When to Assess for Suicide

WHEN TO ASSESS for SUICIDE

A suicide assessment should be done with almost all callers in crisis. We get a lot of calls from the chronically mentally ill and the majority of the time, the chronic caller is not suicidal. NEVER ASSUME A CHRONIC CALLER IS SAFE. They are at the most risk for suicide. Ask about suicidal ideation if you notice any clues/ warning signs. If you are experiencing any anxiety about a caller, or feel anything in your gut, ask about suicidal feelings. “I hear that you are upset. Are you having any thoughts of suicide?” Below are listed some possible clues. If you hear any of these clues, ASSESS for SUICIDE. When in doubt, ALWAYS ASK!

•Caller indicates that he cuts or harms himself in other ways
o “Were you trying to kill yourself when you cut your leg?”
•Caller states that she is suicidal
•Caller’s Level of Emotional Distress
o Caller is crying profusely, expressing a lot of pain
o Caller is eerily calm while describing horrific situations
•Indirect or Direct references to feelings of hopelessness
•Expression of the Desire to die
o “I just want to sleep and never wake up”
o “I’m tired of it all”
•Caller is drinking or under the influence of other substances
•Caller has not eaten or slept for days
•San Francisco Suicide Uses the following Acronym: PLAIDPALS. These are some things to explore to see if a caller is in imminent danger.
o Plan – Do they have one?
o Lethality -- Is it lethal? Can they die?
o Availability -- Do they have the means to carry it out?
o Illness -- Do they have a mental or physical illness?
o Depression -- Chronic or specific incident(s)?
o Previous attempts -- How many? How recent?
o Alone -- Are they alone? Do they have a support system? partner? Are they alone right now?
o Loss -- Have they suffered a loss? Death, job, relationship, self esteem?
o Substance Abuse (or use) -- Drugs, alcohol, medicine? Current, chronic?