Assessing for Suicide

Suicide Assessment Warning Signs

Warning signs are often a way to reach out and ask for help and must always be taken seriously. However, keep in mind that a person thinking about suicide and reaching out for help is often in less danger than someone who is thinking about suicide and not sending out any signals. That is often because a person who is not asking for help may have decided that suicide is their only option. Once that decision is made, that person may do their best not to say or act in a way that suggests they may be suicidal because they do not want to be stopped. Those individuals are, of course, the most difficult to identify.

Common warning signs for suicide assessment include the following signs/symptoms:

A. Verbal

  • DIRECT: “I am going to kill myself.”

  • INDIRECT: “You are all going to be sorry, when I am no longer here.” “My life is not worth living anymore.”

B. Psychological

  • long-term depression or a condition such as bipolar disorder

  • feeling helpless

  • feeling hopeless

  • feeling overwhelmed

  • feeling sad

C. Emotional

  • pre-occupation with death

  • dissociation

  • lack of appetite/overeating

  • sleep disturbances

  • poor concentration

  • isolation

  • crying

D. Behavioral

  • low self-esteem

  • inability to perform daily tasks

  • previous suicide attempts

  • risky or impulsive behavior

  • sudden poor school or job performance

  • giving away important things

  • lack of interest in things previously enjoyed

  • suddenly refraining from activities with family and friends

  • sudden unexplained recovery from depression, sudden positive outlook- like the person is fine

E. Situational

  • school or career problems

  • loss of job/career

  • death of a loved one or peer

  • suicide of a loved one or peer

  • relationship break-up/separation/divorce

  • multiple losses

  • terminal illness

Things you should ask and do:

Are you thinking of hurting yourself (taking your life)?

  • How long have you been thinking about suicide (frequency, intensity, duration)?

  • Do you have a plan? Get specific information if there is a plan. • Do you have the means to carry out the plan (accessibility of a weapon, pills, drugs, etc.)?

  • Have you attempted suicide before?

  • Has someone in your family died bysuicide?

  • Is there anything or anyone to stop you (religious beliefs, children left behind, pets, etc.)?

Depending on the responses:

  • Set up a suicide contract.

  • Provide the client with emergency/crisis numbers.

  • Explore what resources are available, e.g. family support, friends, etc.

  • Develop a plan to deal with potential weapons, medications, drugs, etc.

  • Increase frequency of counseling sessions, possible phone check-ins

  • Assess the need for getting the client assessed for medications

  • Assess the need to contact the “crisis team” if one is available, either through your local government or a mental health clinic.

  • Hospitalize client if necessary and only if no other feasible options exist, as hospitalization can be traumatizing, frightening, and even counter productive.

 
Danielle Spires