EFTA00032191.pdf

Type: pdf
Source set: data-set-8
Extracted text

PDS-BEMR SUICIDE RISK ASSESSMENT GUIDE — Version 3 
Key Principles to Consider When Conducting Suicide Risk Assessment (adapted from Granello, 2011): 
- Risk or Protective Factor Absent 
0 Risk or Protective *tor Not Assessed 
Mental Status Exam: In PDS you will be required to select a value for each of the areas below. You can make additional comments. 
O Level of Consciousness 
O Mood 
O Psychomotor Activity 
O General Appearance 
O Thought Process 
O Thought Content 
In PDS you will be required to select a value for each of the 
+ - 0 STATIC FACTORS 
OOO Chronic Medical Condition 
OOO Family Hx of Suicide 
000 
High Profile Crime 
OOO Hx of Childhood Abuse 
000 
Hx of Psychiatric Hospitalization 
000 
History of Mental Illness 
000 
Past Suicide Attempt 
OOO History of Violent Behavior 
000 
Lack of Family Connections 
OOO Sex Offender Status 
+ - 0 DYNAMIC FACTORS 
risk/dynamic/protective 
000 
Agitation 
000 
Current Intoxication 
000 
Current Physical Pain 
000 
Current Suicidal Ideation 
000 
Current Suicidal Intent 
000 
Current Suicidal Plan 
000 
Fear for Own Safety 
000 
Feeling Hopeless/Helpless 
000 
Feels Like a Burden 
000 
Non-Adherence to Medical Tx 
000 
Problem Solving Deficits 
000 
Recent Significant Loss 
000 
Sleeps Problems 
000 
Social Isolation 
OOO Uncontrolled Mental Health Issues 
O Behavior 
factors below: 
+ - 0 PROTECTIVE FACTORS 
OOO Able to Identify Reasons to Live 
000 
Adequate Problem Solving Skills 
000 
Denial of Suicidal Ideation 
OOO Future Orientation 
O00 Religious Beliefs Against Suicide 
OOO Social Support in the Institution 
O00 Supportive Family Relationships 
OOO View of Death as Negative 
000 
Willingness to Engage in Tx 
Additional validated risk factors that may be relevant: Sentence >20 years; Self-harm in past month; Dual Diagnosis; 
Male Gender; History of Self-Injurious Behavior; Chronic/Uncontrolled Pain; No Spouse (Single, Divorced, Widowed) 
EFTA00032191


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