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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