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Suicide Risk Assessment Guide a Resource for Health Care Organizations

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Suicide Risk Assessment Guide a Resource for Health Care Organizations Suicide Risk Assessment Guide A Resource for Health Care Organizations Disclaimer The Suicide Risk Assessment Guide: A Resource for Health Care Organizations, was prepared by the Ontario Hospital Association (OHA) in partnership with the Canadian Patient Safety Institute (CPSI) as a general guide to help health care organizations with understanding and standardizing the practice of high- quality suicide risk assessment. The research findings, tools and other materials in this resource guide are for general information only and should be utilized by each health care organization in a manner that is tailored to its circumstances. This resource reflects the interpretations and recommendations regarded as valid at the time of publication based on available research, and is not intended as, nor should it be construed as, clinical or professional advice or opinion. Health care organizations and individuals concerned about the applicability of the materials are advised to seek legal or professional counsel. Neither the OHA nor CPSI will be held responsible or liable for any harm, damage, or other losses resulting from reliance on, or the use or misuse of the general information contained in this resource guide. ISBN # 978-0-88621-335-0 Publication Number: #332 Suicide Risk Assessment Guide: A Resource for Health Care Organizations Sponsored By: The Ontario Hospital Association & The Canadian Patient Safety Institute Prepared By: Christopher Perlman, Ph.D. Research Project Lead Homewood Research Institute & Michael G. DeGroote School of Medicine, McMaster University, Waterloo Regional Campus Eva Neufeld, M.A. (Ph.D. Candidate) Research Associate Homewood Research Institute & the Department of Health Studies and Gerontology, University of Waterloo Lynn Martin, Ph.D. Associate Professor Department of Health Sciences, Lakehead University Mary Goy, BScN (MScN Candidate) Nurse Clinician Homewood Research Institute & Homewood Health Centre John P. Hirdes, Ph.D. Professor Department of Health Studies and Gerentology, University of Waterloo Suggested Citation: Perlman CM, Neufeld E, Martin L, Goy M, & Hirdes JP (2011). Suicide Risk Assessment Inventory: A Resource Guide for Canadian Health care Organizations. Toronto, ON: Ontario Hospital Association and Canadian Patient Safety Institute. Acknowledgements We are extremely grateful to everyone who contributed to the development of this resource guide. In particular, we would like to thank the interview participants and their affiliated organizations for sharing their enthusiasm, experiences, and unique insights regarding suicide risk assessment. We were also fortunate to receive feedback from international members – the interRAI Network of Excellence in Mental Health – who provided enthusiastic support and shared their perspectives on the importance of suicide risk assessment for promoting patient safety. The research team would also like to thank several people and groups for their support in developing this resource guide. Kaitlin Bellai from Homewood Research Institute provided assistance with the organization of the literature review, and Karen Parsons provided detailed editing of the resource guide. We are very grateful to Josephine Muxlow, Clinical Nurse Specialist in Adult Mental Health in the First Nations and Inuit Health Atlantic Region, for her extensive review and for providing insight into the content and writing of this guide. The Waterloo Region Suicide Prevention Council (WRSPC) was also a valuable resource for added perspectives on suicide risk assessment. We would also like to acknowledge the in-kind support of the Homewood Research Institute in Guelph, Ontario; the Department of Health Studies and Gerontology at the University of Waterloo in Waterloo, Ontario; and the School of Public Health at Lakehead University in Thunder Bay, Ontario. We would like to acknowledge the commitment of the Patient Safety in Mental Health Pan-Canadian Advisory Group in the development of this resource guide. This group has shared their extensive experience and advice to support and shape this guide into a resource that is grounded in practical application for Canadian health care organizations, while maintaining person-centred care and safety. The members of the advisory group are: • Glenna Raymond (Chair), President and CEO, Ontario Shores Centre for Mental Health Sciences, Ontario • Lisa Crawley Beames, Clinical Leader Manager, St. Michael’s Hospital, Ontario and President, Canadian Federation of Mental Health Nurses • Dr. Linda Courey, Director, Mental Health and Addiction Services, Cape Breton District Health Authority, Nova Scotia • Margaret Doma, Director of Risk, Legal, and Medical Affairs, St. Joseph’s Health Care Hamilton, Ontario • Beth Hamer, Mental Health/Psychiatric Nursing Practice Leader, Waypoint, Centre for Mental Health Care, Penetanguishene, Ontario • Isabelle Jarrin, Nurse Educator, Mental Health, Winnipeg Health Sciences Centre, Manitoba • Denice Klavano, Member, Patients for Patient Safety Canada, Nova Scotia • Dr. David Koczerginski, Chief of Psychiatry, William Osler Health System, Ontario • Judith Macrae, Manager, Tertiary Mental Health and Substance Use Services, Fraser Health, British Columbia and Director on Board for CRPNBC • Dr. Saibal Nandy, Private Practice Psychiatrist • Ann Pottinger, Advanced Practice Nurse, Centre for Addiction and Mental Health (CAMH), Ontario • Margaret Tansey, VP Professional Practice and Chief Nursing Executive, Royal Ottawa Health Care Group, Ontario • Dr. Michael Trew, Senior Medical Director, Addictions and Mental Health, Alberta Health Services, Alberta • Dr. Tristin Wayte, Manager, Risk and Evaluation, BC Mental Health and Addiction Services, British Columbia The research team is also extremely grateful to the Ontario Hospital Association (OHA) and the Canadian Patient Safety Institute (CPSI) for establishing this very important initiative. In terms of facilitation and management, the research team would like to thank Michelle Caplan, Cyrelle Muskat, Sharon Walker, Elizabeth Carlton, and Sudha Kutty from the OHA, and Sandi Kossey, Hina Laeeque, and Marie Owen from the CPSI. We are grateful to the OHA and CPSI for taking steps to develop this valuable resource to support Canadian health care organizations in improving patient safety and the quality of care. Table of Contents Executive Summary . i Background . i The Need for Suicide Risk Assessment . i This Guide . ii Overview of Suicide Risk Assessment Principles, Processes, and Considerations . 1 The Content of Suicide Risk Assessment . 2 The Difference Between Suicide and Self-Harm . 3 The Appraisal of Underlying Factors that Indicate Suicide Risk: Warning Signs, Risk Factors and Protective Factors. 3 The Principles that Guide the Assessment Process . 11 Principle One – The Therapeutic Relationship . .12 Principle Two – Communication and Collaboration . .13 Principle Three – Documentation in the Assessment Process . .16 Principle Four – Cultural Awareness . 20 Summary of Key Principles . 20 Applying the Principles – Special Considerations for Given Care Settings and Populations . 23 Care Settings . .23 Considerations Related to Lifespan and Traumatic Life Experiences . 29 Inventory Of Suicide Risk Assessment Tools . 35 The Use of Tools in Suicide Risk Assessment . .36 Technical Considerations for the Selection of Suicide Risk Assessment Tools . .36 Inventory of Risk Assessment Tools . 38 Commonly Used Suicide Risk Assessment Tools . 38 Beck Hopelessness Scale . 39 Beck Scale for Suicide Ideation (BSS ®) . 40 Columbia-Suicide Severity Rating Scale . 41 Geriatric Suicide Ideation Scale . 42 interRAI Severity of Self-harm Scale (interRAI SOS) . 43 Mental Health Environment of Care Checklist. 45 Modified Scale for Suicide Ideation . 46 Nurses’ Global Assessment of Suicide Risk . 47 Reasons for Living Inventory . 48 SAD PERSONS and SAD PERSONAS Scales . 49 Scale for Impact of Suicidality – Management, Assessment and Planning of Care . 51 Suicidal Behaviors Questionnaire . 52 Suicide Intent Scale . 53 Suicide Probability Scale . 55 Tool for Assessment of Suicide Risk . 57 Evaluating and Using Risk Assessment Tools . 62 Summary of Assessment Tools and Implications for Practice . 62 A Framework for Suicide Risk Assessment and Quality Monitoring . .65 Getting to High-Quality Suicide Risk Assessment . 66 Framework for the Suicide Risk Assessment Process . 66 The Five Dimensions of the Framework for Risk Assessment . 66 Suicide Risk Assessment Tools and the Risk Assessment Framework . ..
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