Suicide: A patient safety issue requiring a standardized approach

Globally, the rate of suicide is increasing at a dramatic rate impacting all age groups, socio-economic levels, cultures and religions. Suicide is now an internationally recognized patient safety issue in health care. In Canada, more attention is gradually being focused on gaining a better understanding of the factors that put people at risk of suicide and on developing a systems strategy for addressing them.

One important first step to improving suicide prevention is the development of accessible and effective suicide risk assessment resources. A 2009 report by the Canadian Patient Safety Institute [CPSI] and the Ontario Hospital Association [OHA] identified suicide risk as a key issue in patient safety requiring a standardized approach to risk assessment and the identification of assessment tools. In an effort to address this identified need in 2011, the CPSI and OHA jointly developed the Suicide Risk Assessment Guide: A Resource for Health Care Organizations (guide), which was published last fall.

One of the key lessons highlighted in the guide is that no single tool can, or should, be used to assess risk of suicide. Although risk assessment tools are useful for providing additional information and corroboration to inform clinical decision-making about risk, a high-quality suicide risk assessment needs to incorporate multiple approaches to determine a person’s level of distress and risk of suicide. This includes using a person-centered approach, coupled with clinical judgment and collaboration, and in conjunction with the risk assessment tools.

The guide further summarizes the key principles for carrying out a high-quality risk assessment, which includes the principles of suicide risk assessment and special considerations for certain populations and care settings.
The guide is divided into four main sections.

•    The first section presents an overview of suicide risk assessment principles, processes, and considerations to help guide risk assessment in a variety of health settings.

•    The second section consists of an inventory of suicide risk assessment tools that includes information on their psychometric properties and recommendations for their use.

•    The third section provides a framework for suicide risk assessment, including application of risk assessment tools and recommendations for monitoring the quality of the risk assessment process.

•    The fourth section provides resources for hospitals including key concepts, tips and diagrams which may be reproduced and posted in the organization. Additionally, it contains more detail on the project methodology as well as references to cited works.

Although the guide was primarily designed with health care organizations in mind, it may also be useful within other settings (e.g., school, workplace) and for a variety of individuals (e.g., individuals at risk, family members, friends, employers, and teachers).

“It’s the first resource of its kind in Canada,” says Dr. Chris Perlman, Research Project Lead, and Associate Director with the Homewood Research Institute. “It was exciting for the research team to work with such a knowledgeable, multidisciplinary advisory panel from across Canada. This led to the creation of a resource that covers diverse approaches to understanding suicide risk while maintaining a unique focus on the person’s lived experience.”

Health care organizations will also be pleased to know that the guide aligns with Accreditation Canada’s “Required Organization Practice” (ROP) on suicide prevention which requires a regular assessment of suicide risk for all persons in mental health service settings. It can assist organizations as they work to meet Accreditation Canada’s ROP around suicide risk assessment.

“It’s absolutely crucial for diverse health care professionals to have a similar lens with which to view suicide risk assessment,” says Denice Klavano, patient safety champion with Patients for Patient Safety Canada, and a member of the advisory panel that helped with the development of the resource guide. “I almost lost my son to suicide four years ago, and at the time, I felt that we hadn’t been listened to by those very people we sought help from.”

Download the guide for free at, or at For more information about the guide, email Cyrelle Muskat;