Risk assessment and indication for psychiatric admission

What it is

Risk assessment means direct questions about a patient's intentions and about the details of any attempt already made. Physicians should be direct in questioning and give the patient an opportunity to discuss his or her intentions. Questions to ask include: have you been feeling like life is not worth living; have you been having thoughts of harming yourself; have you developed a plan for taking your life; and do you have access to a weapon or means to commit the act. How the interview is done carries marks of its own: introduced himself or herself, stated the aim of the interview, and rapport, empathy and style, as does the overall approach.

Causes and risk

The mnemonic SAD PERSONS is helpful to remember when assessing a patient's suicide risk. It stands for sex (male gender), age (older), depression, previous suicide attempt, ethanol abuse, rational thinking loss, social support lacking, organized plan, no spouse or partner, and sickness.

The history adds its own weight: an ongoing stressor; personal history and marital status; past psychiatric history such as depression or bipolar disorder; past suicidal attempts, which are very important to ask about; past medical history; substance misuse, especially alcohol; and employment.