Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Warning Signs
Practice Box – Warning Signs
The following information may be reported or observed by the client and/or their family, friends, community supports, medical records and mental health professionals (Holkup, Centre for Suicide Prevention, 2002; 2002a; NZGG, 2003):
  • Talking about suicide or death directly (e.g. “I wish I was dead.”)
  • Talking about suicide or death indirectly, including themes of hopelessness and worthlessness (e.g. “What’s the point of going on?”, “I’m tired”, “Everyone would be better off without me.”)
  • Threatening suicide, describing methods of suicide or researching methods of suicide on the Internet.
  • Formation of suicide plan.
  • Increased intensity of suicidal ideation.
  • Putting affairs in order (e.g. making or changing a will, giving money or possessions away, donating
  • one’s body to science, saying good bye, writing suicide notes).
  • Purchasing or stockpiling medications, firearms, razors.
  • Exploring balconies, bridges, rooftops.
  • Engaging in risky behaviour (e.g. increased use of alcohol or substances, reckless driving).
  • Self-neglect (e.g. change in appearance, including changes in weight and appetite).
  • Change in personality. 
  • Change in mood (e.g. depression, anxiety, agitation).
  • Social withdrawal and isolation, including a loss of enjoyment in activities.

Type IV Evidence