1.What factors in the scenario demonstrate an increased risk of suicide?

Recently divorced

Increased insomnia and fatigue

High stress job of law enforcement

Had a high stress situation at work in which he fired his firearm

Does not regularly exercise

Drinks alcohol

Has not been treated for mental health outside his mandated appointments

  1. What should you include in a suicide risk assessment?

Using the SAD PERSONAS can help evaluate the risk of acute suicide for the patient (Dunphy et al., 2022). In addition, the use of the PHQ 9 – specifically the last two questions can help identify patients who are at risk of suicidal ideation (Kim et al., 2021). Some other specific questions to ask the patient would be to ask if they have had any suicide attempts in the past or if anyone in their family has attempted suicide as family history can increase the risk of suicide (Dunphy et al., 2022).

  1. 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?

Being aware of the patient’s feelings and providing a safe environment for the patient is crucial. Asking the patient if they have had thoughts of suicide or ending their life, if they have a plan for in place to end their life, if they have the things they need to carry out their plan, and what has stopped them from carrying out their plan (Dunphy et al., 2022). It is important to validate the patient’s feeling and make them feel ok to share so that you can help them.

  1. 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?

The three main things that need to happen are arranging for outpatient follow up care, giving resources to the patient including the crisis line and contact information, and creating a safety plan with the patient (King et al., 2017). By developing a safety plan it can help the individual figure out coping strategies that are an alternative to suicide (King et al., 2017). An urgent referral to behavioral health or having the patient present to the ED for urgent evaluation could be considered as well. It would also be important to ask the patient if he has anyone that he would want to be with him so he wouldn’t be home alone.

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

A study by Lewis (2007) has found that there hasn’t been defined date to show that a no harm or no suicide contract works or prevents suicide and there is concern that patients who are actively suicidal should not be signing a contract regarding their care. At this point I would not enter a no-suicide contract with the patient. I would develop a safety plan with the patient and have him agree to removing lethal harm from his house, agreeing to outpatient treatment/therapy, listing alternatives to suicide, and listing people that can be contacted if he has thoughts of suicide. Crisis numbers would be given to the patient and discussion of antidepressants to help would also be offered along with a referral for talk therapy.

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