Suicide And Crisis Assessment Form Guidelines
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6Appendix B: Suicide Assessment
Crisis Assessment Form – Guidelines*
risk assessment
Part A: Danger to Self
Suicidal Ideation:
Yes
No
• Are you currently having any thoughts of hurting yourself (self-harm) or
suicidal thoughts?
• If yes, tell me more about what the thoughts are (find out specifics).
• Are the thoughts increasing in frequency and intensity?
• Are you spending a lot of time contemplating suicide or hurting yourself,
or are they fleeting thoughts? (during the last
hours)
• How are you responding to the thoughts? (dwelling vs. distracting self)
Active suicidal thought with intensity, increasing frequency, and occupying a lot
of time all increase risk.
Suicidal Plan:
Yes
No
• Are you spending a lot of time planning how you would hurt or kill
yourself?
• Do you have a specific plan?
• Find out as many details as possible about the plan (when, what, where,
how).
• Do you have a specific date of when you would hurt or kill yourself?
• Is there anything that would hold you back? (e.g., family, friends, religious
convictions, pet)
A well-thought-out plan increases risk.
Access to Plan:
Yes
No
• Do you have access to your plan? (e.g., Do you have a gun or are you able
to get a gun?)
• If plan involves an overdose, ask what pills they plan to take, where the
*Developed by Sandra Cushing,
, and
pills are now, and have they been stockpiling pills?
Susan Boyd,
, Alcohol, Drug and Gambling
Services, Social and Public Health Services
• Assess location of means (e.g., Where is the gun/rope/pills, etc.?)
Division, City of Hamilton and Regional
Municipality of Hamilton-Wentworth.
The more accessible the plan, the higher the risk.
Reprinted by permission of the authors.
appendix b
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