A step-by-step approach on how to develop a local suicide care pathway, including a toolkit that supports local health districts and specialty health networks to:
review current practices and the pathway for suicide care and align it to best practice
use sound methodology and principles to co-design, collaborate with and engage local stakeholders.
The work is part of a Zero Suicides in Care initiative, led by the NSW Ministry of Health.
On this page
Clinical pathway
Published: July 2022.
The pathway is not a fixed linear process. Movement between components of the pathway should occur in response to changes in the needs and circumstances of the person.
Identify
Early identification and engagement
Identify
Assessment
Engage
Formulation
Engage
Brief intervention
Treat
Treatment
Transition
Transition of care
Early identification and engagement
Establish a therapeutic relationship
A good alliance between the clinician and the person in the early stages of therapy is vital for therapy success. A positive therapeutic relationship includes:
trust, care and respect
agreed goals of care
collaboration on the care plan and tasks to be undertaken.
Ask directly about suicide
Most people who die by suicide contacted a clinician weeks or months before their death. Many don’t talk about suicidal thoughts and plans unless asked. Asking doesn’t make the situation worse. It is critical to identifying and supporting a person who may be contemplating suicide.
Engage with family and the support network where appropriate
With the person’s consent, contact family members or other people who support them during difficult times. This allows you to explore who can help in assessment and treatment planning and to collaboratively develop an escalation process.
Assessment
Conduct a comprehensive mental health assessment
This includes information about:
current life stressors
the person’s strengths, supports and protective factors
acute mental or physical illness or substance use.
Ask if the person has thought about hurting themselves and ending their life, even when there are no indications of suicidality.
Consider nature of suicidality and its drivers
Identify factors that contribute to a person’s distress, thoughts about suicide and their capacity to navigate suicidal crises. Explore the severity and frequency of suicidal ideation and check:
if this has changed over time
the contextual factors that may be impacting the person.
Gather collateral information
If appropriate, mental health assessments and assessment of suicidality, should include the views of family and carers and information from other health professionals who support the person.
Person-centred suicide prevention formulation requires you to learn about what is happening in the person’s life. This helps to identify and address risk factors that can be modified. It also enables the most appropriate and valuable support, treatment and care.
Explore protective factors
Determine the nature of the person’s protective factors and how they can be strengthened.
Identify available resources
Take note of the person’s internal and external resources and what is available to help them cope during times of crisis.
Brief intervention
Brief intervention requires an immediate action plan consisting of:
Address access to lethal means
As part of an immediate action plan, minimise the availability of lethal means. Doing this can delay a person’s ability to act on suicidal thoughts until the thoughts subside, or care can be provided.
Provide person, family, carer education
The person, their family and support networks need to be given information relevant to the person’s experiences and the supports available to them. This will empower the person to make informed decisions about their recovery.
Develop a safety plan and review
This includes listing coping strategies and sources of support a person wishes to use when they experience a suicidal crisis. The list may cover:
exploring warning signs of an impending suicidal crisis
internal coping strategies
use of social contacts and social settings
seeking help from friends and family members
engaging professional help
addressing access to lethal means.
Rapid follow up
All people identified as at risk of suicide should be followed up, ideally within 24-48 hours.
Treatment
Treatment requires a comprehensive care plan consisting of:
Treatment for suicidality and address drivers of suicidality
Include therapies that specifically aim to reduce suicidality. Also include treatments or interventions that address the drivers of the person’s suicidality, for example, isolation.
Examples of treatment include cognitive behaviour therapy for suicide prevention (CBT-SP) collaborative assessment and management of suicidality (CAMS) and dialectical behaviour therapy (DBT-SP).
Address modifiable suicide risk factors
These could include:
underlying mood
depression
psychotic and other mental disorders
substance misuse
physical illness
pain and pain syndromes
past trauma
isolation.
These risk factors apply even if there is no direct causal link between the experience and the suicidality for a particular person.
Consider and incorporate social and cultural supports and networks
These assist a person to thrive and have a life they want to live. Promote activities that strengthen recovery and consolidate protective factors. This includes considering factors such as employment, housing, spirituality, cultural connections, and social networks.
Transition of care
Facilitate a warm handover
Combining written referrals with a person-to-person discussion with other service providers enables clinicians to highlight key points and introduce the service to the person.
Assertive follow-up during transition
Proactive contact with a person needs to be maintained during transitions of care to ensure the person connects with the new services or supports. Contacts after discharge provide reminders and encouragement about recovery and the supports available. During follow-up contacts, suicide risk formulations need to be reviewed and supports amended accordingly.
Ensure holistic supports are engaged
Ensuring these supports are activated helps the person to recover. The supports may include assistance with:
employment
housing issues
connecting people with peer-led or social networks.
Many people don't talk about suicidal thoughts and plans unless asked directly.
The Consumer Pathway is a guide for consumers and families, carers and kinship groups who are accessing health services for suicidal thoughts or behaviours. Share the pathway with a consumer to help explain the process of care, what questions will be asked and how you will work out the next steps together.
We acknowledge Illawarra Shoalhaven and Mid North Coast Local Health Districts for their work and contribution to consumer pathways.
