EFTA00032191.pdf
1.21 MB
Extraction Summary
4
People
2
Organizations
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Locations
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Events
1
Relationships
4
Quotes
Document Information
Type:
Administrative template / medical form
File Size:
1.21 MB
Summary
This document is a blank template for the 'PDS-BEMR Suicide Risk Assessment Guide - Version 3'. It provides a structured protocol for evaluating inmates for suicide risk, including checklists for static and dynamic risk factors, protective factors, and mental status exams. The guide defines various levels of lethality and acute risk, outlines the 'Suicidal Mode' via flowcharts, and includes forms for post-suicide watch reporting and progress notes.
People (4)
| Name | Role | Context |
|---|---|---|
| Christopher Bush | Guide Developer |
Credited in footer for the development of the guide
|
| Scott Forbes | Guide Developer |
Credited in footer for the development of the guide
|
| Granello | Researcher/Author |
Cited in text (2011) regarding suicide risk assessment principles
|
| Sanchez | Researcher/Author |
Cited in text (2001) regarding protective factors
|
Organizations (2)
| Name | Type | Context |
|---|---|---|
| PDS-BEMR |
Psychology Data System - Bureau Electronic Medical Record (implied system name in title)
|
|
| United States Public Health Service |
Cited in text (1999) regarding protective factors
|
Relationships (1)
Both credited for the development of this guide in the footer of the document.
Key Quotes (4)
"Suicide Related Communication: Any verbal or non-verbal interpersonal communication of thoughts, wishes, or intent for suicide that does NOT produce self-injury."Source
EFTA00032191.pdf
Quote #1
"Non-Suicidal Self Directed Violence: If there is no evidence, whether implicit or explicit, of suicidal intent it is not an attempt, it is Non-Suicidal Self-Directed Violence – Behavior that is self-directed and deliberately results in injury or the potential for injury to oneself."Source
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Quote #2
"High Acute Risk: Frequent, intense, and enduring suicidal ideation, specific plans. Many risk factors are identified."Source
EFTA00032191.pdf
Quote #3
"ALWAYS consult with another psychologist if NOT putting an inmate on suicide watch (and upon release)."Source
EFTA00032191.pdf
Quote #4
Full Extracted Text
Complete text extracted from the document (15,026 characters)
PDS-BEMR SUICIDE RISK ASSESSMENT GUIDE – Version 3
Key Principles to Consider When Conducting Suicide Risk Assessment (adapted from Granello, 2011):
Suicide Risk Assessment....
1. Is Treatment and Occurs in the Context of a Therapeutic Relationship
2. Is Unique for Each Person
3. Is Complex and Challenging
4. Is an Ongoing Process
5. Errs on the Side of Caution
6. Is Collaborative and Relies on Effective Communication
7. Relies on Clinical Judgement
8. Takes all Threats, Warning Signs, and Risk Factors Seriously
9. Asks the Tough Questions
10. Tries to Uncover the Underlying Message
11. Is Done in a Cultural Context
12. Is Documented
1. Is Treatment and Occurs in the Context of a Therapeutic Relationship
2. Is Unique for Each Person
3. Is Complex and Challenging
4. Is an Ongoing Process
5. Errs on the Side of Caution
6. Is Collaborative and Relies on Effective Communication
7. Relies on Clinical Judgement
8. Takes all Threats, Warning Signs, and Risk Factors Seriously
9. Asks the Tough Questions
10. Tries to Uncover the Underlying Message
11. Is Done in a Cultural Context
12. Is Documented
+ Risk or Protective Factor Present
- Risk or Protective Factor Absent
0 Risk or Protective Factor Not Assessed
- Risk or Protective Factor Absent
0 Risk or Protective Factor Not Assessed
Mental Status Exam: In PDS you will be required to select a value for each of the areas below. You can make additional comments.
O Level of Consciousness
O Psychomotor Activity
O General Appearance
O Behavior
O Mood
O Thought Process
O Thought Content
O Level of Consciousness
O Psychomotor Activity
O General Appearance
O Behavior
O Mood
O Thought Process
O Thought Content
In PDS you will be required to select a value for each of the risk/dynamic/protective factors below:
+ - 0 STATIC FACTORS
OOO Chronic Medical Condition
OOO Family Hx of Suicide
OOO High Profile Crime
OOO Hx of Childhood Abuse
OOO Hx of Psychiatric Hospitalization
OOO History of Mental Illness
OOO Past Suicide Attempt
OOO History of Violent Behavior
OOO Lack of Family Connections
OOO Sex Offender Status
OOO Chronic Medical Condition
OOO Family Hx of Suicide
OOO High Profile Crime
OOO Hx of Childhood Abuse
OOO Hx of Psychiatric Hospitalization
OOO History of Mental Illness
OOO Past Suicide Attempt
OOO History of Violent Behavior
OOO Lack of Family Connections
OOO Sex Offender Status
+ - 0 DYNAMIC FACTORS
OOO Agitation
OOO Current Intoxication
OOO Current Physical Pain
OOO Current Suicidal Ideation
OOO Current Suicidal Intent
OOO Current Suicidal Plan
OOO Fear for Own Safety
OOO Feeling Hopeless/Helpless
OOO Feels Like a Burden
OOO Non-Adherence to Medical Tx
OOO Problem Solving Deficits
OOO Recent Significant Loss
OOO Sleeps Problems
OOO Social Isolation
OOO Uncontrolled Mental Health Issues
OOO Agitation
OOO Current Intoxication
OOO Current Physical Pain
OOO Current Suicidal Ideation
OOO Current Suicidal Intent
OOO Current Suicidal Plan
OOO Fear for Own Safety
OOO Feeling Hopeless/Helpless
OOO Feels Like a Burden
OOO Non-Adherence to Medical Tx
OOO Problem Solving Deficits
OOO Recent Significant Loss
OOO Sleeps Problems
OOO Social Isolation
OOO Uncontrolled Mental Health Issues
+ - 0 PROTECTIVE FACTORS
OOO Able to Identify Reasons to Live
OOO Adequate Problem Solving Skills
OOO Denial of Suicidal Ideation
OOO Future Orientation
OOO Religious Beliefs Against Suicide
OOO Social Support in the Institution
OOO Supportive Family Relationships
OOO View of Death as Negative
OOO Willingness to Engage in Tx
OOO Able to Identify Reasons to Live
OOO Adequate Problem Solving Skills
OOO Denial of Suicidal Ideation
OOO Future Orientation
OOO Religious Beliefs Against Suicide
OOO Social Support in the Institution
OOO Supportive Family Relationships
OOO View of Death as Negative
OOO Willingness to Engage in Tx
Additional validated risk factors that may be relevant: Sentence >20 years; Self-harm in past month; Dual Diagnosis; Male Gender; History of Self-Injurious Behavior; Chronic/Uncontrolled Pain; No Spouse (Single, Divorced, Widowed)
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Suicide Risk Assessment in PDS-BEMR
Suicide Risk Assessment in PDS-BEMR
Classification of Suicide Related Behaviors
Did the inmate communicate regarding self-injury?
Did the inmate communicate regarding self-injury?
Suicide Related Communication:
Any verbal or non-verbal interpersonal communication of thoughts, wishes, or intent for suicide that does NOT produce self-injury.
Actions do not produce self-injury, although they have that intent.
Examples may include
- placing a noose around one's neck in the presence of staff;
- writing a letter that states, "the world would be better without me";
- stating, "I'm going to kill myself."
Any verbal or non-verbal interpersonal communication of thoughts, wishes, or intent for suicide that does NOT produce self-injury.
Actions do not produce self-injury, although they have that intent.
Examples may include
- placing a noose around one's neck in the presence of staff;
- writing a letter that states, "the world would be better without me";
- stating, "I'm going to kill myself."
Suicide Related Behavior:
A self-inflicted, potentially injurious behavior for which there is evidence that the person either (a) wished to use the appearance of a suicide attempt to attain some other end, or (b) intended, to some degree, to kill him/herself.
A self-inflicted, potentially injurious behavior for which there is evidence that the person either (a) wished to use the appearance of a suicide attempt to attain some other end, or (b) intended, to some degree, to kill him/herself.
Was the act motivated by any intent to die?
Yes
No
Undetermined
Yes
No
Undetermined
Suicide Attempt:
A non-fatal self-directed potentially injurious behavior with any intent to die as a result of the behavior. A suicide attempt may or may not result in injury.
A non-fatal self-directed potentially injurious behavior with any intent to die as a result of the behavior. A suicide attempt may or may not result in injury.
Non-Suicidal Self Directed Violence:
If there is no evidence, whether implicit or explicit, of suicidal intent it is not an attempt, it is Non-Suicidal Self-Directed Violence – Behavior that is self-directed and deliberately results in injury or the potential for injury to oneself. This is your judgment and includes inmate self-report. Look at the big picture and account for other data that corroborates or contradicts self-report. This is a distinction that the executive staff and/or the IDO need to have made for them.
If there is no evidence, whether implicit or explicit, of suicidal intent it is not an attempt, it is Non-Suicidal Self-Directed Violence – Behavior that is self-directed and deliberately results in injury or the potential for injury to oneself. This is your judgment and includes inmate self-report. Look at the big picture and account for other data that corroborates or contradicts self-report. This is a distinction that the executive staff and/or the IDO need to have made for them.
Did the act result in any injuries?
Yes or No
Yes or No
Medical interventions are not an injury, but are undertaken to avoid or address an injury.
Lethality Assessment
Indicate the method of self-harm or suicide attempt:
Asphyxiation – Hanging
Asphyxiation – Other
Cutting
Fire
Ingestion – Prescription Medication
Ingestion – Non-Prescription Medication
Ingestion – Other
Jumping
Other
Indicate the method of self-harm or suicide attempt:
Asphyxiation – Hanging
Asphyxiation – Other
Cutting
Fire
Ingestion – Prescription Medication
Ingestion – Non-Prescription Medication
Ingestion – Other
Jumping
Other
Most of these are self-explanatory. Ingestion – Other is appropriate for swallowing razors and other foreign objects.
Lethality Risk:
Lethality Risk:
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Low Lethality:
- Death is impossible or highly improbable.
- The individual may receive medical attention, but it is not required for survival.
- Frequently, the act is done in a public setting, or is reported by the individual to ensure detection and assistance.
- Examples placed noose loosely around neck and did not attach the other end to another object; swallowed 10 Tylenol pills in front of staff; scratches or superficial cuts on neck or wrist.
Low Lethality:
- Death is impossible or highly improbable.
- The individual may receive medical attention, but it is not required for survival.
- Frequently, the act is done in a public setting, or is reported by the individual to ensure detection and assistance.
- Examples placed noose loosely around neck and did not attach the other end to another object; swallowed 10 Tylenol pills in front of staff; scratches or superficial cuts on neck or wrist.
Moderate Lethality:
- Death is a possible, but not highly probably, outcome of the act, in the opinion of the average person.
- Opportunity for detection and intervention was not certain.
- Medical or crisis intervention may be required to reduce the risk of death (e.g., pumping stomach, suturing cuts).
- Examples: swallowed 30 Tylenol cut neck and lost significant blood; placed ligature around neck and applied pressure.
- Death is a possible, but not highly probably, outcome of the act, in the opinion of the average person.
- Opportunity for detection and intervention was not certain.
- Medical or crisis intervention may be required to reduce the risk of death (e.g., pumping stomach, suturing cuts).
- Examples: swallowed 30 Tylenol cut neck and lost significant blood; placed ligature around neck and applied pressure.
High Lethality:
- Death is the probable outcome, although immediate and vigorous medical attention may reduce the risk.
- The individual took measures to avoid detection and intervention, or the method was so lethal that intervention was not likely to prevent death.
- Examples: placed ligature around neck and lost consciousness; attempted to hang self, but stopped when cellmate awoke; took a potentially lethal overdose and did not alert staff.
- Death is the probable outcome, although immediate and vigorous medical attention may reduce the risk.
- The individual took measures to avoid detection and intervention, or the method was so lethal that intervention was not likely to prevent death.
- Examples: placed ligature around neck and lost consciousness; attempted to hang self, but stopped when cellmate awoke; took a potentially lethal overdose and did not alert staff.
Examples of Protective Factors (Sanchez, 2001; United States Public Health Service, 1999)
• Strong connections to family and community support
• Sense of belonging, sense of identity, and good self-esteem
• Identification of future goals
• Support through ongoing medical and mental health care relationships
• Easy access to a variety of clinical interventions and support for help seeking
• Skills in problem solving, coping and conflict resolution
• Cultural, spiritual, and religious connections and beliefs
• Constructive use of leisure time (enjoyable activities)
• Effective clinical care for mental, physical and substance use disorders
• Restricted access to highly lethal means of suicide
• Strong connections to family and community support
• Sense of belonging, sense of identity, and good self-esteem
• Identification of future goals
• Support through ongoing medical and mental health care relationships
• Easy access to a variety of clinical interventions and support for help seeking
• Skills in problem solving, coping and conflict resolution
• Cultural, spiritual, and religious connections and beliefs
• Constructive use of leisure time (enjoyable activities)
• Effective clinical care for mental, physical and substance use disorders
• Restricted access to highly lethal means of suicide
Narrative should describe and reconcile your assessment of Risk & Protective Factors. This is the opportunity to explain your decision making and make it transparent. Risk and protective factors are not equally weighted and therefore cannot be simply compared on a one to one basis. One protective factor may outweigh several risk factors. Please do a case conceptualization here and use the narrative to make the inmate come to life for a reader.
Low Acute Risk
Suicidal ideation is absent or is of limited frequency, intensity, duration and specificity. There are NO identifiable plans and NO associated intent. There is good self-control based on both self-report and objective assessment. There may be mild symptomatology and morbid rumination may be present. Few risk factors are present and protective factors are identified, including available and accessible social support.
Suicidal ideation is absent or is of limited frequency, intensity, duration and specificity. There are NO identifiable plans and NO associated intent. There is good self-control based on both self-report and objective assessment. There may be mild symptomatology and morbid rumination may be present. Few risk factors are present and protective factors are identified, including available and accessible social support.
Moderate Acute Risk
Suicidal ideation is frequent with limited intensity and duration. Suicidal plans have some specificity, but NO associated intent. There is good self-control, limited to moderate symptomatology, some risk factors are present, and protective factors are identified, including available and accessible social support. Denial of ideation and intent may be present, if objective markers, such as suicide threats to others and agitation, contradict the self-report.
Suicidal ideation is frequent with limited intensity and duration. Suicidal plans have some specificity, but NO associated intent. There is good self-control, limited to moderate symptomatology, some risk factors are present, and protective factors are identified, including available and accessible social support. Denial of ideation and intent may be present, if objective markers, such as suicide threats to others and agitation, contradict the self-report.
High Acute Risk
Frequent, intense, and enduring suicidal ideation, specific plans. Many risk factors are identified. Objective markers of risk are present (e.g., lethal method, rehearsal behaviors, saying "goodbye"); self-report of subjective intent may or may not be present. There is evidence of impaired self-control, severe symptomatology, multiple risk factors are present, and few, if any protective factors.
Frequent, intense, and enduring suicidal ideation, specific plans. Many risk factors are identified. Objective markers of risk are present (e.g., lethal method, rehearsal behaviors, saying "goodbye"); self-report of subjective intent may or may not be present. There is evidence of impaired self-control, severe symptomatology, multiple risk factors are present, and few, if any protective factors.
Present - Chronic Risk is present when there is a history of two or more suicide attempts
Absent - Chronic Risk is absent when there is a history of one or zero suicide attempts.
Absent - Chronic Risk is absent when there is a history of one or zero suicide attempts.
Note: Self-harm behaviors are not counted as suicide attempts.
ALWAYS consult with another psychologist if NOT putting an inmate on suicide watch (and upon release). In order to ensure the availability of a psychologist for consultation, proactively establish a network of psychologist peers both inside and outside of the local institution.
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Recommendations:
If suicide risk is present, consider recommending the following interventions:
- Suicide Watch
- Brief Cognitive Behavioral Therapy for Suicide
- Positive Reinforcement
- Safety Plan
- Psychiatric Referral
- Reasons for Living Card
- CBT/DBT Skills Training Groups
- Coping Cards
- Recommendation for Double Cell
- Psychology Alert Code
- Change Care Level (UPDATE Diagnostic and Care Level Formulation)
- Property Restriction (If Returning to Restricted Housing)
- Suicide Risk Management Plan
- Consult with Unit Team
- Assign a Mental Health Cadre
Recommendations:
If suicide risk is present, consider recommending the following interventions:
- Suicide Watch
- Brief Cognitive Behavioral Therapy for Suicide
- Positive Reinforcement
- Safety Plan
- Psychiatric Referral
- Reasons for Living Card
- CBT/DBT Skills Training Groups
- Coping Cards
- Recommendation for Double Cell
- Psychology Alert Code
- Change Care Level (UPDATE Diagnostic and Care Level Formulation)
- Property Restriction (If Returning to Restricted Housing)
- Suicide Risk Management Plan
- Consult with Unit Team
- Assign a Mental Health Cadre
Suicide Watch:
- A suicide watch is not warranted at this time
- A suicide watch is to be initiated immediately
- A suicide watch was initiated by non-clinical staff and continues to be warranted
- A suicide watch was initiated by non-clinical staff and is no longer warranted
- A suicide watch is not warranted at this time
- A suicide watch is to be initiated immediately
- A suicide watch was initiated by non-clinical staff and continues to be warranted
- A suicide watch was initiated by non-clinical staff and is no longer warranted
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Date
Notes
[Blank lines]
Date
Notes
[Blank lines]
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The Suicidal Mode
The Suicidal Mode
Predispositions to Suicide
Genetic & biological factors
Family history of suicide
Abuse or other trauma history
Impulsivity
Aggression
Previous suicidal behaviors
Psychiatric history
Genetic & biological factors
Family history of suicide
Abuse or other trauma history
Impulsivity
Aggression
Previous suicidal behaviors
Psychiatric history
Trigger (Perceived Loss)
Relationship problems
Financial stress
Onset of illness
Legal problems
Traumatic events
Recent loss of a significant other
Other major life changes
Relationship problems
Financial stress
Onset of illness
Legal problems
Traumatic events
Recent loss of a significant other
Other major life changes
Thoughts
Hopelessness
Perceived burdensomeness
Isolation / loneliness
Reasons for living
Reasons for dying
Impaired problem solving
Hopelessness
Perceived burdensomeness
Isolation / loneliness
Reasons for living
Reasons for dying
Impaired problem solving
Behaviors
Substance abuse
Self-harm
Preparing for death
Practicing / rehearsing suicide
Suicide threats
Poor expression of emotion
Social withdrawal
Substance abuse
Self-harm
Preparing for death
Practicing / rehearsing suicide
Suicide threats
Poor expression of emotion
Social withdrawal
Suicidality
Emotions
Shame or guilt
Anger
Anxiety or panic
Depression
Shame or guilt
Anger
Anxiety or panic
Depression
Physiology
Agitation
Sleep disturbance
Concentration problems
Physical pain
Agitation
Sleep disturbance
Concentration problems
Physical pain
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The Suicidal Mode
[Diagram with blank boxes corresponding to the previous page's layout]
Predispositions to Suicide
Trigger (Perceived Loss)
Thoughts
Behaviors
Suicidality
Emotions
Physiology
The Suicidal Mode
[Diagram with blank boxes corresponding to the previous page's layout]
Predispositions to Suicide
Trigger (Perceived Loss)
Thoughts
Behaviors
Suicidality
Emotions
Physiology
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PDS-BEMR POST SUICIDE WATCH REPORT GUIDE
PDS-BEMR POST SUICIDE WATCH REPORT GUIDE
Watch End Date: ________ Watch End Time: ________ AM/PM
Watch Conducted By:
Both Inmates & Staff
Inmate
Staff
Both Inmates & Staff
Inmate
Staff
Transferred to a Medical Center: No/Yes
Mental Status Exam: In PDS you will be required to select a value for each of the areas below. Elaborate below.
O Level of Consciousness O Psychomotor Activity O General Appearance O Behavior
O Mood O Thought Process O Thought Content
O Level of Consciousness O Psychomotor Activity O General Appearance O Behavior
O Mood O Thought Process O Thought Content
Narrative for Risk Factors Assessed:
[Blank box]
[Blank box]
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+ Risk or Protective Factor Present
- Risk or Protective Factor Absent
0 Risk or Protective Factor Not Assessed
+ Risk or Protective Factor Present
- Risk or Protective Factor Absent
0 Risk or Protective Factor Not Assessed
Mental Status Exam: In PDS you will be required to select a value for each of the areas below. You can make additional comments.
O Level of Consciousness
O Psychomotor Activity
O General Appearance
O Behavior
O Mood
O Thought Process
O Thought Content
O Level of Consciousness
O Psychomotor Activity
O General Appearance
O Behavior
O Mood
O Thought Process
O Thought Content
In PDS you will be required to select a value for each of the risk/dynamic/protective factors below:
+ - 0 STATIC FACTORS
OOO Chronic Medical Condition
OOO Family Hx of Suicide
OOO High Profile Crime
OOO Hx of Childhood Abuse
OOO Hx of Psychiatric Hospitalization
OOO History of Mental Illness
OOO Past Suicide Attempt
OOO History of Violent Behavior
OOO Lack of Family Connections
OOO Sex Offender Status
OOO Chronic Medical Condition
OOO Family Hx of Suicide
OOO High Profile Crime
OOO Hx of Childhood Abuse
OOO Hx of Psychiatric Hospitalization
OOO History of Mental Illness
OOO Past Suicide Attempt
OOO History of Violent Behavior
OOO Lack of Family Connections
OOO Sex Offender Status
+ - 0 DYNAMIC FACTORS
OOO Agitation
OOO Current Intoxication
OOO Current Physical Pain
OOO Current Suicidal Ideation
OOO Current Suicidal Intent
OOO Current Suicidal Plan
OOO Fear for Own Safety
OOO Feeling Hopeless/Helpless
OOO Feels Like a Burden
OOO Non-Adherence to Medical Tx
OOO Problem Solving Deficits
OOO Recent Significant Loss
OOO Sleeps Problems
OOO Social Isolation
OOO Uncontrolled Mental Health Issues
OOO Agitation
OOO Current Intoxication
OOO Current Physical Pain
OOO Current Suicidal Ideation
OOO Current Suicidal Intent
OOO Current Suicidal Plan
OOO Fear for Own Safety
OOO Feeling Hopeless/Helpless
OOO Feels Like a Burden
OOO Non-Adherence to Medical Tx
OOO Problem Solving Deficits
OOO Recent Significant Loss
OOO Sleeps Problems
OOO Social Isolation
OOO Uncontrolled Mental Health Issues
+ - 0 PROTECTIVE FACTORS
OOO Able to Identify Reasons to Live
OOO Adequate Problem Solving Skills
OOO Denial of Suicidal Ideation
OOO Future Orientation
OOO Religious Beliefs Against Suicide
OOO Social Support in the Institution
OOO Supportive Family Relationships
OOO View of Death as Negative
OOO Willingness to Engage in Tx
OOO Able to Identify Reasons to Live
OOO Adequate Problem Solving Skills
OOO Denial of Suicidal Ideation
OOO Future Orientation
OOO Religious Beliefs Against Suicide
OOO Social Support in the Institution
OOO Supportive Family Relationships
OOO View of Death as Negative
OOO Willingness to Engage in Tx
Additional validated risk factors that may be relevant: Sentence >20 years; Self-harm in past month; Dual Diagnosis; Male Gender; History of Self-Injurious Behavior; Chronic/Uncontrolled Pain; No Spouse (Single, Divorced, Widowed)
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Low Acute Risk
Suicidal ideation is absent or is of limited frequency, intensity, duration and specificity. There are NO identifiable plans and NO associated intent. There is good self-control based on both self-report and objective assessment. There may be mild symptomatology and morbid rumination may be present. Few risk factors are present and protective factors are identified, including available and accessible social support.
Low Acute Risk
Suicidal ideation is absent or is of limited frequency, intensity, duration and specificity. There are NO identifiable plans and NO associated intent. There is good self-control based on both self-report and objective assessment. There may be mild symptomatology and morbid rumination may be present. Few risk factors are present and protective factors are identified, including available and accessible social support.
Moderate Acute Risk
Suicidal ideation is frequent with limited intensity and duration. Suicidal plans have some specificity, but NO associated intent. There is good self-control, limited to moderate symptomatology, some risk factors are present, and protective factors are identified, including available and accessible social support. Denial of ideation and intent may be present, if objective markers, such as suicide threats to others and agitation, contradict the self-report.
Suicidal ideation is frequent with limited intensity and duration. Suicidal plans have some specificity, but NO associated intent. There is good self-control, limited to moderate symptomatology, some risk factors are present, and protective factors are identified, including available and accessible social support. Denial of ideation and intent may be present, if objective markers, such as suicide threats to others and agitation, contradict the self-report.
High Acute Risk
Frequent, intense, and enduring suicidal ideation, specific plans. Many risk factors are identified. Objective markers of risk are present (e.g., lethal method, rehearsal behaviors, saying "goodbye"); self-report of subjective intent may or may not be present. There is evidence of impaired self-control, severe symptomatology, multiple risk factors are present, and few, if any protective factors.
Frequent, intense, and enduring suicidal ideation, specific plans. Many risk factors are identified. Objective markers of risk are present (e.g., lethal method, rehearsal behaviors, saying "goodbye"); self-report of subjective intent may or may not be present. There is evidence of impaired self-control, severe symptomatology, multiple risk factors are present, and few, if any protective factors.
Present
Chronic Risk is present when there is a history of two or more suicide attempts
Absent
Chronic Risk is absent when there is a history of one or zero suicide attempts.
Chronic Risk is present when there is a history of two or more suicide attempts
Absent
Chronic Risk is absent when there is a history of one or zero suicide attempts.
Reason for referral:
Change in risk factors:
Reason for removal from watch:
Diagnosis:
Recommendations:
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Date
Progress Notes
[Blank lines]
Date
Progress Notes
[Blank lines]
Thanks to Christopher Bush & Scott Forbes in the development of this guide
Version 3
Version 3
[Footer] EFTA00032201
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