In honor of the launch of the HelpPRO Suicide Prevention Therapist Finder (see Press Release) we bring you this five part series of clinical tips with the most up to date research and thinking on suicide prevention.
Paul Quinnett, PhD, President and CEO, The QPR Institute, Inc, says eighteen veterans will take their own lives today. So will someone's daughter, a brother, a co-worker, and far too many working men and grandfathers. According to the Centers for Disease Control and Prevention, in just one day, more then 101 of our fellow Americans will die by suicide. Perhaps this clinical tip will save just one.
Clinical tip #5 -- Communicating Suicide Risk
The nature of modern clinical care by multiple providers requires clear communication to assure consumer safety. Not only do prescriptions need to be clearly written, but progress notes must be legible to all providers of care. In the root cause analysis of 400 consumers in active care who attempted or died by suicide while inpatients, communication failures ranked at the top of the list of contributory causes (National Center for Patient Safety, 2006).
To improve communications between clinicians regarding suicide risk, there is little consensus about a) how to assess immediate risk or b) how to determine its severity. Still, risk stratification decisions and clinical judgments must be made every day as these assessments necessarily guide our interventions, monitoring levels, and frequency of contact. For a variety of reasons, suicidal consumers may not be entirely helpful in disclosing their suicidal intent, desire and plans. If, after an assessment, you are not confident of your conclusions, it may be helpful to others on your team to add a chart note to this effect.
An explanatory note of “low confidence” would be warranted when the consumer:
· Has been uncooperative and refused to collaborate in the assessment process
· Has or may have psychotic symptoms, especially paranoia
· Is or has been recently intoxicated
· Has a history of impulsivity
· Is faced with an uncontrollable external event, such as the serving of divorce papers or an arrest warrant
In sum, a note of low confidence in the assessment suggests higher risk and that reassessment is indicated in the near term (not more than 24 hours), as well as the need for a second opinion, greater vigilance, and more frequent observation.
The QPR Institute (www.QPRinstitute.com) provides Online Advanced Suicide Prevention Courses for a wide range of professionals including: Mental health professionals, school counselors, crisis line workers, substance abuse professionals, EMS/firefighters, law enforcement, primary care providers, nurses and correctional workers. For more information please visit our full library of advanced courses!
Paul Quinnett, PhD., Founder & CEO QPR Institute, www.QPRInstitute.com