What is a Suicide Assessment?

Suicide assessments are informal evaluation processes psychological professionals go through to decide

* Whether a client might be suicidal and * How immediate any danger is

When is a Suicide Assessment Done?

Suicide assessments are usually done as part of the initial intake interview, and any other time that a client indicates possible suicidal ideation (thoughts about suicide) through behavior or speech.

Who Does the Assessment?

Sometimes the client is in the office when she indicates that she has suicidal ideation, but sometimes a concerned friend, family member, or even coworker will call. If the therapist already sees the person in question, it's her job to assess the client's present state of mind. If the person in question isn't the therapist's client, she'll advise the caller to go to the nearest emergency room.

Immediate Danger

If the client is clearly in immediate danger of harming himself, the therapist will ask the client or caller to go directly to the closest hospital's emergency room. All emergency rooms have a social worker available to decide whether the person should be admitted. If that particular hospital doesn't have a psychiatric unit, the person will be transported to a hospital that does.

If the client is going to be admitted, the therapist will often meet her at the emergency room. Thanks to the red tape of insurance, it's not uncommon for the admittance process to take 3 to 5 hours, which means a lot of sitting around the waiting room.

Less Immediate Danger

If the caller or client isn't in immediate danger but is still feeling unsafe, the therapist will ask him to come in for an emergency appointment. She'll encourage him to have someone drive him, not only because it's safer for him (and probably the other folks on the road), but also so the client has a ride and emotional support if he does need to go to the hospital.

How is the Suicide Assessment Done?

A therapist never talks to anyone outside the office about a client unless she has the client's written permission (for example, because she's consulting with another of the client's doctors) or the client is in immediate danger. That means that when suicidality is involved, she must assess whether the situation is serious enough to involve other people.

Every suicide assessment contains three parts: plan, means, and time. The therapist asks:

If the person knows how s/he would kill him or herself (plan).

If s/he has the means to do it (means).

If s/he has a time planned (time). People who are serious often do, or they may just say, "I can't stand it anymore," which pretty much means "now." If someone doesn't have a clear and immediate answer to this question, the therapist may ask, "Can you be safe?" or "Can you stay safe if you go home?" Someone who is really in trouble will say, "No," "I don't know," or "I don't think so."

Therapists can usually tell pretty quickly how urgent the situation is, mostly because people have little problem telling them! Obviously, if someone is in so much emotional pain that he'd rather die than finish the day, the hospital is the next stop.

Involuntary Hospitalizations

Psychiatric hospitalization is like any other hospitalization. The doctors work hard to provide symptom relief as fast as possible, and keep the person in an environment where if there's an emergency, someone is there right away to help.

You can compare this to medical care for physical injuries: if you've broken your leg, the hospital may be the only place the bone can be set properly. It may also be the best place to get medications to quickly reduce the physical pain. If you have life-threatening pneumonia, you are admitted so doctors and nurses can monitor your health and immediately make any necessary adjustments to your care to help you feel better as quickly as possible. Likewise, if you're suicidal, you may be given antidepressants or another medicine that will quickly help stabilize brain chemicals and reduce the emotional pain. Staying in the hospital for a few days allows the doctors to be sure the medicine is working, to give you emotional support, and to make any adjustments needed to get you feeling better as quickly as possible.

Involuntary hospitalizations are actually very rare: most people who feel this bad really just want to feel better, and if that means going to the hospital, they're ready to go! You also have to remember that people who really want to die don't tell anyone. They just do it. If someone realizes your character is suicidal, it's because he's struggling to keep himself going. People who do commit suicide do so because they've reached the point where they see no other solution.

In the rare situation that a client really doesn't want to go and is really in danger of killing himself, the therapist can explain that she's legally and ethically obligated to do everything she can to keep him safe, up to and including involuntary hospitalization. Then she explains that the police are the ones responsible for taking him to the hospital, which means he's likely to end up in the back of a squad car. In the end, most people agree that it's a lot easier to just go voluntarily.

Safety Plans

If the client believes he can stay safe for a given period of time (say, a week--asking a client to stay safe for one week at a time is reasonable) and can promise to tell someone or go to the hospital if that changes, he and the therapist may create a Safety Plan. In a safety plan, the client promises (often in writing) that he will not harm himself, and if he feels he can't hold to that, he has a series of things to do, in the order he should do them. Usually safety plans include things like calling a trusted friend, asking someone to come over and stay, calling the therapist, and going to the emergency room.

About the Author

Dr. Carolyn Kaufman is a clinical psychologist who teaches at Columbus State Community College in Columbus, Ohio. A published writer, she recently launched Archetype Writing: Psychology for Fiction Writers (http://www.archetypewriting.com). Visitors will find not only articles about psychology tailored to their needs, but they can ask Dr. K their writing/psychology questions. She is often quoted by the media as an expert resource.