The treatment and care of a person at risk of suicide should always be appropriate to their assessed level of risk.
Preparing a treatment plan
Treatment plans should include written information regarding available community resources (for example, help lines), dates of review appointments, and specific services to contact in a crisis. Family members should be given a copy of the plan, advised to remove any means of self-harm within the home, and asked to monitor the person’s whereabouts and any sudden changes in their behaviour.
Involve the person in preparation of the treatment plan
It is vital to involve the person in the preparation of any treatment plan, providing them with both written and verbal information about the nature and purpose of the treatment they are being offered. This can help to alleviate pressure on people who may be incapable of making important healthcare decisions due to their distress.
Understand level of support available
Careful consideration should be given to the degree of support available to the person, as well as their legal status under the Mental Health Act 2014. While people facing an acute suicide risk are generally managed better in an inpatient environment, a home-based treatment plan may be more appropriate for a person facing a mild or moderate risk.
Home-based plans require detailed evaluation of the person’s home environment and social supports, to gauge levels of personal support as well as potential stress factors.
In the case of suicidal behaviour, the level of risk often requires broader enquiry into a person’s living and family circumstances than might otherwise be appropriate. Collection of information from the person’s family or other service providers is governed by the Health Records Act 2001 and the Health Privacy Principles, which relate to consent and the need to collect information to prevent or mitigate a serious threat to a person’s life.
Under the Mental Health Act 2014, informed consent should always be sought for the disclosure of a person’s health information to a third party. Generally speaking, the disclosure of personal information should be in the best interests of the consumer, and the treating clinician must balance the need for disclosure with their rights to privacy and confidentiality.
When a person is dangerously suicidal or has severe psychiatric illness or inadequate social supports, there is a clear need for inpatient management and close supervision. It is important to remember that inpatient management does not always prevent suicide, which can occur in inpatient settings or during day leave.
Determining the level of supervision
Depending on the acuity of risk, the level of supervision may range from management in a high-dependency area to continuous one-to-one observation by a staff member.
If the person at risk is subject to an order under the Mental Health Act, or making an order is an appropriate clinical decision, it may be necessary to detain them against their will to provide appropriate treatment and care. If they are not mentally ill within the meaning of the Act, the clinician should document the clinical basis for their diagnosis, together with the nature of the treatment and care offered, and contact family and friends so that they can provide informed support.
Careful and detailed documentation is particularly critical to keep clinical staff and caregivers informed of the continuing assessment and management of people facing a suicide risk.
Keep the treatment plan up to date
As levels of risk can fluctuate, a treatment plan should be kept up to date with the most current information available, including actual and proposed treatments and their clinical basis, medications, tests, precautions or contra-indications, and plans for follow-up assessments.
Treatment plans should also include records of all assessments, clinical decisions, consultations and referrals, as well as the person’s personal contacts, a list of care providers and a detailed record of contacts with them.