There is evidence that the period immediately following discharge from an inpatient unit is a time when suicide risk is at its greatest. Maintaining active clinical contact with a person after their discharge can alleviate this risk and encourage them to participate in their continuing care.
The guidelines on Working with the suicidal person offer a series of criteria for planning safe discharge services, including:
- A comprehensive suicide risk assessment has been conducted and an appropriate treatment plan is in place.
- The person is medically stable and has adequate social supports.
- The person has agreed to return to the mental health service if their suicidal intent returns.
- The person, their caregiver and family have been provided with written copies of their treatment plan, including details of any medications, ways to deal with symptoms and distress, dates of follow-up appointments, and contact numbers for times of crisis.
- All attempts have been made to remove potentially lethal means of self-harm.
- Treatment of any underlying psychiatric diagnoses has been arranged.
- Appropriate steps have been taken to address psychosocial precipitating factors.
- GPs, counsellors and other community services have been consulted and are in agreement with the discharge arrangements.
- A written report will be sent to the person’s GP and psychiatrist/psychologist within 72 hours.
- Follow-up with the person will be conducted as soon as possible, ideally within 72 hours.
Suicide risk should be reassessed within 24 hours for people at high risk, seven days for people at moderate risk, and one month for people facing a mild but current risk.
Reassessments of the risk of suicide by a mental health clinician are most effective when they are conducted face-to-face and the clinician is cognisant of the level of risk initially assigned.
The follow-up assessment allows for:
- a review of the person’s current living environment
- a review of any changes to their risk or protective factors
- a review of the effectiveness of their treatment and engagement with service providers
- the re-evaluation of at-risk mental states
- the collection of information from family, friends and relevant service providers.
Any variance from previously assessed risks must be clearly documented by the clinician.