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Assessing and Managing Risk of Suicide and Violence. Brief presentation by Mr Geoff Argus (MAPS) & Dr Rachel Inglis (MAPS) APS Toowoomba Branch Meeting 14 June 2011. Caveat.

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assessing and managing risk of suicide and violence

Assessing and Managing Risk of Suicide and Violence

Brief presentation by

Mr Geoff Argus (MAPS) & Dr Rachel Inglis (MAPS)

APS Toowoomba Branch Meeting 14 June 2011


Due to presentation time constraints, this is only a VERY brief introduction to concepts of risk assessment and management.

risk framework
Risk Framework


  • Components of risk
  • Domains of risk
  • Static and Dynamic Factors
  • Risk increasing/reducing factors
components of risk
Components of Risk
    • Likelihood

- How likely is it that the event will occur?

  • Immediacy/imminence

- When and under what conditions is the event likely to occur?

  • Severity of outcome

- If the event did occur, how serious would it be?

risk domains
Risk Domains
  • Dispositional factors
    • Individual background, personality traits, cognitive functioning, etc
  • Historical factors
    • Past events that predisposes the person to harm self or others
  • Clinical factors
    • Diagnoses and symptoms of mental illness or disorder
  • Contextual factors
    • Current environmental factors (e.g., relationships, finance, etc)
special groups
Special groups
  • Indigenous Australians
    • Higher rates than general population
    • Higher risk under 29 years of age
    • High rates of incarceration
    • People from non-English speaking backgrounds
      • Rates vary among immigrant groups
      • High rates among elderly immigrants
      • Females at greater risk
      • Trauma or torture considerations
      • Cultural isolation
risk increasing dynamic processes
Risk INCREASING Dynamic processes



Suicidal ideation

Suicidal plans



Previous attempts

Recent losses

Poor coping skills

Fear or shame

Mental disturbance (e.g., depression, psychosis)


Chronic pain

risk reducing dynamic processes
Risk REDUCING Dynamic Processes

Positive about the future

Feels supported

Feels able to cope

Seeks help when needed

Insight/coping strategies

Good problem solving

Stable mental state

Stable relationships

No major stressors


suicide risk management
Suicide Risk Management
  • Address immediate concerns for safety
  • Discuss options, alternatives and strategies
  • Increase social support network
  • Remove access to weapons
  • Assist with coping and problem-solving skills
  • Consider after hours options
  • Hospitalisation (EEO, JEO, local Mental Health Service)
  • Speak with key people (e.g., family, other service providers). Consider confidentiality and consent issues.
  • Plans for further appts and follow-up
myth busting
Myth busting
  • People of ALL ages commit suicide.
  • “Manipulative” people DO commit suicide.
  • 60-70% of people who suicide HAVE NO KNOWN history of prior attempts.
  • Asking someone about suicide WON’T give a person ideas to commit suicide. There may actually be some relief.
  • People who say they want to kill themselves while intoxicated DO commit suicide.
  • A non threatening life attempt DOES NOT mean that the person is not a high risk.
risk increasing dynamic processes1
Risk INCREASING Dynamic Processes

Substance use

Active symptoms

Multiple psych. diganoses

Treatment non-compliance/engagement

Violent ideation




Recent relationship breakdown

Younger adult

Lower SE group

Unstable living situation

risk decreasing dynamic processes
Risk DECREASING Dynamic Processes

Minimal substance use

No active symptoms

Engaged in treatment

Insight/coping strategies

Social supports

Stable living situation

Few stressors

No opportunity/access

Conflict resolution skills

Good problem solving

violence risk management
Violence Risk Management
  • Compliance with/engagement in treatment
  • Removing access to weapons
  • Increase support network
  • Stable accommodation
  • Assistance with problem-solving and coping skills
  • Strong follow-up support
  • Duties to third parties (e.g., intended victim, police, other agencies
  • Hospitalisation (EEO, JEO, local mental health service)
  • Attention to the environment
justices examination order jeo
Justices Examination Order (JEO)
  • Applied for by any community member
  • At the court house or with a JP
  • Used for non-urgent mental health assessment

If a JEO is then issued-

  • JEO is faxed by Justice to nearest mental health service.
  • Valid for up to seven days
  • Authorises a doctor or authorised mental health practitioner to assess the person
  • Police assistance may be sought
  • Person can only be taken to an mental health service if the assessment documents are made.
emergency examination order eeo
Emergency Examination Order (EEO)
  • Can be made by a police officer, ambulance officer or a psychiatrist.
  • Strict criteria apply
  • Used in urgent or emergency circumstances
  • Authorises a person to be taken to mental health service and detained for up to six hours
  • The person must be examined by a doctor or authorised mental health practitioner
  • If a recommendation for assessment is not made, the person must be returned to home

Information gathered from the following sources

  • Community Forensic Outreach Service (2003) Clinical Risk Assessment and Management Training Project
  • Commonwealth Government Department of Health and Ageing and Government of South Australia. (2007). SQuARe – Suicide, QUestions, Answers and Resources: An education resource for primary health care, specialist and community settings.
  • Commonwealth Government Department of Health and Ageing. (2007). Living is for everyone (LIFE): A framework for the prevention of suicide in Australia