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Suicidal Risk

Assessment
Tablet [Course title]
TABLE OF CONTENTS
Risk Assessment..............................................................................................................................2
Selection of Patient..........................................................................................................................2
Importance of Risk Assessment for Selected Patient......................................................................3
Findings...........................................................................................................................................4
Actions to be Taken:........................................................................................................................5
Effectiveness of actions taken:........................................................................................................8
References......................................................................................................................................10
Risk assessment

Risk assessment can simply be defined as an evaluation process (HSE, 2009). Practically, the
evaluation process consists of identifying the possible danger and analyzing the risk associated
with that danger. The process starts by determining situations or processes that may cause harm
to a group of people (HSE, 2009). It then proceeds and evaluates how likely the risk is. Risk
assessment is completed by developing the measures that eliminates the associated risks and
mitigates the harm (HSE, 2009). Thus, risk assessment is all about controlling and preventing a
possible harm. Clinical or health care risk assessment involves evaluating the possible risks
associated with particular treatments and making appropriate strategies in consideration with the
risks (HSE, 2009). Safety is the on the priority list of health service providers, hence, a risk
assessment tool ensures that the safest healthcare services are provided to the service users.

Selection of patient

Suicide is described as a self-inflicted harm done with the intention of ending ones own life.
Self-harm can be described as an act of inflicting physical injuries that are fatal and is associated
with an increased risk of suicide. Suicidal behavior can be sudden or can be associated with a
past history of mental health problem (Morriss et al, 2013).

Number of suicides has increased considerably, in recent years, all around the world. According
to World Health Organization report (2014), on an average suicide has been the cause of death
for almost 1 million people in a year. The rate indicates that suicide is becoming a major health
concern and therefore needs to be addressed. Suicide has although is an alarming problem yet it
is very much preventable with proper intervention methods. It is imperative for all the health care
professionals to identify and intervene with a suicidal patient. Nursing practices are most
effective interventions in treating suicidal patients. They are the primary source of interaction
between a health service provider and service user and thus have a better chance of assessing,
evaluating and treating a suicidal patient. Therefore, they are a key to suicide prevention and
should be well trained for suicide risk assessment. Luoma, Martin & Pearson (2002) asserts that
individuals who complete suicide pay a visit to healthcare, prior to their suicide; hence, it is
imperative to target healthcare professionals to intervene and prevent suicides. It is also essential
to educate healthcare service providers about importance of depression treatment, as it will
mitigate suicides (Mann et al, 2008).

Suicide assessment involves an evaluation done by health care professional to identify the
possible suicide risk (Morgan, 2000). The assessment also includes a careful estimation of an
immediate danger to the patient and determining of preventive measures. Quality suicide risk
assessments involve interactions with patients and patients family to identify the behavior and
thought process of the patient. The assessment also provides insight to possible risk factors.

Importance of risk assessment particularly for selected patient

Preventing suicide is essential to save lives. In order to prevent suicides, it is critical to detect
suicide risk and provide immediate services to the population that is at risk. The risk of suicide is
higher among people who are engaged in drugs, alcohol and substance abuse (Walsh, 1996). The
risk of suicide is also greater in people who suffer from mental disorder and are a user of mental
health service (Walsh, 1996). There is a need to assess and diagnose people with these issues,
particularly people with mental disorders. The issues need to be addressed in order to effectively
manger the suicide risk. Treatment services may only generate positive outcomes if the
treatment services have proper tools to assess and manage the risk (Woods, 2013). To fully
understand the patients thought process and inclination towards suicide, suicide risk assessment
is imperative. Suicide Risk assessment allows the risk to be managed and mitigated in case of
immediate interventions by health service providers (Woods, 2013). Moreover, suicidal
behaviors indicate presence of mental disorders which need to be addressed for the societal
benefit. Besides, there is a lack of assessment tools to effectively manage the suicidal behavior
and establish policies and procedures to manage the risk. Therefore, there is a need to develop a
number of resources and tools that will better equip health service providers with management
and assessment of suicide risks.

Suicide risk assessment should be an enduring process and not a one-time event. It is important
to continuously monitor the patients with suicidal behaviors, as the inclination of a suicide may
vary over the course of treatment. For instance, a person with a suicidal inclination may enter a
treatment; however his suicidal urge may diminish during the treatment. On the contrary a person
may develop a suicidal tendency during the course of treatment. Thus, it is necessary to carefully
draw out the suicidal tendencies in a patient to reduce the risk of a suicide. Suicide risk
assessment is also vital to treat other members that are close to suicidal patient (Ryan, 1998). It
also ensures that issues of non-compliance on behalf of patient are addressed. Furthermore, it
ensures quality delivery of services by addressing the shortfalls in the services. Also, risk
assessment is important for the better and effective recovery of the patient. Therefore, people
involved in risk assessment shall be encouraged and supported. Health professionals that engage
directly with suicidal patient can facilitate the effective treatment as they have better
understanding of patients perspective risk (Ryan, 1998). Therefore, they shall be part of risk
assessment team to devise appropriate strategies and targets of personal safety and well being.
Safety planning is essential part of risk assessment process and cane be ensured by establishing a
two-way dialogue process.

Findings of the risk assessment in selected patient

Suicide risk assessment is based on certain principles. Firstly, the assessment can only be
conducted if the patient seeks help of a healthcare professional. Secondly, it is a continuous
process and assessment is conducted throughout the course of admission of the patient. Risks are
reassessed and observations recorded. After a careful assessment, management plan is needed.
Effective management requires commitment not only from patient but also from the family
members and all the concerned members. To ensure a consistent care a clear and concise
communication process is also imperative.

Suicidal behaviors are mostly the result of mental health disorders. Research also suggests that
people try frequent suicide attempts in prison, secure units or psychiatric hospitals. Dissociation
and Dissociative disorders are influencing the patients towards self harming problems. These
patients do not keep engaged themselves with the society, which results in the stressful feelings.
Stressed patients go towards self-harming behaviour automatically. Eating disorders also
increase the number of self- harming patients significantly. Hunger influences the mental health
and results in the harming. If the depression and the major causes of depression are not cured at
right time then self harming disorder increases positively in the patients. Excess of alcoholic
use is also one of the self harm creating problem in the patients (Patrick L. Kerr, 2010).
Research suggests that self-harm practices are associated with poverty, poor social and economic
conditions (Faulkner, 2012). People from lower strata of society tend to indulge in repeated self-
harm behaviour because of depression. The repetition increases the risk of completed suicide
(Woods, 2013). Other factors that directly contribute to complete suicide are unemployment and
violence, particularly among young men. Furthermore, increased loneliness and isolation, creates
a greater risk of self-harm behaviour and completed suicide.

All the above risk factors points out that suicide risk assessment shall not be done in isolation.
Suicide risk assessment shall be accompanied by mental health assessment, assessment for
depression, anxiety, and drug and alcohol behaviours. An assessment of these behaviours will
enlighten the health professionals about the associated risk levels and related treatments. Apart
from these, the other external risk factors that are to be considered includes, major life events and
personal vulnerabilities of the patient. Life events that involve humiliation, hopelessness, shame,
guilt and anger increases the suicidal inclination of the patient.

Actions to be taken in response to risk assessment

There is a need to strengthen the protective factors, as they reduce the risk of suicide (Slade,
2009). The protective factors include providing social supports and strong group affiliations. The
factors also focus on establishing positive values and beliefs and encourage individuals to seek
help. To make risk assessment effective it is also important to remove uncertainties associated
with the assessments. To mitigate uncertainty actions are to be taken to establish corroborative
information (Slade, 2009). Corroboration ensures accurate information and effective
management plans. It extends the confidence of health professionals in risk assessment tools and
builds a rapport between the patient and the health service provider.

Actions are to be taken to provide a safe environment to the patient. Identifying and controlling
the harmful factors will ensure a physically safe environment. Patients consent is important and
should be sought. All personal items that may potentially be harmful shall be taken away.
Patients activities shall be regularly monitored, especially during transition times. The transition
times includes the staff hand-over or unit transfers. Patients with higher risks requires a detailed
management plan. The detailed plan should integrate all associated aspects. It shall take care of
level of suicide risk. It shall also include nature of risk and appropriate safety plans. The
management plan shall also include level of medication. For instance, suicidal patients with habit
of substance abuse need interventions other than medication. The external interventions may
involve an appointment of special nurse or appropriate supportive therapy (Woods, 2013). Steps
are also to be taken regarding active community involvement (Woods, 2013). Assistance of
family and friends is to be sought particularly before discharge plans. The assistance can be in
form of education and moral support. Patients family members should be made aware of suicide
risks and educated about effective actions to minimize the risk. Patients medical records shall
be placed on observational charts to be communicated to associated health staff, particularly
nursing staff.

Lastly, necessary steps are to be taken regarding discharge procedures (Slade, 2009). There is a
need to develop discharge plan which shall include a follow-up and reassessment of the risk.
Contingency planning is also essential and should be done in communication with family
members, patient, and community care coordinator. A discharge plan must present a valid
rationale for discharge and be accompanied with a home treatment plan.

Effectiveness of actions undertaken

The above actions if undertaken can enhance the effectiveness of risk assessment and safety
plans. Corroboration is effective in providing services users and family members with a timely
review. Thus, it becomes easy to reflect on a potential for change in the level of risk. Such timely
awareness enables appropriate changes to be made in safety management strategies over time.
Furthermore, concept of ongoing supervision enables health policymakers to make changes to
existing frameworks. The up-to date changes also allow health professional such as nurses to
become competent in their practice. Development of a patient-centered assessment tools ensures
accurate assessment of risks and enhances the ownership of the process and care plan (Higgins et
al. 2015; Langan and Lindow 2004). If the friends, family members or the health experts try to
the patients to be cured then there are much chances of their attitudes towards recovery.
Sometimes the patients can put their energies to get rid of this psychological order. Furthermore,
actions involving active listening and in-care planning reduce the suicidal risk. Research
suggests that psychological support has substantially reduced the suicidal risk. A proper
discharge procedure also increases the confidence of the patient and the family in the assessment
tools and motivates them for reassessment and re-entry if required. Moreover, these actions
ensure that all physical, sociological and psychological dimensions are taken into account in a
risk assessment analysis. This further increases the effectiveness of risk assessment practice. The
suggested actions ensures that risk assessment not only extends nursing skills but also
incorporate other relevant health disciplines (Busfield, 2004). Furthermore, a multidisciplinary
approach and strategies may result improving the quality of decision making and extend the
implications of the developed frameworks (Carr, 2010). Focusing on risk factors, external or
personal, can eliminate inconsistencies that are often observed in safety management of suicidal
patients. The actions related to community involvement also encourage acceptability and support
for the patients within a community. Thus, they help establish positive attitudes among all the
concerned stakeholders.
References

Boardman, J. and Roberts, G. (2013) Risk, Safety and Recovery. London: Centre for Mental
Health/NHS Confederation.

Busfield, J. (2004) 'Mental health problems, psychotropic drug technologies and risk'. Health,
Risk & Society, 6(4): 361-375.

Carr, S. (2010) Enabling Risk, Ensuring Safety: Self-directed Support and Personal Budgets,
SCIE Report 36. London: Social Care Institute for Excellence.

Department of Health (DH) UK (2007) Best Practice in Managing Risk. London: Department of
Health.

Faulkner, A. (2012) The right to take risks. The Journal of Adult Protection, 14 (6): 287-296.

Health Service Executive (HSE) (2009) Risk Management in Mental Health Services: Guidance
Document. Dublin: HSE.

Higgins, A., Doyle, L., Downes, C., Nash, M., Morrissey, J., Brennan, M. and Costello, P. (2015)
Exploring practices, policies and processes around risk and safety management within
mental health nursing services. Dublin: Health Service Executive.
Langan, J. and Lindow, L. (2004). Living with risk: mental health service user involvement in
risk assessment and management. Bristol: The Policy Press. Weblink:
http://www.jrf.org.uk/sites/files/jrf/jr162-mental-health-service.pdf

Luoma, J.B., Martin, C.E. & Pearson, J.L. (2002). Contact with mental health and primary care
providers before suicide: A review of the evidence. American Journal of Psychiatry,
159(6), 909-916. doi:10.1176/appi.ajp.159.6.909

Mann, J.J, Apter, A., Bertolote J., Beautrais, A., Currier, D., Haas, A.,Hendin, H. (2008).
Suicide prevention strategies: A systematic review. Journal of the American Medical
Association, 294(16), 2064-2074

Morgan, S. (2000) Clinical risk management: a clinical tool and practitioner manual. London:
Sainsbury Centre for Mental Health.

Morriss, R., Kapur, N., & Byng, R. (2013). Assessing risk of suicide or self harm in adults.
BMJ. doi: 10.1136/bmj.f4572.

Patrick L. Kerr, P. J. (2010). Nonsuicidal Self-Injury: A Review of Current Research for Family
Medicine and Primary Care Physicians. J Am Board Fam Med March-April 2010 vol. 23
no. 2 240-259.

Ryan, T. (1998) 'Perceived risks associated with mental illness: Beyond homicide and suicide'.
Social Science & Medicine, 46 (2): 287-297.

Slade, M. (2009) Personal Recovery & Mental Illness: A Guide for Mental Health Professionals
(Values-Based Practice). Cambridge: Cambridge University Press.

Walsh, D. (1996) A Journey towards recover: from the inside out. Psychiatric Rehabilitation
Journal, 20 (2): 85 90.
Woods, P. (2013) Risk assessment and management approaches on mental health units. Journal
of Psychiatric & Mental Health Nursing, 20 (9): 807-813.

World Health Organization. (2014). Preventing suicide: A global imperative. Retrieved


from www.who.int/mental_health/suicide-prevention/world_report_2014/en/

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