1. Safety Assessment 1. How do we think through a safety assessment? 2. How do we document the assessment?

2. How Information gathering: – Static risk factors – Dynamic risk factors – Protective factors

3. Static Risk Factors Static risk factors are things that increase a person’s risk for violence to others or self that can’t be changed Static risk factors can also be called un- modifiable risk factors, e.g. a history of a suicide attempt cannot be changed or modified but it increases risk for a future attempt

4. Static Risk Factors Examples – History of violence or suicide attempts – Psychiatric and medical co-morbidities – Age (bimodal: late teenage years to early twenties; elderly) – Gender (male > female)

5. Dynamic Risk Factors Dynamic risk factors are things that are happening in real-time that increase risk for violence to self or others Another name for dynamic risk factors is modifiable risk factors, because they can be changed and/or improved by the right treatment, e.g. starting an antipsychotic targets the dynamic risk factor of command hallucinations

6. Dynamic Risk Factors Examples of dynamic risk factors: – Active symptoms of psychiatric conditions, such as hallucinations, depression, panic – Substance abuse – Psychosocial stressors – recent loss of a job, home, relationship, etc.

7. Protective Factors Protective factors are things that help a patient to stay alive and/or not act on the thought impulse to harm self or others There are some general categories listed in Breevy but you should elicit specifics from your patients, such as “It’s against my religion…” Or, “I wouldn’t want to do that to my kid.”

8. Protective Factors Future-orientation Engagement with treatment Close relationships Moral, spiritual, familial imperatives Hopefulness

9. SAD PERSONS SAD PERSONS is a mnemonic developed by Patterson et al. (1983) that can be helpful for remember to ask about risk factors – S = Sex: Men are more like to commit/complete suicide than women – A = Age: teenagers and elderly have the highest risk – P = Previous attempt: 10% of patients who have attempted suicide will eventually die by suicide

10. SAD PERSONS Continued: – E = Ethanol (alcohol ) abuse: 15% of alcoholics commit suicide – R = Rational thinking loss; 10 % of patients with schizophrenia die by suicide – S = Supports are limited – O = Organized plan; having an organized plan to kill yourself increases risk – N= No partner or family

11. SAD PERSONS Continued: – S = Sickness: chronic medical conditions also increase risk for suicide

12. Documentation with Breevy We have added smartphrases to your Breevy library to help you document risk factors and decision-making in your safety assessment

13. Safety in Breevy There are 2 smartphrases you can use to help document –.safetyL provides the structure for documenting and assess risk in L/List form –.safetyN provides the structure for documenting and assess risk in L/List form You should choose the smartphrase that best fits your style

14. Consultation “Never worry alone!” Always get consultation through a supervisor or colleague when making difficult safety decisions