Suicidal Ideation

History:
  • Prior attempts?
  • > 2/3 of patients who commit suicide saw a clinician in the month before
  • Ask questions in a calm, non-judgmental, non-threatening way.
  • Do they have a support system?
  • Are they caring for anyone?
  • Spirituality?
Affirm and normalize the strong emotion
Have the family step out of the room – improves honesty
Focus on the reasons why they’re still here:  strengths, what are they living for?
Creating a Safety Plan:
  • Does not mean they won’t commit suicide.
  • Identify contacts for when they feel overwhelmed, brainstorm plan to manage symptoms.
We often get derailed (or derail ourselves) into talking about the mechanics of the suicide attempt (amount of drug, etc.).
The harder conversation is to acknowledge their suffering and desperation.
What if they don’t want to talk about it?
  • If they state no more SI, then go with “so how can we sustain that?” and offer yourself as a resource of support.
  • In the inpatient setting, may be okay not to push too hard, since PET team is coming to dig deep soon.
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