Assessing for Risk of Self-Harm

A question I tend to utilize in my assessments is, “Walk me through the day you decided you were experiencing suicidal thoughts, or the day you decided you were going to kill yourself.”

Some of you are saying to yourselves that that sounds either too personal or too upfront.

Keep in mind, as you are asking these important questions, that it is essential to keep track of your own “affect” and to remain calm, maintain good eye contact, and remain even toned and nonjudgmental. This may be easier said than done. I know this takes practice and working through your own countertransference in supervision, especially for most of you who may feel you are impinging upon a patient’s privacy. However, once you get past this phase that prevents you from asking these questions, the patient will let their guard down and tell you their story. This is quite an important part of the role as a clinician, since we are evaluating the patient’s level of safety. It is important to focus on the details, including what led them to the suicidal gesture, the frequency of their suicidal thoughts, how often they were having these thoughts, and whether it was a planned or an impulsive attempt. Did they keep this to themselves and not tell anyone, do they have a history of attempts, if so what were they, were they hospitalized due to this, was there any regret over not having succeeded in the attempt, was there a suicide note, and most importantly, is there a history of suicide attempt in their family?

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