Mental Health · 13 min read
Suicide Risk & Therapeutic Communication
Asking directly, judging lethality, and the communication techniques that earn points.
Assessing risk
Risk assessment moves from ideation to plan to means to intent. 'Are you thinking about killing yourself?' is the correct question, asked plainly. Follow with 'Do you have a plan?' and 'Do you have access to what you would need?'
Lethality rises with specificity and availability. A vague wish to not wake up is lower risk than a stated method, a chosen date and a firearm in the home.
Test pattern
An option that avoids naming suicide — 'you have so much to live for,' 'let's talk about something positive' — is always wrong. So is any promise of secrecy.
Therapeutic technique
The techniques that score are open-ended questions, reflection, restating, clarifying, offering self, silence and making observations. They keep the client talking and keep the nurse from steering.
The blocks that lose points are giving advice, offering false reassurance, asking 'why', changing the subject, minimizing feelings and approving or disapproving.
- Making an observation — 'You seem quieter today.'
- Offering self — 'I will sit with you for a while.'
- Reflection — 'You are feeling that nothing you try helps.'
- Silence — allowing the client to fill the space
Environment and safety
For a client at active risk, the environment is the intervention: remove belts, cords, sharps, glass and medication; use continuous one-to-one observation rather than fifteen-minute checks; and search belongings on admission per policy.
Contracts for safety are not evidence-based and are not a substitute for observation. Do not select them.