Assessment of suicide risk

Family-focused, social-learning-theory-based interventions for the management of suicide risk emphasize the importance of adopting a structured problem-solving approach that takes account of the child’s or adolescent’s personal features and the social context within which the suicide attempt was made (American Academy of Child And Adolescent Psychiatry, 2001a; Berman & Jobes, 1996; Brent, 1997; Carr, 2002b; Lerner & Clum, 1990; Shaffer & Gutstein, 2002; Richman, 1984; Rotherham-Borus et al., 1994, 1996). The over-riding objective of a family consultation where suicide has been threatened or attempted is to prevent harm, injury or death from occurring. Certain broad principles for assessment may be followed. First, offer immediate consultation. Second, use the consultation process to develop a comprehensive understanding of the situation surrounding the suicide threat or attempt. Third, during the consultation process, establish or deepen your working alliance with all significant members of the network. Fourth, assess all of the factors mentioned below and listed in Table 16.7. Check if the factors were present in the past, the extent to which they were present during the recent episode, and whether they are immediately present. Where possible, obtain information relating to risk factors from as many members of the network as possible. This includes the youngster who has threatened selfharm or attempted suicide, key members of the family, and previously involved professionals. Fifth, identify people within the youngster’s social network and the professional network that may be available to help implement a management plan. Sixth, draw the information you obtain into a clear formulation on which a management plan can be based. The formulation must logically link the risk factors identified in the case together to explain the occurrence of the episode of self-injurious behaviour and the current level of risk. It is important to specify pre-disposing factors and triggering factors that led to an escalation from suicidal ideation to intention or from suicidal intention to self-injury. The management plan must specify the short-term action to be taken in the light of the formulation. The plan must logically indicate that the changes it entails will probably lower the risk of self-harm. It is also vital that until the risk of suicide has reduced, the youngster and the parents make a contract at the conclusion of each session to return to meet the clinician at a specified time. For the youngster, this contract involves making a commitment to not make further suicide attempts. For the parents or carers, the contract involves making a commitment to monitor the youngster so as to prevent further suicide attempts.