Managing patients with suicidal risk

Prevention of suicide is difficult and not always possible. Safety planning is the first step to take as an intervention for all patients where suicide risk is identified. Develop a safety plan in collaboration with a patient at risk of suicide; a safety plan outlines actions the patient can take to manage suicidal thoughts and reduce the risk of acting on them.

If the patient has a significant risk of suicide (eg they have current intent, a specific plan, access to means or have had previous suicide attempts), early consultation or referral to an acute psychiatric service or acute mental health team is indicated. If the risk of suicide is extremely high, consider involuntary treatment¹.

Note: Safety planning is the first step for all patients where suicide risk is identified.

Develop a comprehensive safety plan² for patients at risk of suicide (which may involve a multidisciplinary approach), including:

identify personalised warning signs for an impending suicidal crisis
determine internal coping strategies that distract from suicidal thoughts and urges
identify family, friends and social places that can distract from suicidal thoughts and urges
identify individuals who can help provide support during a suicidal crisis
list mental health professionals and urgent care services to contact during a suicidal crisis
provide counselling to identify and reduce access to lethal means
as relevant, start treatment for any psychiatric disorders (eg major depression).

Helplines and support services for people at risk of suicide include:

Beyond Blue (1300 224 636)
for young people, e-headspace (1800 650 890)
Kids Helpline (1800 551 800)
Lifeline (13 11 14)
Suicide Call Back Service (1300 659 467).

If the patient is acutely agitated, if possible, use nonpharmacological measures, including verbal de-escalation and psychological intervention, to reduce the risk of harm.

If the patient remains acutely agitated and is at risk of harming themselves or others, see Pharmacological management for acute behavioural disturbance in adults or Pharmacological management for acute behavioural disturbance in older people for advice.

For information on assessing and responding to suicidal thoughts in patients receiving palliative care, see Desire to die in palliative care.

¹ If involuntary treatment is required, it must be undertaken in accordance with relevant mental health legislation—see the Royal Australian and New Zealand College of Psychiatrists website.Return

² Various suicide safety plans are available online or via an app, including the Beyond Now app and the ReMinder app. Return