This document discusses suicide risk assessment and intervention. It provides information on: - The common purposes of suicide as seeking a solution to problems and ending suffering. - Warning signs of suicide risk like hopelessness, helplessness, and escape-seeking behaviors. - Key risk factors like depression, previous attempts, substance abuse, and relationship or health problems. - Effective questions to ask someone expressing suicidal thoughts to determine risk and get help like "Have you thought about killing yourself?" and eliciting details of plans, history, reasons for living, and willingness to seek help. - The importance of active listening, persuading the person to get help, and referring them to emergency services if at high risk.

1. Brenda L. Melton,
Ph.D., LPC-S, NBCT
The University ofTexas
at SanAntonio

2. “The common purpose of suicide is to seek a solution.
Suicide is not a random act. It is never done pointlessly
or purposelessly. It is a way out of a problem, a
dilemma, a bind, a crisis, an unbearable situation. It has
an inexorable logic and impetus of its own… Every
suicide makes this statement:‘This far, and no further.’”
Edwin Scheidman, Ph.D.

3. I find hope in the
darkest of days,and
focus in the brightest.
I do not judge the
universe.
~Dalai Lama
80 Million Reasons

4.  To seek a solution to one or more seemingly insoluble
problems
 Bad grades
 Failed relationship
 Not getting accepted to college
 A personally humiliating exposure
 No suicide is a random act; all have purpose and
meaning
 Solve the problem and suicide loses it appeal

5.  Helplessness
 “I can’t do anything to fix what is wrong.”
 Hopelessness
 The utter belief that nothing will ever be right or well or
bright again forever and ever.

6. “Suicide is a
permanent solution
to a temporary
problem.”
Phil Donohue

7.  Escape
 Suicide provides a way out when none is
otherwise perceived.
 For humans, there is always a well lighted exit
sign over the door to death.

8.  A previous suicide
 Talking about being dead or wishing they were dead
 Repeatedly engaging in very risky or dangerous thrill
seeking behavior.
 "Getting the house in order"
 Extreme mood swings
 Regular expressions of worthlessness, helplessness,
sadness and/or loneliness.

9.  Drastic changes in habits, friends, or appearance, ie;
new friends, skipping school, dropping out of favorite
activities, and no longer caring about appearance or
cleanliness.
 Changes in weight, sleeping habits, and physical
activity.
 Withdrawing from friends, family, or activities that
once gave the person pleasure or a sense of identity

10.  Sex (male)
 Age (younger than 19 or older than 45 years of age)
 Depression (severe enough to be considered clinically
significant)
 Previous suicide attempts or received mental health
services of any kind
 Excessive alcohol or other drug use

11.  Rational thinking lost
 Separated, divorced, or widowed (or other ending of
significant relationship)
 Organized suicide plan or serious attempt
 No or little social support
 Sickness or chronic medical illness
Retrieved from Medicinenet.com

12. Assessment is based on:
 How much we learn from the person
 The context in which suicide is being considered
 Recognition of warning signs
 Presence of risk factors
 Presence of protective factors
 What the suicidal person is willing to do to help us save his or
her life

13.  Have you had thoughts of killing yourself?
 Are you considering suicide?
 Are you contemplating ending your life?
 Have you had any personal thoughts of death or
suicide?

14. Q for Question the person about suicide
P for Persuade the person to get help
R for Referring the person to someone who
can help

15. What is wrong?
Elicits the person’s narrative explanation or
“story.”
 Person’s perspective
 Value in story telling/emotional release
 Clarify and understand

16. Elicits the precipitating event or events
 Current crisis
 Hopeless a long time
 Magnitude of change event doesn’t matter
 No reserves left
 Hair trigger condition
 Final straw
“I just can’t take it anymore.”

17. Elicits methods of suicide under
consideration
 Only so many ways to die
 How (name them)
 Access to means
 More than one method
 Degree of lethal planning
 Backup plan

18. Elicits possible location and timing of a
suicide attempt
 Lethal planning (less is good)
 Soon, Next week, Next year
 Anniversary date
 Uncontrolled contingency, e.g.,“If she leaves.”
 Home or work
 Chance of rescue

19. Elicits important suicide history
 Past attempts
 Past suicidal ideation
 Rescue sought or avoided
 Timing of attempt
 Social response to attempt
 What saved them
 New method vs. old method

20. Elicits protective factors
 Reasons for living
 Spiritual or religious prohibitions
 Duties to others/pets
 Tidying up or‘to do list’ before dying
 Fear of death
 More reasons is good, none is bad
 Low risk does not equal no risk

21.  Your active listening and questions may have already
won the battle
 Find life-affirming solutions
 Greater risk
 Refusal to seek help
 Angry
 Unwillingness to give up means
 Refuse help- reassess risk

22.  Relationship
 Trust
 Resources
 ‘How to’ instructions
 Personalize the endorsement

23. Suicide risk is
determined, in large
part, by the person’s
willingness to assume
personal
responsibility for his
or her own safety.

24.  What do you do if it is an emergency, life or death,
situation?
 If possible, call the parents, inform them of what is
going on
 Have emergency personnel transport person to the
Emergency Room. The ER will do a complete
evaluation:
 Physician’s Evaluation
 Mental Health Evaluation
 Admit to the hospital or refer to services in the Community

25. The most authentic
thing about us is our
capacity to create, to
overcome, to endure,
to transform, to love,
and to be greater than
our suffering.”
Ben Okri