Mental Health
Risk Assessment
Action Matrix
Suicide Assessment and
Incorporating the
Suicide Assessment and
Prevention Pathway
Prevention Pathway
Key Assessment Information:
Key Assessment Information:
Key Assessment Information:
Key Assessment Information:
• Person is prepared and capable of taking
• Behaviour is co-operative and person
• May demonstrate one or more of the
• Mental health problem(s) present.
responsibility for maintaining their own safety.
demonstrates engagement with health staff
following: highly aroused, reluctant to wait,
• Marked agitation, hyper arousal and
If appropriate, relatives, family or friends are
during assessment and treatment.
markedly low mood, cognitive impairment,
behavioural disturbance present.
prepared to provide informal support.
• Mental state is at risk of deterioration if
thought disorder, perceptual disturbance.
• Difficult to engage and behaviour
• Mental health problems may be present,
current difficulties are not addressed.
• Poor compliance with medication.
demonstrates non co-operation with
but no evidence of immediate risk to self or
• May be physically vulnerable in certain
• Unwilling or unable to take responsibility
assessment and treatment.
others.
circumstances.
for maintaining own safety in the short to
• Mental state will deteriorate rapidly and
• May lack capacity to consent to, or refuse
• May lack capacity to consent to, or refuse
medium term. Unlikely to attend for next day
dangerously without immediate intervention
proposed care and treatment or demonstrate
proposed care and treatment or demonstrate
mental health follow up.
and will almost certainly be physically
cognitive impairment.
cognitive impairment.
• May lack capacity to consent to, or refuse
vulnerable.
• Home circumstances may pose a risk to
• Home circumstances may pose a risk to
proposed care and treatment.
• Poor compliance with medication.
patient, staff or others.
patient, staff or others.
• Home circumstances may pose a risk to
• May lack capacity to consent to, or refuse
• No alcohol or drug problems/intoxication.
• Evidence of alcohol or drug problem/
patient, staff or others.
proposed care and treatment or demonstrate
• Self harm or suicidal thoughts; now regrets
intoxication.
• Significant alcohol/drug problems/
cognitive impairment.
actions and has
no thoughts or plans
• Self harm or suicidal thoughts present;
intoxication.
• Home circumstances may pose a risk to
relating to further self harm or suicide in
continues to have non-specific thoughts or
• Self harm or suicidal thoughts present; may
patient, staff or others.
the short term.
ideas regarding further self harm or suicide,
have considered methods but no definite
• Significant alcohol or drug problem/
e.g. ambivalent that they did not die, but at
plans to act on these in the short term.
intoxication.
the same time has no immediate thoughts or
plans about repetition.
• Likely to act on thoughts of self harm or
suicide at the earliest opportunity.
• Clear plans to engage in further self harming
behaviour, or to harm others. Suicidal intent
and plan present.
General Multidisciplinary Team Actions and Timescales
• Care needs should be balanced against risk and emphasis should be placed on positive risk management
• Ensure person’s safety is maintained, e.g. set observation level and review as per policy (inpatient),
(risk enablement) involving all stakeholders. Support patient to incorporate identified risks into their
maximise safety in home environment (community) using aids/adaptations and assistive technology
staying well plan.
where appropriate.
• Diffuse emotional distress as far as possible and encourage/allow verbal/emotional expression of distress.
• Consider appropriate information, education and psychosocial interventions.
• If lack of capacity, consider use of appropriate legislation pending mental health assessment and
specialist advice.
Multidisciplinary Team
Multidisciplinary Team
Multidisciplinary Team
Multidisciplinary Team
Actions and Timescales:
Actions and Timescales:
Actions and Timescales:
Actions and Timescales:
• Patient may benefit from referral back to
• Non-urgent mental health referral – next day
• Arrange for full mental health assessment
• Arrange for full mental health assessment as a
Primary Care services, e.g. GP.
mental health follow-up appointment can be
to be undertaken within a timescale
priority within a timescale appropriate to the
• If indication or evidence of mental illness,
offered.
appropriate to the level of risk and taking into
level of risk and taking into consideration the
arrange for assessment by an appropriate
• Person’s agreement to engage should be
consideration the person’s physical condition.
person’s physical condition.
professional (if not already carried out).
sought but no urgent/immediate action if the
• If person fails to engage with arranged
• Undertake a test of capacity if any doubt
• Consider engaging family, friends and
do not wish to engage. Liaise with GP.
support, initiate pro-active follow-up as per
regarding ability to consent to treatment
community support.
• If indication or evidence of mental illness,
local policy.
or should they refuse to remain in hospital
pending mental health assessment.
• In community, signpost to Tier 0 and Tier 1
arrange for assessment by an appropriate
• Consider engaging family, friends, community
(Primary Care) services, i.e. social prescribing,
professional (if not already carried out).
and professional support.
• If person fails to engage with arranged
healthy reading, self-help material.
• Consider engaging family, friends and
• Consider other appropriate medication
support, initiate pro-active follow-up as per
community support.
supplies, e.g. blister packs or referrals to other
local policy.
• In community, signpost to Tier 0 and Tier 1
relevant services.
• Consider engaging family, friends, community
(Primary Care) services, i.e. social prescribing,
• In community, signpost to Tier 0 and Tier 1
and professional support.
healthy reading, self-help material.
(Primary Care) services, i.e. social prescribing,
• Follow Absconding/Locked Door policies if
healthy reading, self-help material.
required.
• Non-urgent mental health referral – next day
• Consider other appropriate medication
mental health follow-up appointment can be
supplies, e.g. blister packs or referrals to other
Provide appropriate information:
offered.
relevant services. Ensure person’s safety is
Risk factors for suicide include:
• Leaflet
• Person’s agreement to engage should be
maintained, e.g. set observation level and
• Social characteristics:
• www.depression.org.nz
sought but no urgent/immediate action if the
review as per policy (inpatient), maximise
- male gender
do not wish to engage. Liaise with GP.
safety in home environment (community)
using aids/adaptations and assistive
- young age (less than 30 years)
• If indication or evidence of mental illness,
technology where appropriate.
arrange for assessment by an appropriate
- advanced age
professional (if not already carried out).
• Consider appropriate information, education
- single or living alone
and psychosocial interventions.
• Consider engaging family, friends and
• History:
community support.
• Refer to working alone policy for community
visits.
- prior suicide attempt
• In community, signpost to Tier 0 and Tier 1
(Primary Care) services, i.e. social prescribing,
• Explore protective factors and strengths as per
- family history of suicide or mental
healthy reading, self-help material.
guidance.
illness
Open up when you’re
- history of substance abuse
feeling down
- recently started antidepressants
- history of impulsive acts and/or
violence
Ensure compliance with Child Protection
• Clinical features:
Guidance
- hopelessness
- psychosis
- severe anxiety, agitation, panic
attacks
Record suicide risk, action taken, those
involved and review risk in future if change
- concurrent physical illness
in clinical presentation
- severe depression
• Life stressors
• Lace of protective factors
Suicide Assessment and Treatment Pathway
2016
