8.8 Suicide risk assessment
When assessing suicide risk in individuals with both schizophrenia and substance use disorder, it’s important to be sensitive and structured.
The goal is to understand the risk level, recognize protective factors, and plan effective ways to support them.
Encourage open, nonjudgmental dialogue
Starting with open-ended questions helps create a safe space where the person feels comfortable sharing their thoughts.
A caregiver might say:
“Would you like to talk about what’s been on your mind lately? Are there moments when things feel especially tough?”
This approach allows them to express difficult feelings without fear of judgment, making it easier to discuss suicidal thoughts and emotions.
Creating a safety plan when needed
For those at higher risk, having a safety plan can be a helpful tool. This plan might include:
• Emergency contact information
• Grounding techniques for moments of crisis
• A list of supportive friends or family members to reach out to
A well-thought safety plan provides reassurance and practical steps to follow when things feel difficult.
Offer regular check-ins and ongoing support
Checking in regularly after an initial suicide risk assessment can be important, especially for those with dual diagnoses. These follow-ups offer opportunities to reassess risk, adjust any necessary interventions, and continue providing support when needed.
A simple check-in can go a long way in offering continued support.
Suicide risk assessments shouldn’t be a one-time event.
Looking Beyond Risk Levels
While understanding the risk level is crucial, it’s also helpful to explore other factors that can influence intervention planning. These factors can be:
• Protective factors – supportive relationships, coping skills, or personal strengths
• Current stressors – recent losses, isolation, or struggles with daily life
Identifying these elements helps in creating a plan that meets the individual’s specific needs.
Example conversation for suicide risk assessment
“I’d like to check in and see how things have been going for you. Sometimes, having a lot on our minds can feel overwhelming. Are there times lately when it’s been difficult to manage things on your own?”
“Sometimes, yeah. It’s hard to explain. Some days are just really heavy.”
“That sounds challenging. Let’s talk about some things we can try when it feels that way. I’m here to help you find ways to get through those moments safely, and I’d like to support you in any way I can.”
This kind of conversation creates a safe and open dialogue, helping the person feel heard and supported, which leads to a more effective assessment and intervention.
Communication Techniques
Use open-ended questions
This encourages the individual to share more about their feelings and experiences. Questions that can be answered with a simple “yes” or “no” should be avoided.
• Example:
“Can you tell me more about what you’re going through right now?”
Active listening
Repeat back or summarize what the person is saying to show that you are listening and understand. This builds trust and cooperation.
• Example:
“It sounds like you’re feeling really overwhelmed by everything. Is that right?”
Non-stigmatizing language
Avoid judgmental terms. Use neutral language to discuss substance use and mental health symptoms to prevent the person from feeling criticized or ashamed.
• Example:
Instead of saying “Why do you keep using drugs?”, try something like
“It seems like substance use has been part of what you’re going through. Can you tell me more about how it affects you?”
Validate their experience
Validate their feelings and struggles without judgment, letting them know that their experiences are real and understandable.
• Example:
“I can see how hard this must be for you, and it makes sense that you’re feeling this way.”
Stay calm and patient
Schizophrenia can cause disorganized thinking, and substance use can increase confusion. Be patient and don’t rush the conversation, allowing them the time to gather their thoughts.
• Example:
If they lose their train of thought, gently remind them about the discussion:
“You were telling me about how things have been difficult lately. Can you tell me more about that?”
Offer reassurance, not solutions
Sometimes, individuals are not ready for solutions and may just need someone to listen. Offer comfort and the opportunity to talk rather than trying to “fix” things immediately.
• Example:
“I’m here for you, and we can work through this together.”
