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NIDA5 NIMH4 BPDRF1 TREATMENT NOTES 2003-2008

3)

Not Reported Not Observed

NO

YES

HISTORY of suicide attempts/self-injury

CURRENT suicide intent, including client belief that he/she is going to commit suicide or hurt self

Preferred METHOD CURRENTLY or easily AVAILABLE

LETHAL MEANS (of any sort) CURRENTLY or easily available CURRENT PLAN and/or preparation (including specific method and time) CURRENT PRECAUTIONS against discovery; deception about timing, place, etc. CURRENT SUBSTANCE USE, including ETOH and Rx meds (last 3 hours)

Currently or will be ISOLATED or ALONE

PROMPTING EVENTS for previous parasuicide

SUDDEN LOSS, other negative event.

ABRUPT CLINICAL CHANGE, either negative or positive

INDIFFERENCE/DISSATISFACTION with therapy

First night of INCARCERATION

Current Severe HOPELESSNESS.

Current MAJOR DEPRESSION PLUS:

Current Severe TURMOIL, ANXIETY, PANIC attacks, mood CYCLING

Current Severe, GLOBAL INSOMNIA

Current Severe ANHEDONIA

Current Inability to CONCENTRATE, INDECISION

Current PSYCHOSIS, voices telling client to commit suicide

CHRONIC PHYSICAL pain

USUALLY OR CURRENTLY HIGHLY IMPULSIVE

Client MOTIVATED TO UNDER-REPORT/LIE about risk

Required if no:

OTHER:

C : \ D o c u m e n t s a n d S e t t i n g s \ e r i n w 6 \ L o c a l S e t t i n g s \ T e m p o r a r y I n t e r n e t F i l e s \ O L K 8 7 \ 2 0 0 8 - 1 0 - 1 0 _ I m m i n e n t _ R i s k _ A n d _ A c t i o n _ P l a n . d o c

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