RISK ASSESSMENT OF SUICIDE IN CLINICAL PRACTICE AMRESH SHRIVASTAVA1.

Suicide is a public health problem presents as the most serious psychiatric emergency. Identification and assessment of suicidality is a skill that every physician needs to have, skills for identification and intervention Risk assessments are done in number of settings like: emergency rooms, psychiatric outpatient, primary care, general medical wards, post-operative and intensive care settings, crisis centers, day hospitals for crisis beds, telephone helplines, psychiatric outpatients, psychiatric acute services, community psychiatry settings, early intervention programs, sometimes in special settings like jails, prisons, schools, workplaces and legal justice systems. In every setting and in every situation, the format, content and method of risk assessment varies to some extent depending upon the client’s level of comfort, engagement of the patient with the therapist and the availability of collateral data. Collateral data and objective information from referring sources, accompanying persons, family members, significant others, friends and colleagues from work place is of great value in determining level of risk and for the planning of disposition and care. Risk assessment is also a responsibility of all non-health professionals (anyone who comes in contact with vulnerable population) should Clinicians have to consider a number of issues that may affect both the patient as well as the physician. Most common questions and actions that every clinician faces are: 1. Is the patient at risk of suicide? 2. Is the patient at risk of suicide to a degree that needs immediate attention? 3. Does the patient have the level of risk that cannot be treated on an outpatient basis? 4. Does the patient need to be hospitalized as a voluntary or involuntary status? 5. Carry out an assessment of suicide during the stay in the hospital to monitor the progress 6. Carry out an assessment of suicide to decide fitness for discharge 7. Determine the level of risk before sending patient on leave of absence, and can the risk be managed with the given resources in the community? Compressive risk assessment involves the following : A. Step 1. Detect predisposing factor; a. Axis I disorder; 1b. Specific suicide inquiry. What are the thoughts? Are they active or passive? When did they begin? B. How frequent are they? How persistent are they? Are they obsessive? Can you control them? Do they command hallucination? C. Step 2. Identify or detect a predisposing factor D. Step 3. Detecting potentiating factors like family history, personality disorders, life stressors, physical illness and access to lethal means of suicide. E. Step 4. Determine the level of intervention: a distinguishing disorder-based suicidality from personality-based suicidality. F. Step.5 Provide documentation for Assessment, Degree of risk, Objective data, Subjective data

risk assessment is most important skill that clinicians across the disciplines require.