NOTE: While this assessment is still very useful, I have changed my recommendation for a comprehensive suicide risk assessment to the DCIB Suicide Risk Assessment.
Suicide Risk Assessment with CPR Model
The CPR Model is a simple and effective model for suicide risk assessment. It is versatile enough to be used by crisis helplines and community service workers but simple enough to be used by teachers, physicians, and the general public.
Once you’ve asked the question about suicide, it’s time to conduct your actual suicide risk assessment. You can start by explaining that you’d like to perform a risk assessment, or that you’d like to ask them some questions that will help you make sure they’re safe.
C: I feel like falling asleep and never waking up.
W: Sometimes when people say they want to fall asleep and never wake up, they’re talking about suicide. Are you talking about suicide?
C: Yeah, actually I have been feeling suicidal for a while.
W: That must have been really hard to admit. I need to ask you a few questions about that, is that okay?
From here, you can begin asking the CPR questions as detailed below. The CPR model focuses on three elements of suicide risk, a Current Plan, Previous Exposure to Suicide and Resources (or Protective Factors.)
Current Plan describes the elements of a person’s plan for ending their life. This can be as vague as “Soon” or “I don’t have on yet” to as specific as “I’m going to jump in front of the Number 10 bus next Thursday at 6:45pm.”
When you ask about the plan, it’s important to realize that it may not just be one question you’re asking about. You may need to ask several in order to fully flesh out the depth of a person’s method. These questions can include:
“How would you kill yourself if you had to?” This one seems simple but your approach may differ if the person wants to shoot themselves than if they want to overdose on pills.
“Do you have access to <a gun/pills/a rope>?” Particularly if they don’t own a firearm but do have a stash of lethal medication this can be very helpful.
“What date/time” do you plan to kill yourself?” Knowing how far away their plan is can be extremely helpful. Someone who wants to kill themselves in 2 weeks has a higher chance of changing their mind than someone who plans to kill themselves tomorrow.
Essentially you want to know the what, when, and where of the person’s plan. The more concrete and detailed their plan to kill themselves, the greater risk they’re in. If a person has chosen a suicide method, this is one risk factor.
Someone with only one risk factor is LOW RISK.
Previous Exposure to Suicide
Previous exposure to suicide is the second risk factor. Often times people think about previous suicide attempts when they think about this item, but it’s more than. Previous exposure to suicide also covers being bereaved by suicide.
When someone you know dies by suicide, your suicide risk increases. So it’s important to know if the suicidal person you’re speaking to has experienced either:
- A suicide attempt
- Someone close to them has killed themselves
With regard to the first question, you need to ask some follow-up questions. How long ago was the suicide attempt? If within 90 days, their suicide risk is increased more-so than if it’s been longer than that. Next, you need to find out what care occurred after the last suicide attempt.
For instance, if someone went to the hospital and got counselling, that’s a different situation than if they overdosed on medication, woke up and didn’t seek any physical or mental health care.
Next, you need to find out whether they’ve lost anyone to suicide. As mentioned earlier, losing someone to suicide increases their suicide risk. This is because their death provides powerful modeling behaviour. People have no reason to lie about this, and if you’ve got a good rapport with them it will only help learn more about where they’re at with their suicidal pain.
An example question would be “Have you ever attempted suicide before?” and “Do you know anyone else who died by suicide before?”
If they’ve ever attempted suicide before, or if they’ve lost someone close to them to suicide, this is a risk factor. Someone with two risk factors is MEDIUM RISK.
Access to Resources
The final element in the CPR Model is a person’s access to resources. It’s important that you not confuse access to resources for help with access to resources that help them end their life. We are looking at positive, protective factors that help reduce a person’s suicide risk.
When a suicidal person is talking to you, you’ve become one of their resources in the moment of their pain. But you’re not available 24/7 and it’s important that the suicidal individual have access to other people who they know care about them.
Sometimes, we have people in our lives (like our family) who we consider a resource to us, but the suicidal person may not. If their family is abusive or the cause of their suicidal pain, they would not be considered a resource. So you should work on resources that they find helpful.
Resources are separated into three categories, Internal, External and Peripheral. The focus of the CPR Model’s Resources section only looks at the latter two, External and Peripheral. External resources are the people in our daily life who can provide emotional support. Examples include:
- Close friends
- Pets (people often underestimate the benefits that pets can have on our emotional and mental health)
- Significant other/partner
Often suicidal individuals experience a form of tunnel vision where they find themselves unable to notice the resources in their lives. Therefore it may take some questioning. Examples of questions to help flesh out a person’s resources include:
“Who in your life do you turn to when you need someone to talk to?”
“Who is going to miss you if you die?”
“If something really amazing or really terrible happened, who’s the first person you would call?”
The next part of the resources section is the Peripheral resources. These are individuals we may not see in our daily lives but who are there to provide us with additional support in times of need. Examples include:
- Helplines and crisis lines
- Therapists, counsellors, social workers
- Teachers (if a student)
- Clergy (if religious)
Sometimes people without any family, people who have been isolated or people who have experienced an addiction or other life situation that causes a personality change find themselves without any external resources, and in those situations the peripheral resources will become more important as a way of providing emotional support while a person works to build up their external resources.
If a person has few or no external or peripheral resources, that is one risk factor. A person with 3 risk factors (a current plan, a previous history of exposure to suicide and few or no resources) is HIGH RISK on the CPR Model.
Next Steps for Suicide Risk Assessment
Now that you know where someone is on the CPR Model, you can proceed to the ABC Model of Crisis Intervention to learn what your next steps should be.
In brief, someone who is low risk should be treated with empathy and respect, and empowered to make decisions for themselves.
A person who is medium risk should be engaged in a more collaborative approach, with the help providing access to information and resources but still ultimately leaving things up to the suicidal individual.
A person who is high risk should be handled directively, with the helper taking steps to ensure their immediate and long-term safety and connecting them to resources.