Assessing Suicide Risk and Risk to the Infant: Full Risk Assessment Protocol
If you or someone else is concerned about a woman or her infant’s safety, the next step must always be to conduct a risk assessment. When using a depression screening tool, such as the Edinburgh Postnatal Depression Scale (EPDS), check the woman’s response to questions asking about thoughts of self-harm (e.g., EPDS Q10). A full risk assessment protocol (see below) needs to be followed if the item is endorsed (e.g., EPDS Q10 scored ≥1), as this indicates the need for an immediate risk assessment.
Risk Assessment Protocol: to be followed as part of administering depression screening
Assess suicide risk
Below are the main concerns that are used to assess the severity of the mother’s risk of suicide. If you don’t feel qualified to conduct a full risk assessment, refer on to a qualified health professional; however, assessment of the woman’s current thoughts and plans would need to be discussed to know if she is safe to leave.
Suicidal thoughts: “What exactly have you been thinking? How often? How compelling or powerful are these thoughts? Is it worse than previously? What triggers these thoughts?”
Planning: “What have you been thinking you might do?” Press for plan details
Lethality: “Is the specific method likely to be lethal?”
Means: “Have you been thinking about how you might do it? Do you have the means to carry out your plan using this method?” “Do you have access to (drugs, weapon etc)?
Intention: “How likely do you think you are to follow through and act on your thoughts or plan? What stops you?”
Protective factors: “What stops you from acting on these thoughts?” “Sounds like you’ve been feeling pretty awful, what’s kept you going?”
Actions to Take
If EPDS Q10 scored ≥1 and further questioning indicate reason for concern:
- Develop a safety and management plan (include risk assessment for infant and contacts for crisis services). If urgent contact CATT team and arrange for person to be picked up.
- Provide safety numbers (see below)
- Ensure the client is aware of the health professionals that need to be informed
- Contact family members for support
- Document the results of this assessment and actions you have taken.
Assess risk to the infant
Questions to assess risk to the Infant
- “Have you had thoughts of harming your baby?”
- “Have you felt irritated by your baby?”
- “Have you had significant regrets about having this baby?”
- “Does the baby feel like it’s not yours at times?”
- “Have you wanted to shake or slap your baby?”
- “Have you ever harmed your baby?
Safety numbers
- Crisis Assessment & Treatment Team (CATT) – 9450 9090
- Lifeline – 131114
- Suicide Helpline – 1300 651 251
- Suicide call back – 1300 659 467
- Mental Health Advice Line – 1300 280 737
- Parentline (8am – 12am Mon-Fri & 10am-10pm on weekends) – 132289
- Panda – 1300 726 306
Obtain permission to contact other health professionals involved