Table 1 Examples of statements endorsed for inclusion in the guidelines

Section 1: Identification of suicide risk

 The first aider should not assume that the person will get better without help

1

 The first aider should be aware that if a person is suicidal, asking them about suicidal thoughts will not increase the risk that they will act on these

2

 The first aider should be aware that a person who self-harms may not be suicidal. If the first aider is unsure whether noticed injuries are from self-harm or from a suicidal attempt, the first aider should ask the person directly

2

Section 2: Assessing seriousness of the suicide risk

 The first aider should find out if the suicidal person has already taken steps to secure the means to end their life

1

 The first aider should ask the suicidal person if they have ever made a suicide attempt in the past

1

 The first aider should be aware that the method and specific modality (e.g. quantity of poison) the suicidal person plans to use indicate the seriousness of the suicidal intention

2

Section 3: Initial Assistance to suicidal people

 The first aider should remain calm and in control when communicating with a suicidal person

1

 The first aider should work collaboratively with the suicidal person to ensure their safety, rather than acting alone to prevent suicide

1

 The first aider should provide the suicidal person with information and resources about where they can seek help

1

Section 4: Talking to a suicidal person

 The first aider should ask open questions to find out more about the suicidal thoughts and feelings and the problems behind these

1

 The first aider needs to allow the suicidal person to talk about their reasons for wanting to die

1

 The first aider should reassure the suicidal person that it is not a crime, a sin or shame to feel suicidal

2

Section 5: Safety planning with suicidal people

 The first aider should engage the suicidal person to the fullest possible extent in decisions about a safety plan

1

 If the suicidal person agrees, the first aider should involve someone the person trusts in developing the safety plan such as a friend, family member, mental health professional or a religious or spiritual leader

2

Section 6: Ensuring safety for suicidal people

 The first aider should help the suicidal person decide who they can contact if they become suicidal again

1

 If the suicidal person agrees, the first aider should inform community mental health workers or psychosocial workers in the area about the situation

2

Section 7: Passing time during a crisis

 The first aider should develop a list with the suicidal person of other things they can do distract themselves

1

Section 8: What the first aider should know in providing suicide first aid

 The first aider should be aware that openly talking about suicidal thoughts and feelings can save a life

1

Section 9: Confidentiality

 The first aider should treat the suicidal person with respect and involve them in decisions about who else knows about the suicidal crisis

1

Section 10: Specific to adolescents

 If the suicidal person is a minor, the first aider must make their significant elders aware of the person’s intention to kill themselves

2

Section 11: Gender specific

 The first aider should be aware of different risk factors for a suicidal women such as domestic violence

2

 The first aider should be aware that some males may be less likely to express their emotions and open up about suicidal intentions

2

 The first aider must be aware that Sri Lankan men may not openly disclose previous suicide attempts and may instead state, for example, that they had an “accidental overdose of medication or poison”

3