Assessing and managing risk of suicide and violence
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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

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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

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


Risk Framework

Consider:

  • Components of risk

  • Domains of risk

  • Static and Dynamic Factors

  • Risk increasing/reducing factors


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

    • 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)


    SUICIDE


    Suicide Risk Factors


    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

    Hopelessness

    Distress

    Suicidal ideation

    Suicidal plans

    Anger/impulsivity

    Intoxication

    Previous attempts

    Recent losses

    Poor coping skills

    Fear or shame

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

    Single/divorced/widow(er)

    Chronic pain


    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

    Sobriety


    Suicide Risk Management

    • Address immediate concerns for safety

    • TALK WITH THE PERSON

    • 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

    • 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.


    VIOLENCE


    Violence Risk Factors


    Risk INCREASING Dynamic Processes

    Substance use

    Active symptoms

    Multiple psych. diganoses

    Treatment non-compliance/engagement

    Violent ideation

    Opportunity/access

    Impulsivity

    Anger

    Recent relationship breakdown

    Younger adult

    Lower SE group

    Unstable living situation


    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

    • 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

    • TALK TO THE PERSON


    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)

    • 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


    Acknowledgements

    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


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