Suicide and suicidal behaviour : Triage

Suicide and suicidal behavior present a pressing public health concern in the UK, exacerbated by ongoing socio-economic stressors, including the recent cost of living crisis. Effective assessment hinges on identifying both individual risk factors—such as mental health disorders, previous suicide attempts, and psychosocial stressors—and broader contextual influences (Cruz et al., 2010).

In response, comprehensive prevention strategies emphasize a coordinated effort among healthcare providers, community organizations, and families. Clinical frameworks like the Zero Suicide Model advocate for systematic risk assessment, means restriction, and ongoing patient monitoring (Brodsky et al., 2018). Complementary community-based interventions, including gatekeeper training for pharmacists and family members (Carpenter et al., 2021; Morton et al., 2021), as well as school-based educational initiatives (Pistone et al., 2019), have demonstrated effectiveness in reducing suicidal ideation. Strengthening family dynamics and support systems further enhances prevention efforts by bolstering resilience and early intervention (Frey et al., 2016). Collectively, these approaches underscore the importance of multidimensional assessment and targeted strategies to mitigate suicide risk in the UK.

Suicide Risk Assessment Triage Questionnaire

1. Initial Screening: Current Suicidal Thoughts

1. Are you having thoughts of harming or killing yourself today?

Yes No

2. How often do you have these thoughts?

3. Have you thought about how you might harm yourself?

Yes (describe): No

Rationale: Directly asking about suicidal thoughts identifies immediate risks and opens the conversation without stigma.

2. Intent and Planning

4. Do you intend to act on these thoughts?

Yes No Unsure

5. Do you have a specific plan?

Yes (describe): No

6. Do you have access to the means to carry out this plan?

Yes (describe): No

Rationale: Assessing intent, planning, and access to means determines the feasibility and immediacy of the suicide risk.

3. History of Suicide Attempts

7. Have you ever attempted suicide in the past?

Yes (describe method and circumstances): No

8. How many times have you attempted suicide?

9. Have you required medical attention for any of these attempts?

Yes No

Rationale: A history of previous suicide attempts is one of the strongest predictors of future suicide risk.

5. Protective Factors

15. Are there any reasons that stop you from acting on these thoughts?

16. Do you have someone you trust that you can talk to? Do they have a social worker ? CPN ? Support worker

17. Do you know how to access crisis services?

Yes No

Rationale: Protective factors such as supportive relationships, awareness of crisis resources, and cultural or religious beliefs can mitigate suicide risk.

6. Recent Life Stressors

18. Have you experienced any major stressors recently? (e.g., relationship problems, financial difficulties, trauma)

19. Do you feel supported by people in your life? Who has suggested that they seek help now ?

Yes No

Rationale: Life stressors and lack of support often exacerbate mental health challenges, increasing suicide risk.

7. Mental State and Comorbidities

20. Are you experiencing symptoms of depression? (e.g., sadness, loss of interest, fatigue)

21.Have you ever been sectioned or detained under mental health legislation?

Yes No

22. Do you have any diagnosed mental health conditions? (e.g., bipolar disorder, PTSD)

23. Are you taking any prescribed medications for mental health conditions? Are you taking them as prescribed?

Yes No

Rationale: Non-adherence to psychiatric medications or untreated mental health conditions increases suicide risk.

8. Digital and Social Media Activity

24. Have you searched online or participated in forums about suicide or self-harm?

Rationale: Online activity related to suicide or self-harm can provide insight into the intensity and progression of suicidal ideation.

9. Family History and Additional Considerations

25. Is there a history of suicide or mental health conditions in your family?

26. Have you written a suicide note or told someone your plans?

Yes No

27. Have you thought about using a specific medication or substance?

28. Are you concerned about your immigration status or facing immigration-related stress?

Rationale: Family history increases risk through genetic and environmental factors. Suicide notes, specific plans, and immigration stress indicate high risk requiring immediate intervention.

Risk Categorization and Guidance

Low Risk: Passive thoughts with no intent or plan. Provide support, resources, and schedule follow-up.

Moderate Risk: Thoughts with intent, possible access to means, no immediate plan. Develop safety plan, monitor closely, and refer to mental health services.

High Risk: Suicidal thoughts with specific plan, access to means, or suicide note. Arrange emergency intervention and refer to crisis services immediately.

A structured triage process for suicide assessment ensures that clinicians comprehensively evaluate risk and allocate resources appropriately. Even if an acute crisis assessment is not immediately required—or has been arranged for a future date—providing safety-net support is critical. Below are several organizations that can offer help, reassurance, and guidance to individuals experiencing suicidal thoughts:

Samaritans: 116 123 (24/7 helpline)
Papyrus HOPELINEUK (for individuals up to 35 years old): 0800 068 4141
Mind Infoline: 0300 123 3393
Shout (Text Service): Text “SHOUT” to 85258
Campaign Against Living Miserably (CALM): 0800 58 58 58 (daily, 5pm–midnight)

Equipping patients and their families with these contact details ensures they know where to turn for immediate emotional support, bridging the gap until further clinical evaluation can take place.

References

[1] https://www.elft.nhs.uk/sites/default/files/ELFT%20PC%20teaching%20-%20Suicide%20and%20Self%20harm.pptx

[2] https://www.nimh.nih.gov/news/science-news/2022/a-clinical-pathway-for-suicide-risk-screening-in-adult-primary-care

[3] https://www.nimh.nih.gov/sites/default/files/documents/research/research-conducted-at-nimh/asq-toolkit-materials/adult-outpatient/bssa_outpatient_adult_asq_nimh_toolkit.pdf

[4] https://pmc.ncbi.nlm.nih.gov/articles/PMC3146379/

[5] https://www.ruralhealthinfo.org/toolkits/suicide/2/screening-tools

[6] https://patient.info/doctor/suicide-risk-assessment-and-threats-of-suicide

[7] https://www.dpt.nhs.uk/download/2hn1ZTaUXY

[8] https://www.mentalhealth.va.gov/docs/suicide_risk_assessment_reference_guide.pdf