SUICIDE RISK ASSESSMENT TOOL
(To be used following the SACS when Kessler > 12 and/or te tamaiti is having suicidal thoughts)
Name of young person: Completed by: Date:
Current suicidal behaviour Notes: suicidal ideation; method; planning; Low (L) Medium High (H) ratin
achievability; preparation (M) g
LMH
Suicidal thoughts Occasional More Intense/
- Has the YP considered and/or frequent or persistent
suicide? brief long- thoughts
thoughts lasting that are
- How often (hourly, daily,
of suicide thoughts hard to get
weekly, etc)? rid of
- How long do the
thoughts last?
- What triggers the
thoughts?
Method Method not Has Method
- Have they identified a identified identified identified
method/s? If so, what method and high
but of lethality.
method/s have they identified?
lower E.g.,
- How lethal are the lethality. hanging,
method/s? E.g., jumping,
overdose, using
cutting firearm
Degree of planning No Some Planning
- Do/did they have a plan planning of planning evident
(know when and where)? how they with with
would evidence intention of
- Do/did they intend to
make but no acting
carry it out? attempt identified
- What stops them time
carrying it out?
Achievability of plan Little or no Some Ready
- Do they have access to access to access to access to
method/means? means and means and means and
low some high
- How likely would they
likelihood likelihood likelihood
be to die if they went ahead of death of death of death
with plan?
Preparatory behaviour Little or no Some Strong
Have they been: writing, talking, preparator evidence evidence
or drawing about suicide; trying y of of
behaviour preparator preparator
out their method or getting
y y
prepared; making suicide behaviour behaviour
threats/letters; making a will,
giving away possessions?
Has there been a sudden
unexplained improvement in
mood?
Previous suicide attempts Notes: previous attempts
Have they attempted suicide/self None, or More than Multiple
harmed before? one of one attempts
How many times? lower attempt of of lower or
lethality lower one or
For each attempt or incident of
lethality more of
self-harm specify: higher
- What their intention was lethality
at the time
- When they did it
- Method used
- Trigger(s) of the
behaviour
- Outcome (e.g., serious
injury, hospitalisation)
Current Emotional Distress Notes: Current distress; mental health; hope
Current distress Little Moderate High
What is their current emotional current distress current
state? distress. with some distress or
despair despair.
(see Kessler screen and notes)
evident Feels
Kessler rejected/u
score > 7 nsupported
/
alone.
Kessler
>15
Evidence of poor mental Some More Significant
health evidence sustained periods of
Mood: Are they sad, irritable, of low problems low mood/
mood but with low sadness/
anxious, guilty, angry, shut-
little mood/feeli irritability,
down? How often and for how impact on ngs of negative
long? their life. sadness/irr thinking
Thoughts: Does their talk reflect itability with
beliefs that they are worthless, with some disturbanc
hopeless, or helpless? other e in a
Behaviour: Are there disturbanc number of
disturbances in motivation/ es e.g. areas of
sleeping, life.
energy levels, appetite, sleep,
being
perception (e.g., hearing voices withdrawn.
urging to harm self/others)?
Have they lost interest/pleasure
in life?
Do they show poor
concentration?
Are they socially withdrawn?
Do they have a diagnosed mental
health disorder?
Level of hope and reasons to Has some Some High
live hope and hopeless- degree of
(this information is often can see ness and hopeless-
that things pessimism ness,
assessed during discussion
can change about helpless-
around protective factors – see future ness and
below) lack of
- what keeps them going? sense of
- do they see any chance of future
change?
Other Risk Factors: Notes: other risks
Family/peer history of suicidal Few risk Several Extensive
behaviour? factors. risk risk
Family/peers who support Little factors. factors.
exposure Exposure Exposure
suicide?
to suicide to suicide to suicide
Family or personal history of
mental health issues?
Major loss/stressor: previous,
current, or upcoming?
Substance misuse?
Impulsive behaviour?
Negative attitudes to getting
help?
Parent/caregiver not taking the
YP’s suicidality seriously?
Parent/caregiver not able to
adequately support the YP?
Current resilience/support: Notes: protective factors
Level of problem solving ability? Numerous Some Minimal
Extent of strong cultural/spiritual protective protective protective
connections? factors factors factors
Presence of family/caregiver
relationships (involving warmth
and belonging)?
Extent of positive peer
relationships?
Availability & accessibility of
supports?
Extent of areas of achievement?
Assessment of risk is an ongoing process. Reassessment is necessary when there are changes in
any of the above areas
Considering all the above factors together, please contact TWB ([email protected]) if you have any
concerns at all about the young person’s suicide risk.
