Suicide risk, aggression and restraint

Suicide risk

The findings that raise concern most are a specific plan with available means, a recent giving away of possessions, and a sudden calm after a period of despair — that last one because a decision has been made.

1. Ask directly: are you thinking of killing yourself, do you have a plan, do you have the means.
2. Do not leave a client at acute risk alone. One-to-one observation within sight at all times.
3. Remove the means: belts, cords, sharps, medications, anything that can bear weight.
4. Notify the provider and document what was said and what was done.

De-escalation, in order

1. Notice early: pacing, raised voice, clenched fists, refusing to sit.
2. Give space. Stay an arm's length beyond reach, keep a clear exit behind you, and do not stand between the client and the door.
3. Speak quietly and briefly, one person talking, and offer real choices.
4. Offer medication, and time away from the stimulation.
5. Only then involve staff in numbers — and having them visible is often enough.

Restraint and seclusion

These are last resorts, applied only when less restrictive measures have failed and only to prevent harm — never for staff convenience and never as a punishment.

• A provider order is required, it is time-limited, and renewal follows an in-person assessment. An emergency application may precede the order but the order follows immediately.
• The least restrictive effective option is used.
• Continuous or very frequent monitoring, with circulation, skin, hydration, toileting and range of motion checked and recorded.
• The knot must release with one hand and the restraint is tied to the STATIONARY bed frame, never to a side rail or any part that moves.
• Discontinued as soon as the client meets the criteria for release.