Suicide Prevention Improving Suicide Risk Assessment

Suicide Prevention: Background Completed Suicides – 2004 Data Suicide the 11 th leading cause of death Suicides accounted for 1.4% of all US deaths More than 32,000 suicides – 89 per day Toxicology in 13 states: 33.3% positive for alcohol 16.4% positive for opiates 9.4% positive for cocaine 7.7% positive for marijuana 3.9% positive for amphetamines

Suicide Prevention: Background Suicidal Ideation and Attempts For Young Adults 15 to 24, one suicide for every 100 – 200 attempts For Adults 65 and older, one suicide for every 4 attempts In 2005, 16.9% of US high school students reported seriously considering suicide in the previous 12 months. More than 8% reported a suicide attempt during the same time frame.

Suicide Prevention: Disparities Men Suicide at nearly 4 times the rate of women 78.8% of all US suicides Suicide is the 8 th leading cause of death Age 75 and over have a rate of 37.4 Firearms are the most common method

Suicide Prevention: Disparities Women Attempt suicide 2 to 3 times more than men Suicide is the 16 th leading cause of death Women in their 40s and 50s have a rate of 8.0, the highest rate for women Poisoning is the most common method of suicide for females

Suicide Prevention: Disparities Suicide is the 2 nd leading cause of death among 25 to 35 year olds Among 15 to 24 year olds suicide accounts for 12.9% of all deaths annually The suicide rate for adults 65 and older was % of students, grade 9 to 12 seriously considered suicide in the past 12 months 8.4% of students reported at least one suicide attempt in the past 12 months

Nonfatal Suicidal Behavior In 2005, 372,722 people were treated in ERs for self inflicted injuries In 2005, 154,598 people were hospitalized due to self inflicted injury There is one suicide for every 25 attempted suicides

Nonfatal Suicidal Behavior Among 15 to 24 year olds, 1 suicide for every 100 – 200 attempts Among 65 and older 1 suicide for every 4 attempts

Risk Factors Some risk factors are associated with suicide and a subset are predictive of completed suicide Risk factors are not necessarily causal There is no validated method of adding up numbers associated with risk factors to identify levels of suicide risk Clinical assessment and judgment regarding risk of suicide must be documented

Risk Factors Suicidal ideation, intent and/or means are NOT the sine qua non of assessing suicide risk All predictive risk factors and protective factors should be identified and a formulation of suicide risk should be written

Risk Factors Risk factors may be further categorized as modifiable or not modifiable Age, race, and gender are in the not modifiable category Illness, grief, and social situation may be modifiable Modifiable risk factors should be addressed in treatment and safety planning for the individual in order to decrease risk of a completed suicide

Risk Factors Family history of suicide Previous suicide attempts Local clusters of suicides Family history of child maltreatment History of mental disorders Depression Schizophrenia Bipolar Disorder Obsessive Compulsive Disorder

Risk Factors History of substance abuse Alcohol Mixed Feelings of hopelessness Impulsive and/or aggressive tendencies Cultural and religious beliefs Isolation Barriers to accessing treatment Unwillingness to seek help due to stigma

Risk Factors Physical illness Impacting relationships Impacting ability to work Cancer or other disabling or lethal illness Loss Relationships Financial Work Easy access to lethal methods

Protective Factors Pregnancy Responsible for children under 18 Sense of responsibility to family Employed Living with another person Positive social support Positive therapeutic relationship Cultural and/or religious beliefs discourage suicide

What Can We Do “no suicidal ideation or intent” is not a suicide risk assessment Ask about other risk factors Ask about protective factors Ask how modifiable risk factors are being addressed in the treatment plan Never accept “contracted for safety” as a reasonable part of a safety plan (and never document this as part of your reason for believing the member to be safe)

What Can We Do When talking with the member Ask about protective factors Ask about a safety plan and develop one if needed Attempt to engage family and/or friends in the safety plan and the attempt to get the member to a clinician for a full evaluation Ensure urgent or emergent appointment

What We Can Do Practitioners/Providers Adoption of a comprehensive suicide risk assessment Educate about risk factors and protective factors Refer to the VO Comprehensive Suicide Risk Assessment for Prevention as a tool for documentation Repeat the suicide risk assessment when circumstances change