I encountered this article on Suicide Assessment in the most recent issue of Academic Psychiatry, and thought it was reasonably concise and coherent--especially in the examination of the patient's Risk Status vs. Risk States, as well as the focus on preventative strategies, anticipating changes in circumstances, and documentation. It should serve as a good supplement to what you are already doing in terms of safety assessments. Does it cause you to think about these assessments in any different way? What do you think it might add to that process for you?
Reformulating Suicide Risk Formulation: From Prediction to Prevention, by Anthony R. Pisani, Daniel C. Murrie, & Morton M. Silverman. Academic Psychiatry 40(4): 623-29 (2016)
Online access: http://link.springer.com/article/10.1007/s40596-015-0434-6
When formulating suicide risk assessment, I use a biopsychosocial approach, which I find to help me holistically gauge at the intervention(s) necessary to understand and reduce suicide risk in the individual case presented. Also, I like this approach because it emphasizes the risk state of the patient, using the patient as their own baseline. As I get more experience at HCMC/Regions, it will be more practical to integrate risk status. However as mentioned in this article, risk status like many subjective clinical judgment, brings the challenge of reliability of judgments across clinicians. I definitely like the suggestion of identifying at least two significant potential changes, which permits the discussion of specific contingency plans.
ReplyDeleteAs a psychiatry intern, I am quite new to the concept of suicide risk assessment and am learning how to be more thorough with this. Having a framework such as the one presented will help me better organize my thoughts and devise a thoughtful and clear individualized plan to best help my patients is incredibly valuable. I think that having these conversations and for patients to hear themselves audibly say who their supports are and to remind them of their strengths can perhaps be therapeutic for the patient and by working together to identify resources builds upon collaborative care and therapeutic alliance - all good things!
ReplyDeleteYes I do find most places using a scale of low-high etc. I have been describing chronic and acute based on a current psychiatry model; which is similar to this excluding comparing patient populations.
ReplyDeleteUseful article, though I'm not sure it brings anything dramatically new to the existing literature on suicide risk assessment. Certainly this is one of our most important skills, though we can still miss -
ReplyDelete"an act like this is prepared within the silence of the heart, as is a great work of art" (Camus)