1. Suicide Risk Assessment

2. Bipolar and suicidality Most likely during transition for cx with bipolar S/I=80% S/A=25% S/C=7-19% Intoxication increases impulsivity and impairs judgment, putting person at greater risk.

3. A mnemonic: IS PATH WARM ideation substance abuse purposelessness anxiety trapped hopelessness withdrawal anger recklessness mood changes

4. Your role 1.Recognize risk factors and respond appropriately 2.Assess seriousness of risk-Fig. D-1, pg 330 What is wrong? Why now? How? Where and when? When and with what in the past? Who is involved? Why not now?

5. 3. Consider appropriate responses-low level of risk Talking about it Address particular triggers Contracting Obtaining support from friends/family Identify and plan use of crisis services Explore reasons for not killing self Refer to medication provider-ARNP or psychiatrist

6. 4.Responses with higher level of risk Schedule additional sessions Eliminate potential methods, e.g. weapons, meds, etc. Explore option of voluntary hospitalization Contact CDMHPs for involuntary outpatient or commitment evaluation-206-461-3222 72 hours, 14 days, 90 days inpatient 90 (adult) or 180 (youth) days of outpatient