Process - Physician - Fraser Health Authority

Problem-Solving CapacityCan the patient generate strategies and options forproblem-solving through their difficulties?Reasons for Living & Level of HopeWhat reasons do you have for living? How hopeful do you feelthat your current situation could change? What is needed tochange to help you feel not so hopeless?Feelings of hopelessness, helplessness, and view offuture as empty or meaningless = HIGHER RISK6. Communicate with families/significant other(s)Obtain contact information for, and consent to speakwith, family/significant other(s). Connecting with familyand friends demystifies what’s happening, and allows thepatient’s support system to develop confidence in theassessment and treatment process.Inform next of kin/emergency contact if patient has madesuicide attempt.Note: In an emergency, consent is not required to releaseinformation to family/significant other(s), although it is acourtesy to inform the patient of disclosure of information.Consent is also not required to obtain information fromfamily/significant other(s).Solicit input from family or significant others, as this ishelpful for risk assessment and safety planning. Inquireabout changes in behaviour, signs of depression,hopelessness, past attempts, any communication of intent,difficulties adhering to treatment, and examples of riskybehaviour (important when decisions are made aboutcertification).7. When to make a specialist referralRefer patients with a psychiatric history to mental health/psychiatry.The high-risk patient should be admitted to hospital orprovided a high-priority referral for a mental health orpsychiatric assessment to provide recommendations aboutmanagement.SAD PERSONS provides a useful screening acronym toidentify the high risk patient:Sex (male)Age (adolescent or elderly)DepressionPrevious attemptEthanol abuseRational thinking loss (psychosis)Social supports lackingOrganized planNo spouse/partnerSickness – especially chronic/uncontrolled painOther factors suggesting high risk are: multiple risk factors;profound hopelessness; lack of protective factors; highlethality; premeditation of present attempt; and/or familyhistory of suicide, depression or substance abuse.8. Communicate with primary careprovider(s)Obtain information from patient and/or their familyabout the patient’s current health and mental health careprovider(s). Communicate with patient’s primary careprovider(s) to ensure continuity of care.Include family/significant other(s) in discussions regardingsafety and treatment planning (discuss ways family/friendscan implement support in the patient’s home environment).Acknowledge feelings of family/friends (e.g., fear, anger).Guide them to seek psycho-educational and emotionalsupports for themselves. Provide referrals for supportagencies.151