I've heard this before, too.
"Having a plan" isn't a magic charm. I'm pretty sure people who had no plan still managed to kill themselves, and I'm sure part of it was because no one would take them seriously and help them when they asked for help.
Yes anyone who asks for help should get it and people who know someone who is talking about suicide should always refer them to a professional. I did not mean to say that if they don’t have a plan then they are okay and can be ignored. I did not mean that and apologize.
Having a plan, is a critical factor in assessment.
Here we go:
Many people when interviewed will say certain very specific things and it is important to ask very specific questions, which is why professionals should intervene, especially in the case of manipulation, because it defuses the 'pay-off' for the manipulative individual.
In assessment you have to judge risk of actual harm and so it is crucial to find out what the person actually wants and is thinking about.
There is some risk but very low is what someone is actually saying, 'I don't like my life right now' , 'I just can't take it anymore' which is actually what a lot of people will say when you ask them. these people can safely be returned to the community with a safety plans and intervention.
There is very high risk when you ask someone "Are you planning on harming yorself?" and they say Yes. In that case a whole host of factors that you asses any way become much more important.
1. Current and past history of impulse control.
2. Level of ability to make reasoned judgments.
3. Level of insight into situation provoking crisis.
(These are the big three, that you have to establish, low impulse control, lack of judgment and lack of insight create very high risk.)
Then:
-past attempts
-current plans
-access to plans
-perceived level of lethality of plan
-guns
(all of those increase risk)
Mental status:
-current perceptions of hopelessness
-stated willingness vs, reluctance
-depression, psychosis or mania
followed by the standard demographics
-male
-older
-isolated
-chronic medical condition that is disabling or causes pain
-isolated
-persistent substance abuse or dependence
-lack of options and perceived control of life
You start with the first three after the judgment of
-are there actual thoughts of self harm
--is there a plan?
If they have just one of the first three, you might be able to set up a supportive plan to keep them safe in the community, but if they have two of three (low impulse control, lack of judgment, lack of insight) and the other factors that increase risk then you will almost always have to go for crisis respite or hospitalization.