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