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University Quick Links

     

     

    Suicide Risk Assessment

     

    2012 Task Force Members: Laura Martin, MD; Jennifer Hagman, MD; Joel Yager, MD; Hal Wortzel, MD; Colleen McGuire, MD; Ergi Gumusanelli, MD

    Updated 2016: Rachel Davis, MD and Jenna Cook, MD

     

     

     

    Visit the Response to Patient Suicide Page

     

     

    Learning Objectives and Introduction

    Suicide Risk Assessment and Response is a four-hour didactic course for R-1 psychiatry residents.   It involves interactive case discussion, a lecture on suicide risk assessment, and a panel discussion of psychiatrists who have lost patients to suicide.

    ​

    Goals and Objectives for the course include:

    ​

    • Developing a beginning understanding of how to structure a suicide risk assessment.

     

    • Increasing familiarity with suicide risk factors and protective factors.

     

    • Understanding that some patients will die from suicide as a result of their illness. 

     

    • Understanding that we cannot accurately predict suicide risk for any individual patient.

     

    • Understanding that clinical failures are not personal failures.

     

    • Developing an awareness of post-suicide reactions.

     

    • Developing an awareness with resources for support after a suicide. 

     

    • Familiarity with University of Colorado Department of Psychiatry residency guidelines for response to patient suicide. 

    As you are aware, one of the most difficult challenges during the career of a psychiatrist is having a patient commit suicide.  This challenge can be especially difficult for psychiatrists in training.  This toolkit is meant to provide you with an introduction to basic concepts of suicide risk assessment.  It is also meant to provide you with information about what it can feel like for a psychiatrist after a patient commits suicide and how to handle these reactions.

    Between 32 – 61% of residents will have a patient who commits suicide prior to or during residency, and 50% of residents who have had a patient commit suicide will have encountered this within their first post-graduate year.  This high rate may be due to the large number of patients treated, the high level of psychopathology in these patients, the inexperience of the residents, or the frequent transitions in care-settings and providers experienced by these patients.  The death of a patient by suicide has a profound impact on any treating physician.  Residents in training may be more vulnerable because they are forming their professional identity.  Formal training can help enhance risk assessment and documentation.  Supervisors and residents also need to learn how to recognize and handle their reactions through formal support, informal support, and the recognition that any support may need to occur over months, as the effect of the suicide is not merely an acute event.

    There is no way to fully prepare for this event.  However, you should walk away from this toolkit with (1) the expectation that some patients will die from suicide as a result of their severe illness, (2) an awareness that although we can recognize and assess risk factors, we cannot accurately predict suicide risk for any individual, (3) the knowledge that clinical failures are not personal failures, (4) a review of risk assessment, and (5) an introduction to post-suicide reactions and mechanisms for support (Simon, RI and Hales, RE. Textbook of Suicide Assessment and Management).

     

     

     

    Case Studies

    Suicidal Student

    Intoxicated and Suicidal

     

    Resources

    Articles

    (For University of Colorado psychiatry residents, email Rachel Davis if you have difficulty accessing full text articles)

    Suicide Risk Assessmentcide

    Bolton - Suicide Risk Assessment and Intervention in People with Mental Illness

    Galynker - Assessing Risk for Imminent Suicide

    Han - Prevalence and Correlates of Past 12-month Suicide Attempt Among Adults with Past-year Suicidal Ideation in the United States 

    Silverman - Suicide Risk Assessment and Suicide Risk Formulation

    Wortzel - A Model for Therapeutic Risk Management of the Suicidal Patient

    Wortzel - Therapeutic Risk Management of the Suicidal Patient: Stratifying Risk in Terms of Severity and Temporality

    Matarazzo - Therapeutic Risk Management of the Suicidal Patient: Safety Planning

    Yager and Feinstein - General Psychiatric Management for Suicidal Patients, With Remarks on Chronicity: Contending With the Angel of Death 

    Wortzel - Why Suicide Risk Assessment Still Matters

    Nazem - Therapeutic Risk Management: Suicide Postvention


    Web Resources

    Rocky Mountain MIRECC for Suicide Prevention

    Suicide Prevention Initiatives

    American Foundation for Suicide Prevention

    Zero Suicide in Health and Behavioral Care

     

    Managing an Acute Patient at CU Medicine Psychiatry Clinics

    National Suicide Prevention Lifeline

     


    Suicide Risk Assessment PowerPoint (Rocky Mountain MIRECC)

    Download the Suicide Risk Assessment Brochure

     

    Contact

    Rachel Davis, MD

    Room E2343

    13001 E 17th Place

    Aurora, CO  80045

    Rachel.Davis@CUAnschutz.edu
    Tel: 303-724-8244
    Fax: 303-724-8859

     

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    Psychiatry (SOM)

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