Observe: Identifying the signs of distress and suicide-related manifestations

The Suicide Prevention Plan – Episode (SPP-E) aims to support professionals in the suicidal danger assessment of persons with an intellectual disability (ID) or autism spectrum disorder (ASD).

The assessment tools described in the IDAS Process are not a standardized grid producing a hazard score, a substitute for expertise and clinical judgment, or an after-the-fact form to compile information unnecessary to the intervention. The screening tools constitute a process to support clinical decision-making regarding the risk of suicide in people with ID or ASD.

The objectives of danger assessment are the following:

  • Qualifying the danger of a suicidal act
  • Identifying the presence/nature/intensity of suicidal ideations
  • Identifying risk and protective factors
  • Identifying triggers
  • Documenting individual and family history of suicidal behaviour
  • Describing the level of despair
  • Understanding the person’s impulsivity
  • Understanding what is happening to the person without preconceived ideas
  • Guiding the intervention (allocating the right services at the right time with the right intensity)

Collecting information to assess danger

The Table below presents clues to observe in order to assess the level of danger and analyse the suicidal episode. The importance of the different factors may vary for each person, depending on their level of ID or ASD, their past experiences, their cognitive, social and affective capacities, etc. The Table aims to support the professional’s clinical judgement when conducting the danger assessment.

A detailed version of this Table can be found in the document Managing the Suicidal Episode.

Risk Factors– History of MAAS (which ones? When?)
– Suicidal behaviour or death, by suicide or not, in the entourage (less than 1 year)
– Level of impulsivity/aggressiveness.
– Mental disorders and associated disorders (SBD, ADHD, etc.)
– Type and levels of ID and ASD
– Negative interpersonal relationships or isolation
– Risk-taking or injuries behaviours
– Current state of disorganization
– Current state of intoxication
– Hopelessness, exasperation, discouragement (short, medium term)
– Ability to plan (in general and the suicidal gesture)
Protective Factors– Varied options for expression (needs, emotions, frustrations, asking for help), and problem solving
– Presence of support during foreseeable events or events that lead to increased stress
– Reasons for living
– Ambivalence about suicide
– Social support
Triggers and Critical Moments– Chronicisation of a situation of powerlessness: increased reactivity to a situation in which the person has an emotional stake, autonomy or self-esteem.
– Accumulation of events (even seemingly minor ones): failures in socialization, hindrance to freedom, mourning or loss of objects.
– Foreseeable major events: Changes, annual recurring events.
– Unexpected major emotional events (bereavement, conflict, rejection episode.
– Inadequacy between the person’s current abilities and the demands of the environment
Episode Impact– Impact of the suicidal episode or MAAS on the person’s activities, cognitions, environment, loved ones and relationships
Information to be collected: assessing the level of danger
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