1. Suicide Risk Assessment • If Depression is suspected • At diagnosis and at different points in treatment • Use of KADS allows for self-reports of suicide ideation • Suicide is more common in males • Self harm attempts more common in females • Pay particular attention to risk if: • A major life stressor occurs • A friend or acquaintance commits suicide • A public figure commits suicide • The media reports on a successful suicide • Explore the impact of occurrences with patient

2. Assessing Suicide Risk • Suicide in children is rare • Research in pre-pubertal suicide is limited • Gently inquire with child if: • Family history of suicide • Parent/child reports of self harm behaviors • Parent/child reports of substantial depressive symptoms • Inquire in age appropriate manner

3. Assessing Suicide Risk • Questions: • When you are feeling this way do you ever wish that you were dead? • Can you tell me what you mean by being dead? (If child) • Have you thought of doing something that could kill you? • Can you tell me about what you are thinking or planning? • Understand what the child means by ‘dead’ • If child understands death then gently further question • If possibility of suicide risk then gently inform parents AND immediately refer to specialty mental health services (emergency assessment)

4. Suicide Risk Assessment • Unrecognized/untreated mental illness is strong risk factor • Suicide increases with the following factors: • Family history of suicide • Substance abuse • History of impulsivity • Hopelessness • Legal difficulties • A previous suicide attempt • Access to lethal means (such as firearms) www.Dreamstime.com ID:1195260

5. TASR-A

6. High risk for suicide is a MEDICAL EMERGENCY! • Assess at baseline & throughout treatment • Not all young people will admit to their plan • Suicide is NOT ALWAYS completely preventative • Assessment identifies those at increased risk of suicide • Appropriate intervention plans can be instituted • Immediate psychiatric assessment • Give a copy of assessment to mental health specialist • Include contact information • Refer to Specialty Mental Health Services • Frequent self-harm attempts • Persistent suicide ideation

7. Suicide Ideation HOPELESSNESS INCREASES RISK remember not everyone who has a diagnosis of anxiety or depression feels hopeless. ALWAYS ask about a suicide plan If there is suicide ideation or hopelessness

8. Safety & Contingency Planning

9. Safety & Contingency Planning • Emergency Contact Cards “wallet card” • Rapid Health Provider Availability • Youth & caregivers rarely overuse this access • Help Phone/Crisis Hot Line • No Suicide Contract • No demonstrated effect – do not use

10. Safety Card • Safety Card- Emergency Contact Number • Dr. (xxxxxxxx) number and email: 604-xxx-xxxx xxxxxxx@xxxxxxx.ca • Emergency room604-xxx-xxxx • Vancouver Child and Youth Mental Health Referral Line: 604-675-3895 • Helpline for children: Toll-Free in BC (no area code needed) 310.1234 • Crisis Intervention and Suicide Prevention Centre of BC • Lower Mainland 604.872.3311 Toll Free 1.866.661.3311 • SAFER (Suicide Attempt Counselling Service)604-675-3985 • Vancouver Island Crisis Line 1-888-494-3888

11. Table Discussion: Suicide Risk Assessment • Have you used the TASR-A with any children or youth before? • How would you use it? • How can you involve the family and others for support?