More Accurately Gauging the Dangerousness of a Suicide Attempt

“Great gifts are the fairest, and often the most dangerous fruits on the tree of humanity. They hang on the weakest branches, which easily break.”

Carl Gustav Jung, M.D.
Swiss Psychiatrist

More Accurately Gauging the Dangerousness of a Suicide Attempt

TISA Description of the Problem: The history of a severe suicide attempt in the near or distant past can be an important factor when determining current lethality. Over 50% of people who die by suicide have had a suicide attempt in the past. During a recent workshop in Calgary, Kathy Fitch, M.D. offered two effective questions for uncovering the most dangerous of past attempts.

Tip: When seeking out dangerous past suicide attempts, I find the following two questions to be of use: “What is the closest you have come to suicide lately?” and “What is the closest you have ever come to suicide?”

Once I get a response to either question, I immediately follow-up with a series of behaviorally specific questions to determine for myself how dangerous the attempts may have been.

TISA Follow-up: Once a clinician has pinpointed the client’s most dangerous attempt as effectively described by Dr. Fitch, it is useful to follow-up on two points: 1) What was the method used in the most dangerous attempt, and 2) What were the triggers prompting the most dangerous attempt. If the current suicidal plan matches the past method and the past stressor, it may suggest that the client’s current suicidal intent is more urgent. Thus if we are interviewing a 29-year old client who is currently undergoing a divorce and is contemplating overdosing on aspirin, a past history of overdosing on 60 aspirin while in college after a girlfriend broke-up with him, might reflect a more dangerous situation, for the method of suicide has been “practiced”. The interweaving of the interviewing techniques described in this month’s Tip of the Month represents yet another example of the delicate interface between clinical interviewing strategies and the clinical formulation of risk.

Tip provided by:

Kathy Fitch, M.D.
Calgary, Alberta