How do I assess for suicide in individuals with serious mental illness?

It is impossible to predict accurately who will make serious suicide attempts, but talking with anyone who you think might be considering suicide is an important effort towards safety and prevention. Mentioning or asking about suicidal thoughts and behaviors will not “put the idea in their head,” instead it gives you the chance to show you care and offer hope that you can help them seek safety. If you have any concerns about suicidal thoughts and behaviors for yourself or a loved one, it is recommended you seek immediate professional help. You can always access immediate support through the National Suicide Prevention Lifeline at 988, which provides free and confidential support for people in distress.

In discussing suicide it is important to use a supportive, empathetic approach. Key areas to discuss are any negative voices they are hearing (e.g., voices telling the individual to kill himself, telling the individual he is worthless, telling the individual he would be better off dead) and the individual’s ability to resist those voices, and any other beliefs that frighten the patient (e.g., warning of terrible torture, warning of being captured, jailed). Vulnerable periods that can trigger suicidal thoughts in individuals with SMI include illness onset (e.g., realization of the severity of their illness), just before hospital discharge or soon after (e.g., insight that the course of the illness is challenging), or the occurrence of a recent adverse life event (e.g., interpersonal conflict, anniversary of a major loss).

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