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The evaluation of suicidal potential can be very difficult. Not everyone who expresses a wish to end life really intends to do so. It is valuable to learn to differentiate between the person who is likely to do so and the person who makes suicidal gestures by performing self-destructive acts (such as wrist or forearm slashing or taking nonlethal overdosage of prescribed medication or toxic substances). Sometimes suicide or suicidal behaviour is an unpredictable impulsive act (for instance, in a schizophrenic person who hears voices compelling him or her to behave in a self-destructive way, or in disinhibited alcoholics and drug abusers), but it may occur in a healthy person who is under extreme stress.
If self-harm occurs, and is concealed or involves significant planning, or if immediate help is not sought, it is more likely to be intended suicide than an impulsive cry for help. Any client who expresses suicidal ideas or a threat to end their life should be promptly referred to a doctor or psychiatric service (see the directory section).
Following an interview with a potentially suicidal person, medical authorities will decide whether this person can be managed safely outside a hospital or institutional setting. If the client is able to rationally commit themselves to a contractual program of therapy as an alternative to performing self-destructive acts, management in the community may be best.