts) and to her alcohol abuse (father). Several untreated relapses into depression and mania have further primed her for this current relapse. She described her father modelling drinking-behaviours to cope with stress; his binges were also followed by absences from the family. Jenny's mother, angered by her husbands drinking, remained cold and aloof throughout Jenny's childhood. Jenny’s current relationship instability and disatisfaction may mirror her parent's relationship. Her low self-esteem and reliance on others to make decisions leave her prone to exploitation and perpetuate low self-worth. 

The trigger for the current relapse appears to be non-adherence with medication preceded by an alcohol binge. This occurred in the context of Jenny’s partner threatening to leave her. Jenny has worked a series of different jobs, most of which were foreshortened by relapses of her bipolar disorder and subsequent hospitalizations. Financial stress is ever present, rekindling noxious childhood memories and threatening her sense of security. Binge drinking to escape her predicament compounds non-adherence to medication thereby furthering her relapses in mania, which becomes a viscous cycle. 

Jenny does, however, have a series of kind, caring friends. Her desire to re-establish involvement in her local church is positive, as is her willingness to engage with her case manager and psychiatrist. She is thankfully physically well despite many years of binge drinking. Whilst not academically minded, Jenny conveys a desire to learn new skills and find meaningful work."]