National Institute of Mental Health (USA)
The Ask Suicide-Screening Questions (ASQ) Toolkit is a free resource for medical settings (emergency department, inpatient medical/surgical units, outpatient clinics/primary care) that can help nurses or physicians successfully identify youth at risk for suicide.
The ASQ is a set of four screening questions that takes 20 seconds to administer. In an NIMH study, a “yes” response to one or more of the four questions identified 97% of youth (aged 10 to 21 years) at risk for suicide. By enabling early identification and assessment of young patients at high risk for suicide, the ASQ toolkit can play a key role in suicide prevention.
Suicide is a global public health problem and the second leading cause of death for young people ages 10-24 worldwide. Suicide is also a major public health concern in the United States. According to the Centers for Disease Control and Prevention (CDC), more than 5,900 youths killed themselves in 2015. Even more common than death by suicide are suicide attempts and suicidal thoughts.
Screening for Suicide Risk
Early detection is a critical prevention strategy. The majority of people who die by suicide visit a healthcare provider within months before their death. This represents a tremendous opportunity to identify those at risk and connect them with mental health resources. Yet, most healthcare settings do not screen for suicide risk. In February 2016, the Joint Commission, the accrediting organization for health care programs in hospitals throughout the United States, issued a Sentinel Event Alert recommending that all medical patients in all medical settings (inpatient hospital units, outpatient practices, emergency departments) be screened for suicide risk. Using valid suicide risk screening tools that have been tested in the medical setting and with youth, will help clinicians accurately detect who is at risk and who needs further intervention.
About the Tool
Beginning in 2008, NIMH led a multi-site study to develop and validate a suicide risk screening tool for youth in the medical setting called the Ask Suicide-Screening Questions (ASQ). The ASQ consists of four yes/no questions and takes only 20 seconds to administer. Screening identifies individuals that require further mental health/suicide safety assessment.
For medical settings, one of the biggest barriers to screening is how to effectively and efficiently manage the patients that screen positive. Prior to screening for suicide risk, each setting will need to have a plan in place to manage patients that screen positive. The ASQ Toolkit was developed to assist with this management plan and to aid implementation of suicide risk screening and provide tools for the management of patients who are found to be at risk.
Using the Toolkit
The Ask Suicide-Screening Questions (ASQ) toolkit is designed for screening youth ages 10-24 (for patients with mental health chief complaints, consider screening below age 10). The ASQ is free of charge and available in multiple languages, including Spanish, Portuguese, French, Arabic, Dutch, Hebrew, Mandarin, and Korean.
It is recommended that screening be conducted without the parent/guardian present. Refer to the nursing script for guidance on requesting that the parent/guardian leave the room during screening. If the parent/guardian refuses to leave or the child insists that they stay, conduct the screening with the parent/guardian present.
What happens if patients screen positive?
Patients who screen positive for suicide risk on the ASQ should receive a brief suicide safety assessment (BSSA) conducted by a trained clinician (e.g., social worker, nurse practitioner, physician assistant, physician, or other mental health clinicians) to determine if a more comprehensive mental health evaluation is needed. The BSSA should be brief and guides what happens next in each setting. Any patient that screens positive, regardless of disposition, should be given the Patient Resource List.
The ASQ toolkit is organized by the medical setting in which it will be used: emergency department, inpatient medical/surgical unit, and outpatient primary care and specialty clinics. For questions regarding toolkit materials or implementing suicide risk screening, please contact: Lisa Horowitz, PhD, MPH at firstname.lastname@example.org or Debbie Snyder, MSW at DeborahSnyder@mail.nih.gov.
Emergency Department (ED/ER):
- ASQ Information Sheet (HTML)*
- ASQ Tool (HTML)*
- Brief Suicide Safety Assessment Guide (HTML)
- Nursing Script (HTML)
- Parent/Guardian Flyer (HTML)
- Patient Resource List (HTML)*
- Educational Videos*
For help in Australia
CAPS – Talk Suicide Support Service – Free telephone and face to face support 1800 008 255
Salvation Army Care Line 1300 36 36 22
Reach Out http://au.reachout.com/tough-times
Headspace Register and chat now at eheadspace, or call 1800 650 890 Headspace
Lifeline 13 11 14
Mensline Australia 1300 78 99 78 (24 hour phone counselling and referral)
Beyond Blue 1300 22 4636
Mates in Construction: 1300 642 111
QLife 1800 184 527 Phone & Chat 3.00 – 12.00 pm everyday
SANE Australia Helpline – Talk to a mental health professional (weekdays, 10am-10pm AEST) 1800 18 72 63
Helpline chat – Chat online with a mental health professional (weekdays 10am-10pm AEST)
Kids Help Line 1800 55 1800 (24 hour phone counselling)
Suicide Call Back Service 1300 659 467 (Professional call back service referral line operates seven days a week)
Veterans Line 1800 011 046 (after hours professional telephone crisis counselling for veterans and their families
MensLine Australia 1300 78 99 78