Assessment and immediate management of people at risk of harming themselves

The ability of health professionals and other professionals in contact with people at risk of committing suicide to assess and respond appropriately to suicide risk is central to any public health programme to reduce suicide in the local population. The sharing of similar concepts concerning suicide risk is essential if services staffed by different professionals from different agencies are going to communicate effectively and respond appropriately to an individual risk of suicide. This contribution outlines the clinical assessment and management of suicide risk in an individual (whatever their sociodemographic background or diagnosis), outlining factors that make the risk of suicide, as opposed to self-harm or mental illness, more or less likely. The assessment of a person who has recently self-harmed is also covered. Immediate management of suicide is outlined, ranging from how to conduct the interview, releasing emotion, specific approaches to bolster self-esteem and hopefulness, ensuring safety and providing support through family and professionals. A categorization of risk, used successfully in studies of mass-training health professionals to assess and manage patients at risk of suicide (STORM studies) is offered, ranging from low to very high risk. The level of risk assessed is allied to a clear action plan for each category of risk. In this way staff will know what the management implications are in terms of managing suicide risk (but not other clinical needs) based on the assessment of category of risk. Finally, the issue of acquiring these clinical skills is discussed briefly.