Quality Statement 2: Suicide Risk Assessment and Intervention

Resources Quality Statements Advisory Committee About

2

Suicide Risk Assessment and Intervention

People with major depression who are at considerable risk to themselves or others, or who show psychotic symptoms, receive immediate access to suicide risk assessment and preventive intervention.

Background

People with major depression have an increased lifetime risk of suicide and should be assessed for suicide risk on initial contact and throughout treatment. Health care providers, family members, and caregivers should be alert for suicide risk in people with a sad or depressed mood, suicidal ideation, and one or more risk factors, including previous suicide attempts, a family history of suicide, physical or sexual abuse, family violence, and chronic pain.

What This Quality Statement Means

For Patients

You should receive immediate help if you or your health care professional feels you’re at risk of harming yourself or someone else. This help might take place at your health care professional’s office or in an emergency department.

For Clinicians

If you suspect a person with major depression may be at risk to themselves or others, or if they show psychotic symptoms, complete and document a full suicide risk assessment, as described in the Definitions section of this statement. If the person is deemed to be at risk for suicide, provide urgent preventive intervention as described in the Definitions section.

For Health Services

Ensure the availability of suicide risk assessment tools, resources, and trained professionals.

Quality Indicators

Process Indicator

Percentage of people with major depression identified by a trained professional to be at considerable risk to themselves or others, or who show psychotic symptoms, who receive immediate access to suicide risk assessment and, if necessary, preventive intervention

Denominator: total number of people with major depression identified by a trained professional to be at considerable risk to themselves or others or who show psychotic symptoms
Numerator: number of people in the denominator who receive immediate access to suicide risk assessment and, if necessary, preventive intervention
Data source: local data collection

Definitions Used Within This Quality Statement

Immediate access

Help is offered at the point of contact.

Suicidal risk assessment

This includes questions about:

Suicidal thoughts, intent, plans, means, and behaviours (hopelessness)
Specific psychiatric symptoms (e.g., psychosis, severe anxiety, substance use) or general medical conditions, as well as psychiatric treatment that may increase the likelihood of acting on suicidal ideas
Past and, particularly, recent suicidal behaviours
Current stressors and potential protective factors (e.g., positive reasons for living, social support)
Family history of suicide or mental illness

Suicide risk assessment scales can be used by trained professionals to guide assessment.

Suicide preventive interventions

These include involuntary admission to hospital, observation every 15 minutes or one-to-one constant observation, urgent medication treatment, and urgent electroconvulsive therapy.

Evidence to Improve Care