SUICIDE

Introduction

Every year, almost one million people die by suicide around the world. Suicide remains a

significant social and public health problem. Suicide is specifically human problem because

only human can kill himself. Only a small number of people deliberately end their lives.

There is no period of history without records of suici##de, and there is no society where

suicide does not occur. How societies view suicide varies by culture, religion, ethnic norms,

and the circumstances under which it occurs. Suicide is an irrational desire to die. The term

“irrational” is used because no matter how bad a person’s life is, suicide is never the best

solution rather suicide is a permanent solution to what is nearly always a temporary problem.

Suicide is a major cause of death across the world. It is usually the second or third leading

cause of death among teenagers, and remains one of the top ten leading causes of death well

into middle age. Suicide is the eighth leading cause of death in males and the 16th leading

cause of death in females. The elderly (above 65 years) and the younger (15-30 years) age

groups are at increased risk of suicide. Recent data suggest an increase in suicide rates in

middle-aged men.

The effects of suicide on the loved ones of the deceased can be devastating, resulting in

suicide survivors enduring a variety of conflicting, painful emotions. Suicide’s effect is tragic

and felt long after the individual has taken his or her own life. Suicide and suicidal behaviour,

however, are not normal responses to the stresses experienced by people.

Definition of commonly used suicidal terms

Here are the descriptions provided by the World Health Organization (WHO, 2012) regarding

suicidal terms that needed to be taken into account:-

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● Suicidality refers to thoughts or actions related to suicide.

● Suicide: a planned act o f killing oneself intentionally. The act can be performed by

the person with or without the full knowledge or expectation of any fatal outcome.

● Suicide attempt is a serious effort to commit suicide involving definite risk. The

outcome frequently depends on circumstances alone and is not under the

person's control. A medical intervention is required in this case, after the person

whom intended to end his or her life committed a life-threatening act with a conscious

intent. An attempted suicide usually indicates that the person is at high risk in the

immediate and short-term period.

● Suicidal gestures: A series of self-threatening behaviour on display, which may be

detrimental or non- detrimental.

● Suicidal idea: The power of the mind to set up the process to end one's own life.

● Suicidal risk: The tendency of ending one's life depends on this characteristic,

depending on its presence or absence.

● Suicidal pact: Two or more people in agreement to die concurrently by committing

the act of suicide.

● Suicidal cluster: People who gather in groups to commit suicide together, usually for

a common objective.

● Suicidal counters: To prevent suicide, this set of factors operates within the

individual, family or society.

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The Concept of Suicide

Suicide is the act of deliberately killing oneself (WHO, 2014). It is death caused by self-

directed injurious behaviour with any intent to die as a result of the behaviour (CDC, 2016).

Suicide is a conscious, self-inflected injurious act that results in a fatal outcome (O’Brien,

Kennedy, & Ballard, 2008).

Suicide is the act of intentionally taking one’s life and is distinguished from natural death.

There may be many reasons why it is done; such as to end one’s suffering, to avert financial

ruins and to escape unbearable pain. Where there is no intention to end one’s life, there is no

suicide. Thus those who risk their life in order to save others or those who refuse to renounce

their faith knowing that this will mean their death do not commit suicide when they die as a

result of this action because they do not explicitly intend their own deaths (Tang, 2014).

Suicide is not a disease, nor the manifestation of a disease, but mental disorders are major

factors associated with suicide. Client may view suicide as an escape from extreme despair or

from a (perceived) intolerable life situation, such as a terminal illness. Suicide may be the

culmination of self-destructive urges that have resulted from the client’s internalized anger; a

desperate act to escape a perceived intolerable psychological state or life situation. The client

may be asking for help by attempting suicide, or the client may be seeking attention or

attempting to manipulate someone with suicidal behaviour. Many people who commit suicide

have given a verbal warning or clue (Schultz & Videbeck, 2013).

Epidemiology of Suicide

According to American Association of Suicidology, 2006 as cited in Stuart (2009) suicide is

the eleventh leading cause of death, outnumbering homicides, which are the fourteenth

leading cause of death in the United States. The actual number of suicides may be two to

three times higher because of the underreporting that occurs. In addition, many single-car

accidents and homicides are in fact suicides.

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The additional statistics regarding suicide in the United States include the following:

The highest suicide rate for any group in the United States is among people older than age 65

years, especially white men older than 85 years (Garand et al, 2006 as cited in Stuart, 2009).

Suicide is the third leading killer of young people. The rate of suicide among youth has

tripled in the past 30 years. Teen suicide in the United States is nearly five times as common

among boys as among girls. The incidence of suicide varies among cultural groups. Suicide is

more common among whites than African Americans at all ages.

Males commit the overwhelming majority of completed suicides; women attempt suicide

twice as often as men. Guns account for half of all completed suicides. Women tend to use

potentially less lethal means such as medications and wrist slashing. One third of all the

women and more than half of those 15 to 29 years of age who completed suicide use guns

(Stuart, 2009).

Some Risk factors for suicide

According to World Health Organization (2014) risk factors for suicide include mental

disorder (such as depression, personality disorder, alcohol dependence, or schizophrenia), and

some physical illnesses, such as neurological disorders, cancer, and HIV infection.

WHO also identified other clinically useful individual and socio-demographic risk factors as

follows:

● Previous suicide attempts;

● Family history of suicide, alcoholism and/or other psychiatric disorders;

● Divorced, widowed or single status;

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 ● Living alone (socially isolated);

● Unemployed or retired;

● Bereavement in childhood.

If the patient is under psychiatric treatment, the risk is higher in:

● Those that have recently been discharged from hospital;

● Those that have made previous suicide attempts.

In addition, recent life stressors associated with increased risk of suicide include:

● Marital separation;

● Bereavement:

● Family disturbances;

● Change in occupational or financial status;

● Rejection by a significant person;

● Shame and threat of being found guilty.

According to Callaghan (2012), others are: being male, younger age group (19–34 years),

older age group (85 + years), Physical health conditions, e.g., chronic medical illness.

Data regarding mental illnesses as risk factors indicate that depression, manic

depression, schizophrenia, substance abuse, eating disorders, and severe anxiety increase the

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probability of suicide attempts and completions. Nine out of 10 people who commit suicide

have a diagnosable mental-health problem and up to three out of four individuals who take

their own life had a physical illness when they committed suicide (Dryden-Edwards, 2013).

Protective Factors

According to Callaghan (2012), Protective factors identified are as follow:

- Effective clinical assessment and care

- Easy access to therapeutic intervention

- Confiding, supportive relationship.

- Good self-esteem and problem-solving skills

- Good emotional relationship with at least one person in family

- Good social support, social interactions, and social network

- Marriage (men)

- Children (women)

- Interests/social engagement/hobby

- Good coping skills

Others are non-violent handling of disputes, restricted access to highly lethal methods of

suicide, conflict resolution skills, effective and appropriate clinical care for mental, physical,

and substance abuse disorders, family and community support, cultural and religious beliefs

that discourage suicide and support self-preservation instinct (Townsend, 2011).

Common means of committing suicide

Firearms are the most common means by which people take their lives. Other common

methods include overdose of medication, poisoning, asphyxiation (self-suffocation), and

hanging. Lethal means of committing suicide include guns, hanging and jumping.

Signs and symptoms

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Warning signs that an individual is imminently planning to kill themselves may include the

person making a will, getting his or her affairs in order, sudden visiting of friends or family

members (one last time), buying instruments of suicide like a gun, hose, rope, pills, or other

forms of medications, a sudden and significant decline or improvement in mood, or writing a

suicide note.

Individuals who take their lives tend to suffer from severe anxiety or depression, symptoms

of which may include moderate alcohol abuse, insomnia, severe agitation, loss of interest in

activities they used to enjoy (anhedonia), hopelessness, and persistent thoughts about the

possibility of something bad happening.

According to Stöppler (2017) 10 Top Suicide warning signs are:

1. Talk of, or preoccupation with, suicide or death; threatening suicide; writing about

death or suicide; researching suicide online.

2. Signs of serious depression, including desperation; feelings of hopelessness; feeling

no sense of purpose; loss of interest in things one used to care about; trouble sleeping

3. Withdrawal from family and friends

4. Reckless behaviour, increased risk-taking, irritability

5. Making statements about life not being worth living, hating life, that the "world would

be better off without me," and similar feelings

6. Increased alcohol or drug use

7. Feelings of rage or uncontrolled anger

8. Seeking access to firearms, pills, or other methods to commit suicide

9. Changing wills, preoccupation with putting one's affairs in order

10. Dramatic changes in personality

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Be especially concerned if a person is exhibiting any of these warning signs and has

attempted suicide in the past. According to the American Foundation for Suicide Prevention,

20% to 50% of people who commit suicide have had a previous attempt.

Suicide Risk Assessment

Assessment of suicide risk is important especially when working with those who present with

warning signs or are at high risk. Assess for the following cues:

● Suicidal ideation cues may be verbal and either direct (i.e., “I just want to end it all”)

or indirect (i.e., “What is the point of going on with life?”).

● Behavioural cues may also be direct (past suicide attempt) or indirect (e.g. giving

away possessions).

● Situational cues may be events that trigger depression and lead to suicide (e.g. death

of spouse, child, or friend or diagnosis of a terminal disease).

● Symptomatic cues such as depression with anxiety, isolation, changes in sleeping and

eating habits, or sudden recovery from a deep depression often are noted prior suicide

(O’Brien, Kennedy, & Ballard, 2008).

The risk assessment for suicidal thoughts and behaviours performed by mental health

professionals often involves an evaluation of the presence, severity, and duration of suicidal

feelings in the individuals they treat as part of a comprehensive evaluation of the person's

mental health. Therefore, in addition to asking questions about family mental health history

and about the symptoms of a variety of emotional problems (for example, anxiety,

depression, mood swings, bizarre thoughts, substance abuse, eating disorders, and any history

of being traumatized), practitioners frequently ask the people they evaluate about any past or

present suicidal thoughts, dreams, intent, and plans. If the individual has ever attempted

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suicide, information about the circumstances surrounding the attempt, as well as the level of

dangerousness of the method and the outcome of the attempt, may be explored. Any other

history of violent behaviour might be evaluated. The person's current circumstances, like

recent stressors (for example, end of a relationship, family problems); sources of support and

accessibility of weapons are often probed. The treatment the person may be receiving and

how he or she has responded to treatment recently and in the past, are other issues mental

health professionals tend to explore during an evaluation.

Sometimes professionals assess suicide risk by using an assessment scale. According to

Dryden-Edwards (2013), one such scale is called the SAD PERSONS Scale, which identifies

risk factors for suicide as follows:

● Sex (male)

● Age younger than 19 or older than 45 years of age

● Depression (severe enough to be considered clinically significant)

● Previous suicide attempt or received mental-health services of any kind

● Excessive alcohol or other drug use

● Rational thinking lost

● Separated, divorced, or widowed (or other ending of significant relationship)

● Organized suicide plan or serious attempt

● No or little social support

● Sickness or chronic medical illness

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Managing a suicidal patient/ suicide attempt

After assessment, crisis intervention is the next step, with the primary goal of maintaining the

individual’s safety. Often it is appropriate that a consultation with a mental health

professional be done to determine if hospitalization is the safest for the person. Treatment can

include treatment of presenting symptoms, referral for individual/group therapy, or referral

for supportive group or community programme. Ongoing monitoring is important and can

show that the individual is overcoming his/her sense of despair and moving towards a healthy

way of resolving his/her difficulties (O’Brien, Kennedy, & Ballard, 2008).

Talk therapy (such as Cognitive behavioural therapy) has been found to be an effective

treatment for many people who struggle with thoughts of harming themselves. Cognitive

behavioural therapy (CBT) is a blend of two therapies: cognitive therapy (CT) and

behavioural therapy (BT). CT focuses on a person's thoughts and beliefs, and how they

influence a person's mood and actions, and aims to change a person's thinking to be more

adaptive and healthy. Behavioural therapy focuses on a person's actions and aims to change

unhealthy behaviour patterns.

Staff should be aware that individuals with a depressive illness and/or suicidal risk are at

particular risk of suicide at certain times in a hospital ward setting.

The risk periods for increased incidence of suicide are:

● Between 10:00pm and 6:30am

● Around change of shift time

● Over the weekend period.

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These times are periods of decreased observation and interaction with staff members. The

safety of both the person being assessed and the clinician is the primary concern at all times

throughout the period.

● The level of observation/supervision needs to be considered crucial during these

times. The level of observation required by a person will depend on the risk and the

physical environment. Wherever possible, a person at risk of suicide should never be

left alone.

● Where the risk is assessed as high or medium, the person should be moved to a

ground floor room, or if this is not possible, the person should be cared for in a room

that is easily observable and from which exit can be monitored.

● If possible, provide a calming support person to stay with the person at risk.

● All items that could be used for self-harm (including belts, ties, dangerous objects)

should be removed from the person and their immediate environment.

● If a person who is considered to be at risk absconds from the ward, the police should

be contacted immediately and provided with a description of the person, and the likely

areas the patient may be located.

● There should be consideration of sleep, hygiene and where appropriate, night sedation

to assist the patient’s rest and sleep.

● Depending on level of risk and availability of specialist service, the use of a ‘special’

nurse or maintaining constant observation may need to be considered.

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 ● The management plan should include information regarding triggers, stressors,

precursors, methods/plans and the individual importance of various factors to the

patient, including anticipation of likely circumstances that may escalate the patient’s

risk.

● It should include information regarding family and friends and details of significant

relationships.

NSW Department of Health (2011) outlined the following measures:

● Do not leave the patient. Obtain assistance from other staff.

● Remove the patient from danger without placing staff or other patients and visitors at

risk.

● If there is a risk to others, obtain assistance from security staff.

● Ensure immediate emergency medical care.

● Assess the patient’s current suicide risk.

● Provide support to other people present who may be acutely distressed, including

other patients, staff and visitors.

● Follow all related procedures in regard to incident reporting, management and review.

Specific Interventions

Power & McGowan (2011) identified the following specific interventions:

Medications

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Continue to treat the person within the ward, which will include ongoing risk assessment and

appropriate treatment. There is evidence that choice of medication can reduce the suicide risk

in patients. Atypical antipsychotics appear more protective than conventional antipsychotics

(Clozapine may specifically reduce suicidal ideation). Antidepressants appear to provide

some benefit in post-psychotic depression and are recommended in acute depressive

psychosis but not in acute phases of schizophrenia or schizoaffective disorders. Lithium may

reduce suicide risk in affective disorders. Prescribing neuroleptic medication to young people

for the first time should only be undertaken by experts experienced in this field. There is a

high risk of unwanted side-effects. Electroconvulsive therapy (ECT) is recommended in

severe affective psychosis and severe suicidal depression.

Psychological interventions

Debriefing after suicide attempts may help to reduce subsequent morbidity. Even where the

attempt is not recent it may still be helpful to provide a form of debriefing to assist the person

come to terms with what happened, understand the reasons behind it and hopefully learn

ways of preventing it happening again. Some cognitive interventions have been shown to

reduce the rate of suicide in controlled trials. However, such findings are few and their effect

appears to be small.

Psychosocial interventions

Psychosocial interventions that support growth and instil hope and optimism are crucial to

recovery. Rehabilitative, vocational/educational and social interventions that address

deprivation and exclusion and that restore confidence, social integration and a sense of

purpose are likely to improve quality of life and reduce levels of secondary morbidity and

suicidality. Practical housing, finances and parenting support can all help to reduce stress and

social exclusion. In addition, family interventions such as psycho-education may reduce

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burden, high expressed emotion, family disintegration, and rejection, thereby protecting

against the risk of suicide.

Discharge and follow-up

Where the decision has been made to discharge a person at risk into the community, adequate

support and follow-up arrangements should be made.

● Prior to leaving the ward, the person and where appropriate, their family must be

provided with information about how to access urgent help including a 24-hour

contact telephone number.

● A follow-up appointment for re-assessment must be provided.

● If the person is under 16 years of age, contact must be made with the parents or

guardian prior to discharge.

● There must be a plan to contact significant support persons about the potential suicide

risk and about follow-up arrangements that have been made. This includes the

general practitioner, private psychiatrist, care coordinator, case manager, family and

friends.

● Information must be provided to relevant health care providers regarding

presentation of the person at risk.

● There must be a verbal report at discharge or an interim summary on the day of

discharge (NSW Department of Health, 2011)

Missed appointment

● Where a suicide attempt has been made or there is ongoing risk and the person does

not attend an initial follow-up appointment, the relevant health care provider with

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 whom the appointment has been made must immediately contact the person and

assess his/her suicidal behaviour.

● All attempts at contact must be documented in the medical file (NSW Department of

Health, 2011).

Intervention with families and friends of suicide victims

Cvinar (2005) as cited in Townsend (2014) stated that Suicide has a profound effect on the

family, friends, and associates of the victim that transcends the immediate loss. As those

close to the victim suffer through bereavement, a variety of reactions and coping mechanisms

are engaged as each individual sorts through individual reactions to the difficult loss.

Bereavement following suicide is complicated by the complex psychological impact of the

act on those close to the victim. It is further complicated by the societal perception that the

act of suicide is a failure by the victim and the family to deal with some emotional issues, and

ultimately society affixes blame for the loss on the survivors. This individual or societal

stigma introduces a unique stress on the bereavement process that in some cases requires

clinical intervention. Suicide of a family member can induce a whole gamut of feelings in the

survivors (Townsend, 2014).

Strategies for assisting survivors of suicide victims include the following:

● Encourage the clients to talk about the suicide, each responding to the others’

viewpoints and reconstructing of events. Share memories.

● Be aware of any blaming of specific family members. Discuss how each person fits

into the family situation, both before and after the suicide.

● Listen to feelings of guilt and self-persecution. Gently move the individuals toward

the reality of the situation.

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 ● Encourage the family members to discuss individual relationships with the lost loved

one. Focus on both positive and negative aspects of the relationships. The family must

be able to recognize both positive and negative aspects about the person before grief

can be resolved.

● No two people grieve in the same way. It may appear that some family members are

“getting over” the grief faster than others. All family members must be made to

understand that if this occurs, it is not because they “care less” but that they “grieve

differently.” Variables that enter into this phenomenon include individual past

experiences, personal relationship with the deceased person, and individual

temperament and coping abilities.

● Recognize how the suicide has caused disorganization in family coping. Reassess

interpersonal relationships in the context of the event. Discuss coping strategies that

have been successful in times of stress in the past and work to re-establish these

within the family. Identify new adaptive coping strategies that can be incorporated.

● Identify resources that provide support: religious beliefs and spiritual counsellors,

close friends and relatives, survivors of suicide support groups. One online connection

that puts individuals in contact with survivors groups specific to each state is the

American Foundation for Suicide Prevention at [Link] (Townsend, 2014).

Prevention of suicide

Suicide is a serious public health problem that can have lasting harmful effects on

individuals, families, and communities. While its causes are complex and determined by

multiple factors, the goal of suicide prevention is simple: Reduce factors that increase risk

(i.e. risk factors) and increase factors that promote resilience (i.e. protective factors). Ideally,

16
prevention addresses all levels of influence: individual, relationship, community, and societal.

Effective prevention strategies are needed to promote awareness of suicide and encourage a

commitment to social change (CDC, 2016).

According to WHO (2014) the effective interventions in preventing suicide include:

● Strategies involving restriction of access to common methods of suicide, such as

firearms or toxic substances like pesticides, have proved to be effective in reducing

suicide rates; however, there is a need to adopt multi-sectoral approaches involving

many levels of intervention and activities.

● There is compelling evidence indicating that adequate prevention and treatment of

depression and alcohol and substance abuse can reduce suicide rates, as well as

follow-up contact with those who have attempted suicide.

● Strong connections to family and community support.

● Skills in problem solving, conflict resolution, and non-violent handling of disputes.

● Personal, social, cultural and religious beliefs that discourage suicide and support

self - preservation.

● Restricted access to means of suicide.

● Seeking help and easy access to quality care for mental and physical illnesses.

ILLUSTRATION

Clinical Example of a suicidal patient

Mr. Job was a 60 year old man who lived alone. His son and daughter were married and

lived in the same state as Mr. Job. His wife died 2 years ago, and since then his children

17
had often asked him to move in with either of them because they noted that after their

mother’s death that their father was grieving inappropriately, unable to solve minor

problems, depressed, and has decreased appetite for food. He consistently refused to move

in with either of his children, believing that he and his children needed privacy in their

lives. Six months ago, he was diagnosed as having advanced prostatic cancer with

metastasis.

After the diagnosis and because of increasing disability, he left his job and began to

receive disability compensation which was unable to meet his role expectations and he

was always sighing and asking “how am I going to survive”. He visited his children and

their families about twice each month and kept his regularly scheduled visit with the

medical clinic. The nurses and physicians at the clinic noted that he was downcast,

discouraged, sad, and withdrawn but thought this was a normal reaction to his diagnosis

and family history. No intervention was implemented based on his emotional needs. A

week after attending the clinic for routine follow-up visit, he went to the cemetery where

his wife was buried and at her gravestone he shot himself in the head. The keeper of the

cemetery heard the shot, discovered what had happened, and called an ambulance. Mr. Job

was taken to the emergency room of the nearest hospital and, with prompt medical care,

survived the suicide attempt.

Medical Diagnosis – Advanced prostatic cancer with metastasis. .

List of cues – loneliness, disability, downcast, disheartened, sadness, withdrawn, and

suicidal behaviour (gunshot), inappropriate grieving, depressed mood, unable to solve

minor problems, decreased appetite, inability to meet role expectations.

Cue cluster (a) – suicidal behaviour (gunshot), withdrawal, sadness, downcast, depressed.

Nursing Diagnosis – Risk for suicide related to feelings of depression evidenced by

attempted suicide.

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Cue cluster (b) – loneliness, increasing disability, suicidal behaviour, decreased appetite,

verbal cues (sighing, “How can I survive”).

Nursing Diagnosis – Hopelessness related to deteriorating physiological condition

evidenced by verbal cues.

Cue cluster (c) – inappropriate grieving, depressed mood, unable to solve minor

problems, decreased appetite, loneliness, disability, inability to meet role expectations,

attempted suicide.

Nursing Diagnosis – Ineffective coping related to situational crisis evidenced by inability

to meet role expectations.

NURSING CARE PLAN OF A SUICIDAL PATIENT (Mr. Job)

NURSING NURSING NURSING ORDERS EVALUATION

DIAGNOSIS OBJECTIVE
1. Suicide attempt related Mr. Job will refrain Suicide prevention 6340 Suicide Self-restraint 140
to feelings of from attempting (NIC) (NOC)
depression evidenced suicide improving - Determine presence and
by attempted suicide. his rating (NOC degree of suicidal risk. - Refrain from attemptin
1408) from one to suicide (140813)
five by 3 weeks - Place patient in least 4 - Often demonstrated
restrictive environment
that is free from suicidal
weapons and allows for
necessary level of
observation.
- Continue regular
assessment of suicidal
risk (at least daily).
- Utilize direct, non-
judgemental approach
in discussing suicide.
- Treat and manage any
symptom that may place
patient at risk for
suicide.
- Interact with patient at
regular intervals to
convey caring and
openness and to

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 provide an opportunity
for patient to talk about
feelings.
- Encourage patient to
seek out care providers
to talk as urge to harm
self occurs.

- Facilitate support of
patient by family and
friends.
- Explain suicide
precaution and safety
issues to patient and
family. Involve family
in discharge plan.

Hopelessness Mr. Job will Hope Inspiration 5310 Hope 1201 (NOC)
(NANDA) related to express faith and (NIC) - Expresses faith (1201
deteriorating reasons to live - Assist patient/family to 4 - often demonstrated
physiological condition improving his identify areas of hope in
evidenced by verbal rating (NOC 1201) life. - Express reasons to live
cues from one to five by (120104)
- Demonstrate hope by 5 - consistently
2 weeks
recognizing the patient’s demonstrated
intrinsic worth and
viewing the patient’s
illness as only one facet
of the individual.
- Teach reality recognition
by surveying the situation
and making contingency
plans.
- Assist the patient to
devise and revise goals
related to the hope
object.
- Help the patient expand
spiritual self.
- Avoiding masking
truth.
- Involve the patient
actively in own care.
- Provide patient /family

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 opportunity to be

involved with support

groups.

Suicidal Caution Card

If you are caring for a suicidal or at risk patient, observe and report patient’s behaviour,

nursing interventions, inform the ward charge, compound nurse and document in ward report

and open up suicidal caution card. Suicidal caution card consists of:

Patient’s Name:
Diagnosis:
Hospital No:
Ward:
Age:
Date/Time Observed Nursing General Handing Taking

Patient Action Remark Over Nurse Over

Behaviour Nurse

Conclusion

In conclusion, Suicide is a priority condition globally and has been identified as such by

WHO. A national suicide prevention strategy should be developed through a stepwise

approach. Such a strategy should acknowledge, as a first step, that suicide is a major

problem and that it is preventable. Health care professionals are in a vital position for

identifying people at risk of suicide and preventing suicide. Management of a person at

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risk of suicide requires assessment of risk, an estimation of the level of risk and

appropriate interventions to minimise the risk.

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