Suicide risk tool – question prompt examples

What is the suicide risk tool

The suicide risk tool is a set of questions that can be asked directly to te tamaiti or rangatahi. They are designed to help a social worker to build and deepen their understanding about what is going on for te tamaiti or rangatahi and whether they are at risk of suicide.

The accuracy of the information gathered depends on a number of factors, including:

• the self-awareness of te tamaiti or rangatahi
• the memory of te tamaiti or rangatahi
• the honesty of te tamaiti or rangatahi.

Other possible sources of information could include:

• direct observation
• asking trustworthy significant others who know the person well – for example, a parent or caregiver
• professional assessment or treatment reports.

When to use it

Use this tool in conjunction with SACS, Kessler and suicide screens when the Kessler result is greater than 12, or when te tamaiti or rangatahi shows signs of having suicidal thoughts.

Who uses it

Anyone working directly with tamariki or rangatahi who's been trained to use the SACs, Kessler and Suicide screens (SKS), or is concerned that te tamaiti or rangatahi is having suicidal thoughts.

How to use this tool

These questions can be used if there are any indications that te tamaiti or rangatahi might be having suicidal thoughts. Their answers can be recorded in the suicide risk assessment tool template. 

Suicide risk assessment tool template (DOC 50 KB)

Using the tool with Māori and Pacific

It's important to consider the principles, values and knowledge within Te Toka Tūmoana and Va'aifetū when using this tool with tamariki and rangatahi Māori and Pacific children and young people.

Working with Māori: Te Toka Tūmoana

Working with Pacific peoples: Va'aifetū

After using this tool

If you have further concerns after using this tool, contact the Towards Wellbeing helpdesk.

Email: help@twb.org.nz

Understanding risk is an ongoing process. We need to continue building and deepening our understanding of this risk, particularly when there are changes in any areas.

Current suicidal behaviour

Suicidal thoughts

Use these prompt questions to identify if te tamaiti or rangatahi has been having suicidal thoughts.

• Have you been thinking about suicide or had thoughts of wanting to die?
• What was happening/going on at the time you had the thoughts?
• What sort of thoughts have you been having? Can you describe them?
• How often are the thoughts there?
• How long do the thoughts last?
• Are there any things that you have noticed trigger or set off the thoughts?

Method

Use these prompt questions to identify if te tamaiti or rangatahi has thought about the method they might use.

• Have you thought about how you would go about committing suicide? Or have you thought about how you would do it?
• What ways have you thought of?
• Anything else? (keep exploring until they say nothing else)

Degree of planning

Use these prompt questions to find out how far te tamaiti or rangatahi has got in planning a suicide attempt.

• Have you worked out how you would go about it (carrying out your plan)?
• What have you worked out?
• Are there any things or people that would make you not want to carry out your plan or go through with it?

If needed you can use more specific prompts.

• Have you worked out where you would do it and what you would use?

Achievability of the plan

Use these prompt questions to identify how achievable their plan is.

• Do you have what you would need to carry out your plan?
• What do you have available?
• How likely is it that you will be able to carry out your plan?

Preparation (usually based on observations)

Use these prompt questions to identify if they have started preparing for a suicide attempt.

• Have you done anything towards preparing to act on your plan?
• If so, what have you done?

Previous suicide attempts

Use these prompt questions to find out if te tamaiti or rangatahi has attempted suicide before.

• Have you ever tried to harm or kill yourself in the past?

Explore the following questions for each attempt.

• Describe to me what happened? (method)
• What was your intention at the time? or Do you think you wanted to die when you did this?
• Did you need to go to hospital or get any other sort of help? If so what happened?
• What was happening at the time you made the attempt? What triggered the attempt?
• When did this happen? (eg date), Are there any other times you have tried to harm yourself?...

Previous self-harming

Use these prompt questions to find out if te tamaiti or rangatahi has self-harmed before.

• Have you ever harmed yourself that wasn’t about wanting to die?
• What have you done and how often does it happen?

Current emotional distress

Mood

Use these prompt questions to find out how te tamaiti or rangatahi is feeling.

• How have you been feeling in yourself lately?
• Have you noticed you are feeling more sad/irritable/anxious/angry/shut-down than usual for you?
• Tell me about those changes? Describe how things are different?
• How long have you been feeling like this?
• Why do you think you are feeling this way?

Has anyone noticed a sudden unexplained improvement in mood?

Thoughts

Use these prompt questions to find out what thoughts te tamaiti or rangatahi is having.

• What do think about yourself at the moment?  How different is this from how you usually think?
• Do you have thoughts that you are worthless or helpless?
• Tell me about these thoughts? (When did they start? How often do you have them? How distressing are they?)
• Do you have thoughts about things being hopeless?
• Tell me about those thoughts?

Other signs/behaviours

Use these prompt questions to identify any signs or changes in behaviour te tamaiti or rangatahi might have noticed about themselves.

• Are there other changes you have noticed in yourself that are different from how you usually are?
• Tell me about those changes? Describe how things are different?

If needed, you can use more specific prompts.

• Have you noticed any changes in your sleep/motivation/ energy levels/appetite/ability to think or concentrate?
• Have you noticed any change in how interested you are in things or how much you enjoy things compared to how you usually are?
• Have you noticed any unusual thoughts or had any unusual experiences? (prompt: like hearing voices?)

Level of hope and reasons to live?

These questions are often asked during discussions around protective factors or while discussing other areas.

• What keeps you going? (people, relationships, plans, activities)
• What would stop you from attempting suicide?
• Do you feel like anything could be done to change the hard things about your current situation?

Other risk factors

Whānau or family/peer history of suicide or mental health

• Do you have any whānau or family or friends who have committed suicide or attempted suicide?
• Do your whānau or family or friends think that committing suicide is OK?
• Do you or any of your whānau or family have a history of mental health difficulties?

What stressors and triggers exist

Stressors that might trigger suicidal behaviour could include:

• relationship break-up
• loss of job
• placement break-down
• conflict with parents
• loss of freedom etc.

What counts as a stressor depends on the individual.

For each tamaiti or rangatahi, you must identify any triggers of significant distress or self-harm (previous or current) and note any upcoming stressors.

• Have there been any recent stressful events that have happened in your life?
• What has happened and how did this affect you?
• Do you have any things coming up that you’re stressed about?
• What things have triggered previous attempts or times that you have self-harmed?

You can use more specific prompts if needed.

• Has there been any relationship break-up or conflict?
• Has there been a death or major illness of someone close to you?
• Has there been a change in your living situation?
• Have there been problems at course/school/job?
• Has there been any offending or getting into trouble with the police?

Substance misuse

SACs, Kessler and Suicide screens (SKS)

How impulsive are they

• Do you do things without thinking through the consequences?  What sort of things?

What are their attitudes to getting help

• Do you think you have a problem or need any help?

How much support do they have

• Who are the people in your life that you get support from?

Current resilience levels and support

Use the following prompt questions to identify the current support systems around te tamaiti or rangatahi and their current level of resilience.

• How do you deal with stress or solve problems?
• How do you feel about the future?
• What are your plans for the future?
• What things are important to you in your life?
• Do you have strong cultural/spiritual connections?
• Do you have friends/family/other important people who you can talk honestly with and be supported by?
• Do you have any special interests or things that you know you are really good at?