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Assessing suicide risk.Suicide risk assessments can be tricky. Someone saying s/he has suicidal ideations does not necessarily mean that their suicide risk is high. Similarly, someone who never mentioned any suicidal thoughts may not be low on the risk scale.The following are some of the questions we ask patients when assessing their risk.Previous history of suicide attempts? (including self-harm)Family history of psychiatric conditions?Male gender increases the risk significantly.Do they feel that their life is completely hopeless.Any concrete plans in place for committing suicide? (E.g time, date, method etc)Have they told anyone of their plans? (If they did, it would lower the risk)Prepared any death note?Any access to means for suicidal act? (E.g sleeping pills, insecticides, firearms etc)Any prior arrangments made in anticipation of death? (E.g sold car/property, resign from job etc)Any social support available? (Family, friends, external support etc)Now if you do have a friend or a family member that is feeling depressed, you can ask these questions to find out the immediate risk. I had a friend in medical school, who was not yet a doctor then, save his peer’s life because he noticed the warning signs early.However, even if you are a clinician like me, DO NOT hesitate to send them to the doctor if you suspect clinical depression. Let the professionals, who are not emotionally attached to the patient, do the proper assessment objectively.

Hi,Mental health clinicians vary in their ability to predict the level of risk a patient poses to themselves or others. Suicide is one of the most difficult areas that a mental health clinician has to deal with.Discuss the client of concern with other cliniciansWhen a clinician believes that their client may be a suicide risk, the best thing they can do is to remain calm and think clearly about the issue. Most clinicians will talk about a client of concern with a colleague or if they are working with others in a clinical team, they usually talk about the client’s risks and other concerns with a clinical supervisor or other team members.Experience and EmpathyI believe that an experienced clinician is better able to predict suicide risk in a client. I also believe that an emphatic psychotherapist is better able to sense if their client is considering suicide or is a serious suicide risk.Communication and listening skillsMoreover, in order for a clinician to develop a good working relationship and empathy with a client, they must have good communication and listening skills. In fact, when it comes to suicide, clinicians are trained to ask a person directly if they are contemplating suicide.Clinician’s personality and ability to think under pressureI believe that a clinician’s personality and their ability to stay cool, calm and collected are essential when it comes to working with suicidal patients. I have worked with many clinicians that just could not cope with the ongoing stress and fear that one of their patients might kill themselves.It takes a particular kind of person to work in Emergency Services and mental health teams that treat people with serious mental illness. For example, whilst working in Psychiatric Triage, I would receive calls from psychotherapists on Thursdays and Fridays that wanted to refer their clients to CATT for treatment over the weekend.I found that certain psychotherapists regularly called to handball their clients to CATT because they just could not relax on the weekend with the thought that their client may self-harm. I discovered that this group of psychotherapists stopped working in the sector or stopped taking on clients that suffered from severe mental illness or that they felt may be a suicide risk.It is impossible for a mental health clinician to accurately predict the future, including the likelihood of self-harm or homicidal behaviour in other people. However, a qualified, skilled and empathic mental health clinician is expected to identify those at risk and deliver an acceptable clinical response.Asking the right questions during a risk assessmentIf a clinician believes that a client is a suicide risk, they must ask the client specific questions that explore various clinical hypotheses. For example, the clinician must ascertain how advanced the patient's suicide plan is.For example:Does the patient have a method in mind (i.e. pills)?Does the client actually have the pills that speak of and do they have enough of them to result is death or serious harm?Does the client have a well thought out premeditated plan?Is the client’s mental state unstable and do they have a history of impulsive behaviour?Has the patient attempted suicide in the past?Has the patient been giving away their possessions?Has the patient been saying goodbye to their significant others?Risk Assessment formsMental health services and private practitioners have developed risk assessments forms that they use to assist them to assess the patients risk factors. The risk assessment form assists the clinician to:make a more comprehensive risk assessment,make a clinical decision about the client’s risk level, anddecisions about treatment/intervention.Please click on the link below to view the South Australian Government Mental Health Services Risk Assessment Guide:https://www.square.org.au/wp-content/uploads/sites/10/2013/05/Risk-Assessment_Colour_May2013_Handout2.pdfI have learnt that the above-mentioned strategies and Risk Assessment forms can assist a clinician to better accurately predict the patient’s suicide risk. However, I have learnt that sometimes our patients make a decision to commit suicide and we cannot save them.The patient may attend their regular therapy session. They compose themselves, state that everything is going well for them and do not give the clinician any indication that they plan to kill themselves.I have also learnt that a good clinician can predict if a particular patient will make an attempt to end their own life. However, to my frustration, we cannot predict the timing of the event or when the patient will actually try to end their life.Kamal

Back in 2016 a British 26 year old man by the name Ben Innes was on board a plane that was on its way from Cyprus to Egypt.The plane was hijacked by an Egyptian man named Seif Eldin Mustafa. He was wearing something that looked like a suicide bomb vest and he threatened to blow up the plane.Ben Innes who works in an oil company in the department of “Risk assessement”, "hazard recognition" and "Behaviour Based Safety" thought that this was a great opportunity to get the worlds greatest selfie.An Egyptian airplane stewardess later joined in for a selfie as well.Ben Innes later said in an interview that it was worth it, if he was going to die he might as well go out while having a bit of fun.Thankfully for everyone the bomb vest was fake and no one was harmed in the event.Seif Eldin Mustafa is now serving life in jail in an Egyptian prison.