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When taking the history of a suicidal patient it is very important to thoroughly assess the first parasuicidal and suicidal episode, the most recent, and the most severe. Questions to ask when taking a history include:
· When did the behavior begin?
· What methods has the person tried?
· How medically severe was the attempt(s)?
· What happened following the attempt (e.g., was the person hospitalized, what type of medical intervention, response from family/friends)?
· What are the controlling variables for suicide attempts (e.g., what events led up to the attempt, what other factors leave the person vulnerable to a particular prompting event in the environment)?
· Does the person currently have access to lethal means?
Once you know how specifically a person has tried to kill themselves in the past and how serious an attempt it was, you need to identify whether they currently have the means to carry it out or have access to the means (e.g., a person may not have lethal means in the home, but may have a prescription for three refills of highly lethal medications that can be easily obtained). If they do, it is imperative to work with the person to remove the access to the lethal means before they become suicidal.
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