Suicide risk assessment and safety planning — KFP-style written assessment

KFP 1 (10 marks)

A 52-year-old farmer presents at your rural practice after his wife insisted. He has been drinking more since drought destroyed his crops, and last week he tells you quietly he "wouldn't mind not waking up". He owns rifles for fox control. His father died by suicide twenty years ago. You have twenty minutes. ^[5]

1. How will you open the conversation about suicide, and what does evidence say about the safety of asking? (3) ^[5]
2. Map his presentation onto chronic factors, dynamic states and acute warning signs — what must you actively probe next? (4) ^[6]
3. His passive ideation has no active plan today. Outline the safety plan you will build before he leaves. (3) ^[8]

Model answers

1. Ask plainly and directly: "Sometimes when people carry this much weight, they think about ending their life — are you having thoughts like that?" Systematic review found no study showing induced ideation among people asked; acknowledging suicide may reduce rather than increase it. Direct asking is safe and improves honesty. ^[5]
2. Chronic/static: prior family suicide (father), male sex, middle age, firearm ownership, occupational loss and financial ruin. Dynamic: depression, increased alcohol, hopelessness, drought stressor. Acute warning signs to probe NOW: active ideation, any plan, preparatory acts (putting affairs in order, giving things away), timeframe, and specifically access to loaded/stored firearms. Preparatory behaviour or stated intent converts today into same-day referral regardless of scores. ^[6]
3. Build a Stanley-Brown six-step plan in his words: (1) his warning signs (drinking alone after market reports); (2) internal coping (walking the boundary, workshop time); (3) distraction people/places (neighbour's shed, footy club); (4) people he can tell (wife, brother); (5) professionals and crisis line numbers; (6) means restriction — wife or licensed dealer holds the rifles' ammunition and bolt during this period, medications locked. Book review within days; give crisis numbers in writing. ^[8]