What are the red flags for suicidal ideation?

Direct Warning Signs (Highest Priority)

These warrant immediate further assessment:

• Suicidal communication: threatening to hurt or kill oneself, talking about wanting to die, ominous statements such as "everyone would be better off without me"
• Seeking access to means: looking for pills, weapons, or other lethal methods
• Making preparations: writing about death/dying/suicide, putting affairs in order, giving away possessions, writing goodbye letters

Indirect Warning Signs

The IS PATH WARM mnemonic is a useful clinical aide-memoire:

Behavioural and Conversational Cues

• Unexplained crying, emotional outbursts
• Neglect of personal hygiene/appearance
• Changes in sleep and appetite
• Saying things like: "I can't take this anymore," "What's the point?," "I just want the pain to stop"

Key Risk Factors to Consider Alongside Warning Signs

• Prior suicide attempt (strongest predictor of future attempts)
• Mental health disorders, particularly mood disorders, psychosis, and substance use disorders
• Recent psychosocial stressors: relationship breakdown, job loss, financial strain, bereavement, legal issues
• Family history of suicide
• Chronic pain or terminal/chronic illness
• Social isolation and lack of support

Assessment Approach in General Practice

The RACGP recommends a case-finding approach rather than universal screening, with GPs remaining alert for patients with higher risk profiles. Assessment should include:

• Direct questioning about suicidal thoughts, plans, intent, and access to means
• Evaluation of both risk factors and protective factors (social connectedness, sense of purpose, children/dependents, problem-solving ability)
• Structured clinical judgement rather than reliance on checklists alone

Contact with primary care is common in the weeks before suicide, so GPs are well-positioned for early identification.

Australian crisis resources: Lifeline 13 11 14 | Suicide Call Back Service 1300 659 467 | Emergency 000