Assessment & Management

Risk assessment and management of suicidal patients should be emphasized as a key component of health care delivery.

Assessment and management of self-harm/ suicide can be challenging. Suicidal ideation and behaviors require immediate attention. It is important to offer timely intervention to a person who has suicidal ideation and/ or behavior. This includes a comprehensive assessment of the risk for self- harm/ suicide. The assessment should be followed by the appropriate intervention that is formulated in collaboration with the patient and any involved supports. This process needs to be tailored to individual needs and requires the collaboration of various stakeholders including the health professionals and support system.

Reaching out to a person with suicidal behavior

The initial contact with the suicidal person is very important. Often the contact occurs in a busy clinic, home or public place where it may be difficult to have a private conversation.



































The aim is to bridge the gap created by mistrust, despair and loss of hope and give the person the hope that things could change for the better.

Communication with a person with self-harm

A calm, open, caring, accepting and non-judgemental approach is required to facilitate communication.

Click the buttons below to read about Do's and Do not's while communicating with a person with self-harm

Assessment of risk of self-harm/ Suicide

When the primary health care staff suspect that suicidal behaviour is a possibility, the following factors need to be assessed:

  • current mental state and thoughts about death and suicide

  • current suicide plan - how prepared the person is, and how soon the act is to be done

  • the person’s support system (family, friends, etc.).

Asking about suicidal thoughts

The best way to find out whether individuals have suicidal thoughts is to ask them. Contrary to popular belief, talking about suicide does not plant the idea in people’s heads. In fact, they are very grateful and relieved to be able to talk openly about the issues and questions they are struggling with.

Does talking about suicide plant the idea in people’s heads?

Click on the tabs below to read more about the questions that can be asked to assess the past and current suicidal behavior.

Recommendations by the mhGAP intervention guide

The Mental Health Gap Action Programme (mhGAP) intervention guide for mental, neurological and substance use disorders has been developed by the World Health Organization. The mhGAP Intervention Guide (mhGAP-IG) has been developed to facilitate mhGAP-related delivery of evidence-based interventions in non-specialized health-care settings. It provides the full range of recommendations to facilitate high quality care at first- and second-level facilities by the non-specialist health-care providers in resource-poor settings. It presents integrated management of priority conditions using protocols for clinical decision-making.


The guide mentions that any person over 10 years of age experiencing any of the following conditions should be asked about thoughts or plans of self-harm in the last month and about acts of self-harm in the last year:

  • any of the other priority conditions as listed in the guide;

  • chronic pain;

  • acute emotional distress.

Evaluate for thoughts, plans and acts of self-harm during the initial assessment and periodically thereafter, as required. Attend to the person’s mental state and emotional distress.


The full version of Mental Health Gap Action Programme (mhGAP) intervention guide can be accessed here.

1. Has the person attempted a medically serious act of self-harm?

Indicators of evidence of self-injury

Observe for evidence of self-injury

Look for:

  • Signs of poisoning or intoxication

  • Signs/ symptoms requiring urgent medical treatment such as:

– bleeding from self-inflicted wound – loss of consciousness

– extreme lethargy

Ask about:

  • Recent poisoning or other self-harm

Click on the flowcharts below to enlarge.

Learn more about Pesticide Intoxication Management; Care for a person with self-harm; Offer and activate psychosocial support; and Maintain regular contact and follow-up in this section

Pesticide Intoxication Management

If health-care facility has a minimum set of skills and resources


If health-care facility does not have a minimum set of skills and resources

  • Transfer the person immediately to a facility that has the following resources:

    • skills and knowledge about how to resuscitate individuals and assess for clinical features of pesticide poisoning;

    • skills and knowledge to manage the airway, in particular to intubate and support breathing until a ventilator can be attached;

    • atropine and means for its intravenous (i.v.) administration if signs of cholinergic poisoning develop;

    • diazepam and means for its i.v. administration if the person develops seizures.


  • Consider giving activated charcoal if the person is conscious, gives informed consent and presents within one hour of the poisoning.

  • Forced emesis is not recommended.

  • Oral fluids should not be given.


Care for a person with self-harm

Offer and activate psychosocial support

Maintain regular contact and follow-up

2. Is there an imminent risk of self-harm / suicide?

Indicators of imminent risk of self-harm/ suicide

Ask person and carer about:

  • Current thoughts or plan to commit suicide or self-harm

  • History of thoughts or plan of self-harm in the past month

  • or act of self-harm in the past year

  • Access to means of self-harm

Look for:

  • Severe emotional distress

  • Hopelessness

  • Extreme agitation

  • Violence

  • Uncommunicative behaviour

  • Social isolation

If there are: current thoughts or plan to commit suicide / self-harm OR history of thoughts or plan of self-harm in the past month or act of self-harm in the past year in a person who is now extremely agitated, violent, distressed or uncommunicative then there is imminent risk of self-harm / suicide.

Click on the flowcharts below to enlarge.

3. Does the person have concurrent priority mental, neurological or drug use disorders?

Click on the flowchart below to enlarge.

4. Does the person have chronic pain?

Click on the flowchart below to enlarge.

5. Does the person have emotional symptoms severe enough to warrant clinical management?

Indicators of emotional symptoms severe enough to warrant clinical management

  • Difficulty carrying out usual work, school, domestic or social activities

  • Marked distress or repeated help-seeking

  • Repeated self-medication for emotional distress or unexplained somatic symptoms

Click on the flowchart below to enlarge.

Accessing and utilising resources

Resources

The usual sources of support available are illustrated below-

How to approach the resources?

  • Try to get the permission of the suicidal person to enlist the support of the resources, and then contact them.

  • Even if permission is not given, try to locate someone who would be particularly sympathetic to the suicidal person.

  • Talk to the suicidal person beforehand and explain that it is sometimes easier to talk to a stranger than a loved one, so that he or she does not feel neglected or hurt.

  • Talk to the resource people without accusing them or making them feel guilty.

  • Enlist their support in the actions to be taken.

  • Be aware of their needs also.

Referring a person with self- harm

Hover over the boxes below to learn the steps in case you have to refer the person with self- harm.

Source/ References:
    • Preventing suicide (2000). A resource for primary health care workers. Department of Mental Health, World Health Organization; Geneva. WHO/MNH/MBD/00.4
    • mhGAP Intervention Guide e-version. World Health Organization. Available at https://www.paho.org/mhgap/en/