Mental Health Nursing

Risk assessment and management in acute mental health care 147
Table 7.1 Factors associated with an increased risk of suicide
(adapted from Zametkin et al., 2001)
The following factors are strongly associated with suicide attempts.
• A previous history of a suicide attempt
• A major depressive disorder
• A substance abuse disorder
• Being male (males tend to use more violent methods)
• Living alone
• A history of physical or sexual abuse
In addition, the following may precipitate a suicide attempt.
• Recent dramatic personality change
• Psychosocial stressor
• Talking about death or dying
• Availability of method of suicide
• Altered mental state (agitated, suffering from auditory hallucinations, delusions,
intoxication or, following a very troubled episode, suddenly becoming calm)
is to be made. By using active listening skills, the keyworker is able
to obtain important information from the patient about self-harming
ideation, which the patient would otherwise find difficult to express to a
stranger due to guilt and fear. Such rapport thus encourages the gradual
development of a therapeutic relationship, helping to prevent destructive
malignant alienation.
Assessment
Given the fact that all people with mental health problems are at increased
risk of self-harming, all patients must be screened for such risk as part of
the overall assessment on admission to in-patient care, preferably using an
evidence-based screening instrument (SNMAC, 1999). Unfortunately,
standardised risk assessment for suicidal intent is not in widespread use
within the United Kingdom, an issue the SNMAC advised should be
addressed. However, specific risk factors to include in an assessment are
listed in Table 7.1.
Information should be obtained from the client and also, where possible,
families, carers and the referrer. Inclusion of additional sources is
important as the patient may well be reluctant to divulge suicidal intent.
The findings of the assessments should be discussed with the ward team
and a level of observation should be set and communicated to the whole
of the multidisciplinary team.
The level of risk must be re-assessed formally, at set intervals, and
informally, by staff observing and sharing their views of the patient’s