{
  "name": "Suicidal Ideation & Self-Harm",
  "slug": "suicidal-ideation",
  "url": "https://nursingplex.com/care-plans/suicidal-ideation",
  "category": "Mental Health & Psychiatric",
  "summary": "Risk assessment, one-to-one observation, environmental safety and safety planning.",
  "nursing_diagnoses": [
    "Risk for suicide",
    "Hopelessness",
    "Ineffective coping"
  ],
  "overview": [
    "Suicidal ideation ranges from passive thoughts that life is not worth living to an active plan with means and intent. Nursing assessment is direct: asking about suicide does not plant the idea, and vague questioning is the most common reason risk is missed.",
    "Risk rises with a specific plan, available means, prior attempts, recent loss, substance use, hopelessness, psychosis with command hallucinations and social isolation. A sudden calm after severe depression can indicate a decision has been made and is not reassuring.",
    "Immediate care is about safety: level of observation, environmental control and removal of means. Longer-term care builds coping skills, treats the underlying disorder, involves the family and constructs a written safety plan with concrete steps and phone numbers."
  ],
  "key_facts": [
    {
      "label": "Ask directly",
      "text": "Ask about thoughts, plan, means, intent and timing in plain words — do not soften into unanswerable questions."
    },
    {
      "label": "Highest risk",
      "text": "A specific plan with available lethal means, prior attempt, and hopelessness."
    },
    {
      "label": "Sudden improvement",
      "text": "An abrupt lift in mood in a severely depressed patient may mean the plan is settled — increase, do not relax, observation."
    },
    {
      "label": "Antidepressant window",
      "text": "Energy returns before mood lifts in the first weeks, raising the ability to act on suicidal thoughts."
    },
    {
      "label": "No-suicide contracts",
      "text": "Contracts are not evidence-based; use a collaborative safety plan instead."
    },
    {
      "label": "Means restriction",
      "text": "Removing firearms and stockpiled medication is one of the strongest prevention measures."
    }
  ],
  "nursing_priorities": [
    "Establish and maintain physical safety.",
    "Assess risk accurately and repeatedly.",
    "Treat the underlying psychiatric illness.",
    "Build hope, coping skills and reasons for living.",
    "Involve support systems and create a discharge safety plan."
  ],
  "assessment": {
    "subjective": [
      "Presence, frequency and intensity of suicidal thoughts",
      "Specific plan, method, access to means and timing",
      "Hopelessness, worthlessness, guilt and perceived burden",
      "Prior attempts, family history and recent losses",
      "Reasons for living, supports and what has helped previously"
    ],
    "objective": [
      "Standardized risk score such as Columbia-Suicide Severity Rating Scale",
      "Affect, psychomotor activity, speech and sudden mood shifts",
      "Evidence of self-harm: cuts, ligature marks, burns, healing scars",
      "Sleep, appetite, weight change and self-care neglect",
      "Giving away possessions, writing letters, finalizing affairs",
      "Substance use and toxicology results"
    ],
    "related_factors": [
      "Major depression, bipolar disorder, schizophrenia or PTSD",
      "Substance intoxication or withdrawal reducing impulse control",
      "Recent loss, humiliation, chronic pain or terminal illness",
      "Social isolation and lack of support",
      "Access to firearms or lethal medication quantities"
    ]
  },
  "goals": [
    "The client will remain free from self-harm throughout hospitalization.",
    "The client will verbally contract to seek staff when suicidal urges rise.",
    "The client will identify at least three reasons for living and two coping strategies.",
    "The client will demonstrate improved mood and reduced hopelessness on serial assessment.",
    "The client and family will leave with a written safety plan and crisis numbers."
  ],
  "interventions": [
    {
      "title": "Immediate safety",
      "points": [
        "Assign the level of observation matched to risk — one-to-one continuous observation for high risk, including in the bathroom.",
        "Search belongings and remove sharps, cords, belts, shoelaces, glass, plastic bags and hoarded medication.",
        "Use a ligature-resistant environment and account for the patient during shift changes and transports.",
        "Reassess risk at every shift, after visits, after bad news and before any privilege change."
      ]
    },
    {
      "title": "Therapeutic engagement",
      "points": [
        "Spend unhurried, planned time with the patient rather than only checking on them.",
        "Ask directly about suicidal thoughts using the patient's own words and listen without alarm or reassurance clichés.",
        "Validate distress and avoid statements like 'you have so much to live for' that shut down disclosure.",
        "Help the patient articulate ambivalence and identify reasons for living."
      ]
    },
    {
      "title": "Treatment and skills",
      "points": [
        "Administer prescribed antidepressants, mood stabilizers or antipsychotics and observe swallowing to prevent hoarding.",
        "Teach and rehearse coping skills: distress tolerance, grounding, distraction, seeking contact.",
        "Structure the day with activities, group therapy and graded responsibility.",
        "Treat co-occurring substance use, insomnia and pain, all of which raise risk."
      ]
    },
    {
      "title": "Family and discharge planning",
      "points": [
        "With consent, involve family in means restriction: firearms out of the home, medications locked and limited quantities.",
        "Build a written safety plan listing warning signs, coping steps, supportive people and crisis contacts including 988.",
        "Arrange follow-up within a week of discharge — the first days after discharge are the highest-risk period.",
        "Document risk assessments, interventions and the patient's response precisely."
      ]
    }
  ],
  "patient_teaching": [
    "Tell someone immediately when suicidal thoughts intensify; the plan is to reach out, not to wait it out alone.",
    "Keep firearms out of the home and store medications locked and in small quantities.",
    "Take medication consistently and expect several weeks before full benefit; report worsening thoughts.",
    "Avoid alcohol and drugs, which lower impulse control.",
    "Use the safety plan steps in order and keep crisis numbers saved in the phone.",
    "Attend the first follow-up appointment even if feeling better."
  ]
}