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Suicide risk assessment and management
Ask directly about suicidal thoughts — asking does not raise the risk — and grade thoughts, intent, plan and preparation; the strongest risk factor is a previous attempt, and management follows the level of risk: no being left alone and urgent assessment at immediate risk, a safety plan and close follow-up at lower risk.
Why it matters in the exam
Exam questions test two things. The first is the risk factors: a previous attempt (the strongest), mental disorder (depression, bipolar disorder, schizophrenia, substance use), male sex and older age for completed suicide, women for attempts, isolation, divorce or widowhood, chronic physical illness and pain, hopelessness, the period soon after discharge from psychiatric admission, and access to lethal means. Protective factors: social support, children at home, faith, and a therapeutic relationship.
The second is what to do: a person with intent and a plan is not left alone, dangerous means are removed from the surroundings, and an urgent psychiatric assessment is done; after an attempt, medical stabilisation comes first and then assessment. If there is immediate danger due to mental illness and the person refuses, Israeli law allows examination and involuntary admission on the order of the district psychiatrist. At lower risk a safety plan is built together, access to means is restricted, the underlying disorder is treated and close follow-up is arranged. A "no-suicide contract" is not recommended and does not protect. Lithium in bipolar disorder and clozapine in schizophrenia reduce suicide.
Key points
- Ask directly; asking does not raise the risk.
- The strongest risk factor: a previous attempt.
- Grade thought, intent, plan and preparation.
- Immediate risk: not alone, remove means, urgent assessment, and involuntary admission if needed.
- Lithium and clozapine reduce suicide.
Summary table
| Level | Findings | Management | Exam notes |
|---|---|---|---|
| Immediate, high risk | Intent and plan, preparation, a recent attempt, psychosis, deep hopelessness | Do not leave alone, remove means, urgent psychiatric assessment and admission | If refusing and in danger due to mental illness — involuntary admission under the law |
| Moderate risk | Thoughts with some intent, no settled plan; many risk factors | Psychiatric assessment, safety plan, follow-up within days | Involve family with consent |
| Low risk | Passing thoughts without intent or plan; protective factors | Treat the underlying disorder, safety plan, follow-up | Leave an available route to help |
| After an attempt | — | Medical stabilisation first, then psychiatric assessment before discharge | Never discharge before assessment |
| Drugs that reduce suicide | — | Lithium in bipolar disorder; clozapine in schizophrenia | Antidepressants under age 25 — close follow-up in the first weeks |
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Sources
- APA Practice Guideline for the Assessment and Treatment of Patients With Suicidal Behaviors, 2003, with later APA guidance — Suicide assessment
- NICE guideline NG225, 2022 — Self-harm: assessment, management and preventing recurrence
- Israel Treatment of Mentally Ill Persons Law, 1991 — Emergency psychiatric examination and involuntary admission
- Kaplan and Sadock's Synopsis of Psychiatry, 12th edition (2021) — Psychiatric Emergencies: Suicide
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.