Risk Assessment

Question 1

Parasuicide

Answer 1

Parasuicide is a term that encompasses deliberate self-harm and attempted suicide
- It is an act with a non-fatal outcome, in which an individual deliberately initiates a non-habitual behaviour that will cause self-harm

Question 2

Suicide

Answer 2

Suicide is the act of killing oneself deliberately, initiated and performed by the person concerned in full knowledge or expectation of its fatal outcome

Question 3

5 Components of Suicide Risk Assessment

Answer 3

History of Current Attempt 
Assessment of Risk Factors 
Assessment of patient's current mood
What are the protective factors 
What are the patient's current thoughts and plans towards suicide

Question 4

History of current attempt

Answer 4

• What precipitated it, were there any triggers
• Was it planned or impulsive
• What was the intention
• What method did they use; violent methods are more worrying, as they are more likely to complete
• Presence of plans for others after death e.g. suicide note, updated will. This indicates motivation and planning
• What steps did they take to avoid discovery
• Did the patient seek help after the attempt, or were they discovered by someone else
• How does the patient feel about the attempt now

Question 5

Assessment of Risk Factors

Answer 5

• Previous suicide attempt or previous deliberate self-harm
• Past psychiatric history, particularly of the following
  ▪ Affective disorders, particularly depression
  ▪ Schizophrenia
  ▪ Alcohol dependence
  ▪ Borderline personality disorder
• The patient’s current mental state being that of hopelessness, unexplained symptom improvement, psychotic symptoms (particularly command hallucinations), or development of insight into their condition
• Past medical history of chronic pain, insomnia, or terminal illness
• Substance misuse
• Financial difficulty
• Relationship problems
• Bereavement
• Discharge from inpatient psychiatric care

Question 6

Management of patient following attempt

Answer 6

Management of patients following suicide attempt is dependent on risk, and should involve the patient in the formation of an MDT care plan. This can include the following

• Admission
• Home with the home treatment team
• Home with referral to secondary mental health services
• Home with GP follow-up, this is not recommended following attempted suicide

Question 7

Risk to Others

Answer 7

When assessing the risk that a patient may pose to others, the following aspects should be addressed
- Situation: consider where the person is, to whom they pose a risk (named victim v general public), and what the risk is (verbal aggression, physical aggression, use of a weapon)
- Past history and psychiatric history
- Current mental state assessment
There are many factors that can increase the risk of violence in a patient
- Past history of violence
- Personality disorder or past psychiatric history
- Current mental state being that of fear, anger, humiliation, jealousy, command hallucinations/ persecutory delusions
- Substance misuse
- Childhood trauma
- Recent major life events
- Availability of weapons is very important, and must be assessed in all potentially violent cases

Question 8

Management of Violent Patients

Answer 8

In the management of violent patients, the least restrictive approach should be used. Safe restraint by nursing staff alongside de-escalation techniques are usually sufficient

• Rapid tranquilisation with medications may be necessary e.g. olanzapine (PO/IM), aripiprazole (IM), haloperidol (PO/IM), quetiapine (PO), chlorpromazine (PO), lorazepam (PO/IM)
• Side effects of these medications can be significant e.g. hypotension, arrhythmia

Question 9

Risk of harm to children

Answer 9

Harm to children can include emotional, physical, sexual abuse, and neglect
- Key risk factors include substance misuse, mental illness, and domestic violence within the household
If there are any safeguarding concerns for children, then there should be referral to the social care interagency team