EXAMPLE STANDARD OPERATING PROCEDURE

Outline of the intervention and who will deliver it

E.g. qualified staff with additional suicide-intervention training

Scope and definition

Risk assessment and allocation

When patients have been identified at significant risk of suicide and there are available staff trained and supervised a suicide-focused intervention should be considered even if the clinician is able to offer only a few sessions. Experience suggests just a few sessions can be extremely helpful and can identify appropriate actions for the patient or changes to the care plan. Allocation to a trained practitioner (band 6 or above) should be made wherever possible within the MDT or, alternatively, if that is not possible, a request could be made to the suicide intervention team.

A suicide intervention is indicated when the person:

  • • Has reported significant risk of suicide.
  • • Is able and willing to engage with the process.

If a patient has some suicidal ideation but not deemed at significant risk, then consider alternative recommendations to address their presenting problems, including other professional and voluntary services; debt advice; support for current or historical abuse, etc. Patients may be unsuitable if they are highly manic or psychotic or despite repeated goodwill attempts refuse to engage. If the person’s mental state is so poor or suicidal intent so high that participation is prevented, then consider any action needed to keep the person safe and review commencement when they are able to participate.

If you are unsure of the level of risk (e.g. you suspect the patient is underreporting their risk) or their suicide risk fluctuates, then closely review this. Patients are discharged when their risk has reduced. If a patient declines either to participate or to take positive steps to maintain their safety, then consider referral to the Crisis Team or Mental Health Act (MHA) assessment as indicated.

A suicide-focused intervention

should be considered at any stage in treatment for any patient at risk of suicide. However, it is not a substitute for more intensive evidence-based therapies, notably DBT.

Capacity

This intervention is a voluntary process which cannot be done against a person’s will and requires their consent for involvement. Efforts should always be made to try to establish consent and support a persons capacity to engage. This can involve extended time working with the person or working with other staff or family members. If someone does not or cannot engage, we should also document our efforts to engage them.

Working remotely

If need be, this intervention can be delivered by telephone or internet platforms.

If the practitioner delivering the intervention is off sick

For more than a week, the team manager should ensure the patient is reviewed. An interim plan to manage risk should be in place. Ideally the patient should be given a choice whether to wait or be re-allocated.

Delay in allocating a patient identified as appropriate

If a team identifies a patient as at significant risk of suicide and the patient is willing to work with someone to address this but there is delay in allocating them then a practitioner within the MDT should continue to support the patient with the following elements:

  • • reviewing their suicide risk as a primary focus at each contact;
  • • agreeing and reviewing a personalised safety plan.

Ending

Ideally the intervention should end when:

  • • the patient is managing suicidal thoughts and feelings and
  • • there has been no suicidal behaviour for the past three weeks.

If other interventions are indicated these may be planned within the service or outside, i.e. patients may or may not be discharged from the mental health service at that point, depending on their broader care plan. If risks remain high, then discuss in wider MDT and consider CRHT referral.

If patients have participated and become suicidal again

Suicidality is often episodic in nature. If the person resolved suicidality recently, and is suicidal again, review risk and revisit treatment goals. If someone has had an intervention that finished some months ago and becomes suicidal again, we can begin the initial assessment process and consider top-up or further intervention.

 
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