What factors in the scenario demonstrate an increased risk for suicide?

The mnemonic “SAD PERSONAS” can be used to screen a patient’s suicide risk.  Sex, age, depression, previous attempt, ethanol abuse, rational thinking loss, social support loss, organized plan, no spouse, availability of lethal means, and sickness are the considered risk factors (Dunphy et al., 2022).  This patient Joe has several risk factors he is an adult male age 56, recently divorced, works in law enforcement, and has access to firearms, taking antihypertension medications for blood pressure, does not exercise, and drinks alcohol.  Antihypertension medications can cause depression which increases suicide risk (Dunphy et al., 2022).  Caucasian males have a higher risk of suicide, and law enforcement is considered an at-risk occupation along with dentists, musicians, firefighters, lawyers, and insurance agents (Dunphy et al., 2022). 

What should you include in a suicide risk assessment?

Primary care practitioners need to be able to identify and assess suicide risk during consults.  80% of patients who die by suicide were in contact with a healthcare service in the year of their death (Thiago et al., 2022).  There are two screening tools a primary care provider can use during a suicide risk assessment.  These tools include the Columbia-Suicide Severity Rating Scale (C-SSRS) and the SAMHSA Suicide Assessment Five-Step Evaluation and Triage (SAFE-T) (Dunphy et al., 2022).  Using the SAFE-T tool, the provider can follow the five steps during the assessment which are identifying risk factors, identifying protective factors, conducting a suicide inquiry, determining risk level and interventions, and documenting a treatment plan (Dunphy et al., 2022). 

During the appointment, Joe states that it’s hard for him to talk about how he is feeling and begins to cry. Taking the opportunity to ask Joe about his intentions, what specific questions could you ask?

Practitioners should question the patient directly about their suicide risk and not use general questions (Dunphy et al., 2022).  The assessment should include the patient’s personal history, recent stressful life events, and changes in mental status (Dunphy et al., 2022).  Specific questions to ask this patient include has he thought of hurting himself or ending his life, does he have a plan for suicide, has he assembled what he needs to carry out the plan, does he have a location picked out, and what has stopped him so far from it (Dunphy et al., 2022). 

You understand that the best predictor of suicide risk is a history of a previous suicide attempt. When asked, Joe admits to placing one of his firearms in his mouth a few times, indicating that the likelihood of Joe attempting suicide is very high. How should you proceed?

Any patient with a history of suicide attempts, threats, or gestures need to be thoroughly screened for suicide risk factors and referred to a specialist for a mental health evaluation and a psychiatrist for evaluation and treatment (Dunphy et al., 2022).  The goals of intervention to maintain Joe’s safety are to eliminate imminent danger, never leave him alone, and to involve support people to stay with the patient until the crisis has passed.  Patients with an acute high risk of suicide require constant supervision and treatment in an inpatient hospital setting (Dunphy et al., 2022).  Given Joe’s high risk of suicide status, his past suicide attempts, and additional contributing risk factors including recent divorce and lack of support persons, and access to firearms, I would proceed with inpatient hospitalization for treatment. 

Could Joe benefit from a no-suicide contract? Why or why not?

A no-suicide contract should be implemented by a mental health professional (Dunphy et al., 2022).  I don’t believe Joe would benefit from a no-suicide contract since he is at high risk of suicide.  No-suicide contracts should not be used as a method for preventing suicide and do not protect clinicians from malpractice litigation if a suicide does occur (Dunphy et al., 2022). 

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