Assessment and immediate management of people at risk of harming themselves

Abstract

Abstract This article reviews the clinical assessment and management of people at risk of suicide and self-harm. Such people are found in many clinical settings. In any given clinical situation, there are identifiable factors which increase or decrease the risk of suicide. The risk that a person has of suicide in the next few hours, days and weeks depends on the degree to which the person has these factors increasing or decreasing suicide risk. These factors are relevant only to suicide and do not necessarily indicate the risk of self-harm not leading to death. A strategy for the assessment of suicide with or without recent self-harm is provided. These require good general interview skills, clarification of current problems, specific questioning about suicide intent, information on past suicide attempts and coping mechanisms, and information on current and past symptoms of mental disorder. From the assessment, people can be categorized as low, medium, medium–high or very high risk. Each risk category is linked to a set of management options that would be typically carried out. These would include ensuring immediate safety, support in the first 24–72 hour period, follow-up, defining the emotional crisis, restricting access to the means of suicide and further assessment of mental health problems, psychosocial problems and crisis prevention strategies.