Suicide

Suicide assessment is not a single question or a score. It is a clinical formulation: the nurse integrates the patient’s current suicidal thinking and behaviour with access to means, recent stressors, mental state, history, and protective factors to determine what must happen next. Begin with the patient’s change from baseline. Chronic, passive thoughts without current intent are clinically different from a sudden increase in suicidal thinking, new planning, or a recent attempt. A history of attempts, mental illness, chronic pain, trauma, or family history can increase baseline vulnerability. Acute factors—intoxication, severe insomnia, agitation, psychosis, recent interpersonal loss, access to lethal means, or a recent psychiatric discharge—can rapidly increase immediate danger. Protective factors such as connection with others, responsibilities, reasons for living, treatment engagement, and willingness to accept help inform the plan. They do not cancel a current plan, intent, or access to lethal means. A patient may love their family and still require emergency containment. Ask directly and calmly. “Are you thinking about killing yourself?” is safer and more clinically useful than vague questions about whether the patient feels low....