Suicide prevention questions always come back to one idea: safety first, and ask directly.
Warning signs
- Talking about wanting to die or being a burden
- Giving away belongings or saying goodbye
- Hopelessness and pulling away from others
- A sudden calm after a period of deep depression, which can mean a decision has been made
- Increased alcohol or drug use
Ask directly
Ask, "Are you thinking about killing yourself?" Asking does not put the idea in someone's head. It opens the door to help. Then assess:
- Plan: Do they have one?
- Means: Do they have access to what they would use?
- Intent and timing
- History: past attempts raise the risk
Keeping the client safe
- Observation as ordered, such as one-to-one or constant observation
- Remove anything that could cause harm: belts, cords, shoelaces, sharps, glass, and plastic bags
- A room close to the nurses' station
- Check that medications are swallowed
- A written safety plan before discharge, including the 988 Suicide & Crisis Lifeline (call or text 988)
When is risk highest?
- When depression starts to lift and energy returns, including early in antidepressant treatment
- After a recent loss or crisis
- Right after discharge from a psych unit
A client with severe depression is suddenly calm and cheerful and is giving away personal items. What should the nurse do first?
- Document that the client's mood is improving
- Ask the client directly about thoughts of suicide
- Encourage the client to join group activities
- Tell the family the client is doing better
Show answer
B. A sudden calm and giving away belongings are warning signs. Assess suicide risk directly and right away.
Practice this in Priority Care
Make safety-first calls on a busy night shift.
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Quick answers
Does asking about suicide increase the risk?
No. Asking directly does not plant the idea. It shows concern and opens the door to safety planning and help.
When is suicide risk highest in depression?
Often when depression begins to lift and energy returns, including early in antidepressant treatment.
Evidence & Clinical Sources
- 988 Suicide & Crisis Lifeline
- Columbia Suicide Severity Rating Scale (C-SSRS)
- Halter, Varcarolis' Foundations of Psychiatric-Mental Health Nursing, Elsevier
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