Checklist for Organisations


These 20 questions are intended to assist you in determining your current staff competencies, and the quality and completeness of documentation of suicide risk in your organisation's records.

If you answer No to more than 10 of these questions you may be at significant risk of losing a client to suicide, and of being held accountable for failure to take reasonable and prudent steps to prevent an avoidable adverse outcome.

Questions 1-5: Staff training, knowledge, and credentials.  Are staff specifically trained in suicide risk detection, assessment and management of suicidal clients, i.e., do they know how to assess the level of risk and match it with the appropriate level of care?

1.       Do employee Human Relations personnel files contain evidence of suicide risk assessment training and or competency?

2.       Among your clinical employees, other than a psychiatrist, who is qualified to conduct a suicide risk assessment and document findings in the clinical record?

3.       What do your policies and procedures say about when, how often, and at what transitions suicide risk assessments are to be completed and documented?

4.       Goal Two of the New Zealand Suicide Prevention Action Plan 2008-2012 says support and education programmes are to be provided for primary care providers "to recognise, treat and manage the mental disorders that contribute to the development of suicidal behaviours", and that such programmes "are among the most promising approaches to suicide prevention."  According to your training records, has this action been accomplished and maintained for all employees?

5.       Are support and volunteer personnel trained in how to recognize client suicide warning signs and what steps to take to prevent a suicide attempt?  For example, a case manager might be told by a suicidal client, "Say goodbye to everyone for me, I'll be six feet under by Friday."

Questions 6-20: Documentation of suicide risk detection, assessment, and risk management decisions.  Evidence of current practices can found in the review of your existing clinical records.

6.       Does your current suicide risk assessment protocol include specific how-to-ask-about-suicide probes that encourage client disclosure of current ideation, plans and past attempts?

7.       If the client was suicidal, were known risk factors for suicide documented?

8.       If the client was suicidal, were precipitating event(s) queried for and documented?

9.       Were the means of suicide, e.g., hanging, determined and documented?

10.     Was the timing and place for a suicide attempt documented?

11.     Was any history of past suicidal ideation, crisis and or attempts determined and documented?

12.     Were the contribution(s) of any social or relationship conflicts assessed and documented?

13.     Were protective factors (reasons to live) elicited, assessed and documented?

14.     Was there an agreement to abstain from substance use as part of the safety plan?

15.     Was there an agreement to follow medical advice, including a medication regimen if instituted (informed consent for treatment of suicidality)?

16.     Was there an agreement to remove the means of suicide, or evidence of a good faith effort to make suicide difficult?

17.     Was there a documented good-faith agreement to not harm self accidentally or on purpose as part of a collaborative consumer safety and treatment plan?

18.     Was there agreement for emergency intervention if needed - return to service provider, call a hotline, mental health provider or other in case of crisis?

19.     Was there an agreement for the client to accept responsibility for the safety plan?

20.     Were family members, whanau or significant others interviewed about suicide risk, and were these third party observations documented and included in the suicide risk assessment?