SayPro Suicide Screening, Assessment, and Monitoring Reports

Suicide screening, assessment, and monitoring are discussed separately because they have crucial and unique components. Although the same rules apply to suicide prevention documentation as to incident report writing, those rules become even more critical when dealing with situations that are literally matters of life or death.

Suicide assessment is not seen as a single event but, rather, an ongoing process. According to the definitive National Center on Institutions and Alternatives research study by Lindsay M. Hayes, youth can become suicidal at any time, including at initial admission, after adjudication when returned from court, after receipt of bad news, after suffering some kind of humiliation or rejection, during confinement in isolation, segregation or time-out, or following prolonged periods of detention. Suicide screening may be part of the medical intake screening or may use a separate form or process. That screening should, at a minimum, include questions such as the following:

• Was the youth a medical, mental health, or suicide risk during any prior contact and/or confinement within the facility?
• Does the arresting and/or transporting officer have any information (from observed behavior, documentation from the sending agency or facility, conversations with family members) that indicates the youth is a medical, mental health, or suicide risk now?
• Has the youth ever attempted suicide?
• Has the youth ever considered suicide?
• Is the youth currently or has the youth ever been treated for mental health or emotional problems?
• Has the youth recently experienced a significant loss (relationship, death of family member, close friend, job, pet)?
• Has a family member or close friend ever attempted or committed suicide?
• Does the youth feel there is nothing to look forward to in the immediate future (expressing helplessness and/or hopelessness?)
• Is the youth thinking of hurting and/or killing yourself?”[6]

Several Intake Screening and Assessment forms are available for the identification of suicide risk, including “The Intake Screening form/Suicide Risk Assessment,” the “Juvenile Risk Assessment,” and the “Massachusetts Youth Screening Instrument—MAYSI-2.” Confinement, whether in a juvenile detention center, a youth correctional facility, or an adult facility that houses youth, is in itself considered a risk factor for suicide. Therefore, all confined youth should be viewed as at risk. It is important to observe confined youth for suicide potential throughout their stay in a facility and to document all observations. “Other supervision aides (e.g., closed circuit television, companions/watchers, etc.) can be utilized as a supplement to, but never as a substitute for, these observation levels.”

Communication between direct care personnel and other professionals in the facility regarding observation for suicide potential is critical. Communication should occur between each shift, during shifts, and between line staff and administrative and/or clinical staff. To ensure that communication occurs, observations must be recorded on designated forms and distributed to all appropriate staff.

In addition, staff members in juvenile detention centers, juvenile correctional facilities, and adult confinement facilities that serve youth must document regular, visual checks of youth, their status, behavior or affect, and other observations at required intervals. Those checks should be random, and their frequency should be based on the youth’s assessed potential for suicide and on the requirements of the facility’s suicide prevention policy. When it is determined that a youth is at imminent risk and is placed on constant suicide watch, that youth must receive one-on-one monitoring on a continuous, uninterrupted basis.

Completing suicide screening, assessment, and monitoring documentation is literally a life or death mandate. Failure to record accurately may not just result in employee discipline or a lawsuit; it could mean a child’s death.