Suicide risk assessment and management

Intent score scale

Area Item Score
Circumstances relating
to suicidal attempt 		Isolation 0 Somebody present
1 Somebody nearby or in contact (as by phone)
2 No-one nearby or in contact
Timing 0 Timed so that intervention is probable
1 Timed so that intervention is unlikely
2 Timed so that intervention is highly unlikely
Precautions against discovery 0 No precautions
1 Passive precautions eg avoiding others but doing nothing to prevent their intervention (eg alone in room, door unlocked)
2 Active precautions (eg locked doors)
Acting to gain help during or after attempt 0 Notified helper regarding attempt
1 Contacted but did not specifically notify helper regarding the attempt
2 Did not contact or notify potential helper
Final acts in anticipation of death 0 None
1 Partial preparation or ideation
2 Definite plans made (eg changes in will, taking out insurance)
Suicide note 0 No note
1 Note written but torn up
2 Presence of note
Self report Patient's statement of lethality 0 Thought that what he had done would not kill him
1 Unsure whether what he had done would kill him
2 Believed that what he had done would kill him
Stated intent 0 Thought that what he had done would not kill him
1 Unsure whether what he had done would kill him
2 Believed that what he had done would kill him
Premeditation 0 Impulsive, no premeditation
1 Considered act for approx 1 hour
2 Considered act for approx 1 day
3 Considered act for more than 1 day
Reaction to act 0 Patient glad he had recovered
1 Patient uncertain whether he is glad or sorry
2 Patient sorry he has recovered
Risk Predictable outcome in terms of lethality of patient's act and circumstances known to him 0 Survival certain
1 Death unlikely
2 Death likely or certain
Would death have occured without medical treatment? 0 No
1 Uncertain
2 Yes
Total score 0-3 Low risk
4-10 Medium risk
11+ High risk

Risk of repetition scale

Scoring: 5+ = significant risk of repetition