Suicide And Crisis Assessment Form Guidelines (Page 4 of 6) in pdf

Suicide And Crisis Assessment Form Guidelines Page 4

. Have you started to follow that person (e.g., stalking)? (Does client know

the person’s routine?)

. If you are following the person, are you carrying weapons with you?

History of Violence:

Yes

. Have you had any past history of violence toward others? If yes, ﬁnd out

details of violent acts — what, when, who, consequences, remorse.

. Have you ever been a victim of violence/abuse?

. Have you ever been charged and/or convicted of violence (assault) in the

past? (When, what was the nature of the offence, etc.)

Fears and Consequences:

Yes

. Are you concerned about the potential consequences if you act on your

plan to harm/kill someone else? (e.g., legal, incarceration, impact on other

person and family, remorse)

Command Hallucinations:

Yes

• Are you hearing any voices (internal or external) or seeing any visions

telling you to hurt or kill someone else?

• If yes, where are the voices/visions coming from?

• What are the voices/visions telling you?

• Do you recognize the voice or the person(s) in the vision?

• How are you coping with hearing the voices? Seeing the vision?

• How long have the voices/visions been occurring? Are they intensifying

(occurring more frequently, for longer periods of time)?

If command hallucinations are occurring, risk of harm to others is very high.

Immediate medical attention/psychiatric assessment should be sought. If person

is unwilling to do so, an involuntary hospital admission may be needed.

Overall Evaluation of Risk for Danger to Others:

None

Low

Moderate

High

• Risk is high if the individual has a clear plan, means and access to the per-

son(s) he or she wishes to harm or kill.

• Command hallucinations also present high risk. Hallucinations could

lead the individual to act impulsively, even if a clear plan and access are

not in place.

helping the problem gambler

Suicide And Crisis Assessment Form Guidelines Page 4