<keypoints>
- **Direct warning signs** (highest priority): threatening to hurt/kill oneself, seeking access to lethal means, talking/writing about death or suicide, making preparations
- **IS PATH WARM** mnemonic captures key indirect warning signs: Ideation, Substance abuse, Purposelessness, Anxiety, Trapped, Hopelessness, Withdrawal, Anger, Recklessness, Mood changes
- Use of multiple self-harm methods and early non-fatal repetition should be considered a **red-flag indicator** of suicidal risk
- Risk factor checklists alone should not determine treatment decisions; comprehensive psychosocial assessment with structured clinical judgement is recommended
</keypoints>
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:
| Letter | Sign | Description |
|---|---|---|
| I | Ideation | Suicidal thoughts |