# Suicide: assessment & response

The skill that outweighs every other in this course. The curriculum makes suicidal-thought assessment a task for *every* client (process task 13), because the question, asked calmly and directly, saves lives and never plants the idea.

**If you or someone near you is at risk right now:** Nepal's National Suicide Prevention Helpline **[1166](tel:1166)** · TUTH mental-health hotline **[1660 012 1600](tel:16600121600)** · emergency **[112](tel:112) / [100](tel:100)**. Do not leave the person alone.

## Myths, signs, and the ladder of risk

| Myth | Fact |
| --- | --- |
| Asking about suicide plants the idea | Asking brings relief and opens help; it never causes suicide |
| People who talk about it don't do it | Many who die gave some warning beforehand; talking about it is often a reach for help |
| It happens without warning | Warning signs usually exist: withdrawal, giving things away, farewell talk, sudden calm after despair |
| Once suicidal, always suicidal | Acute risk is usually time-limited; getting through the crisis matters enormously |
| Only "mental patients" die by suicide | Many deaths follow acute life crises, debt, shame, exam failure, violence, without any prior diagnosis |

**Assess in steps, each question earning the next:** ideation ("Sometimes when people suffer this much, thoughts of death come. Has that happened to you?") → plan ("Have you thought how?") → means ("Do you have access to that?") → timeline and intent → past attempts (the strongest single predictor) → protective factors (children, faith, who they'd miss). Risk rises sharply with a specific plan + available means + previous attempt + intoxication + recent loss or shame.

**Respond by level.** Levels guide urgency; they do not predict, and every plan is individual.

- **Low** (ideation, no plan): safety plan, strengthen supports, follow up soon.
- **Medium** (plan, no immediate intent): safety plan + remove means + involve a trusted person + close follow-up + supervisor.
- **High** (intent, means, or recent attempt): do not leave alone, involve a safe trusted person now (family, when family is safe), **refer/accompany to psychiatric care the same day**.
A *safety plan* (warning signs → my coping steps → people to call → professionals → making my home safer) is written WITH the client. Removing means, pesticides locked away, medicines held by family, is one of the most evidence-backed interventions on earth, and in Nepal pesticide storage is the single conversation that saves most lives. Confidentiality yields to life: this is the ethical exception you must explain in session one.

Nepal

Suicide has repeatedly been flagged as a leading cause of death among Nepali women of reproductive age (2008/09 maternal mortality study); pesticide ingestion and hanging are the most common means; police data undercounts because of stigma and a widespread but mistaken belief that attempting suicide is a crime. Attempting suicide has never been a crime in Nepal. Risk clusters: young women in early marriage, GBV survivors, indebted migrant families, and the post-monsoon exam season. After any death, ask about the client's exposure: suicide risk travels through families and schools.

The ladder of risk. Assessment climbs one rung at a time: ideation, plan, means, intent, attempt. The response tier sits under each rung. Nobody at the red end is left alone, and referral happens the same day.

Key points

1. Ask every client directly about suicidal thoughts; asking brings relief and never plants the idea.
2. Assess in steps (ideation, plan, means, intent, past attempts) and respond by level; high risk means same-day psychiatric care and never alone.
3. Removing means, especially locking away pesticides, saves the most lives in Nepal; confidentiality yields to life.
Learn more

Pick one, not all. This is a heavy topic: take it in small doses, with support.

Article[Utyasheva, Robertson and Sharma (2022): Perception of the criminality of attempted suicide in Nepal](https://doi.org/10.1016/j.ijlp.2022.101796); attempting suicide was never a crime here. The belief that it is drives underreporting.

Article[WHO fact sheet: Suicide](https://www.who.int/news-room/fact-sheets/detail/suicide); global numbers, means restriction, LIVE LIFE strategy.

Article[OnlineKhabar: Suicide prevention helplines in Nepal](https://english.onlinekhabar.com/suicide-prevention-helplines-in-nepal.html); the state of Nepal's helpline system.

Book**Kay Redfield Jamison, Night Falls Fast**: understanding suicide from inside and outside; read slowly.


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*Source: https://manoatlas.com/suicide · Licence: CC BY-NC-SA 4.0. Mano Atlas is an educational resource, not a diagnostic tool.*