How should I screen for and address suicide risk in populations with serious mental illnesses?

Patients across a spectrum of both affective and psychotic diagnoses are at increased risk for suicide. Thus, there is a need to regularly screen for and assess suicide risk as a routine part of clinical assessments and care. Suicide risk in behavioral health settings should be addressed directly, rather than simply as one symptom of particular conditions. Clinical assessments should include present and past history of suicidal ideation, plans and attempts, as well as accompanying risk factors. Comorbid substance use is a particularly important risk factor. Among those who report current suicidal ideation, assessment of risk should include patient’s intended course of action if current symptoms worsen, access to suicide methods including firearms, and positive reasons for living.

REFERENCES

The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults (Third Edition), Arlington VA: American Psychiatric Association, 2016.

National Academies of Sciences, Engineering, and Medicine. 2019. Improving care to prevent suicide among people with serious mental illness: Proceedings of a workshop. Washington, DC: The National Academies Press.

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