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Attempted suicide history

Introduction

  • Wash hands
  • Introduce self
  • Ask Patient’s name, DOB and what they like to be called
  • Explain and obtain consent

The event – Before

  • Events leading up to suicide attempt
    • Life events
    • Depression
  • Planning (e.g. ‘How long was there between thinking of overdosing and doing it?’)
  • Suicide note/did they tell anybody?
  • Precautions taken to avoid being detected (e.g. locking doors, ensuring nobody would be around)

The event – During

  • Their intention – did they intend to commit suicide or was it a cry for help?
  • When and where
  • Alcohol/drug intoxication
  • Exactly how they did it
    • If overdose: what, how many, where they got them, what they thought would happen
    • If self-harm lacerations: where, quantity, depth, how they felt while doing it, what they thought would happen
  • How were they discovered and how did they get here? Who called for help?

The event – After

  • Feelings now
  • Angry/regretful?
  • Current mood

The Future

Protective factors

  • Any positive things or things they want to live for
  • What might stop them committing suicide?

Future feelings

  • How they feel about the future
  • e.g. ‘If you were to go home now, what would happen?’
  • If they’ve changed their mind, what changed?
  • Are they going back to the same situation?

Future plans

  • Any future suicidal plans
  • Any positive plans, e.g. find job, get married, holidays

Further Questions to Help Assess risk

  • Depression symptoms screen: core symptoms (low mood, anhedonia), biological (sleep, energy), future (hopelessness, suicidal thoughts)
  • Psychosis symptoms screen: auditory hallucinations, running commentary, delusions of thought/control/perception
  • Past medical history
    • Past medical history (including any psychiatric diagnoses)
    • Past suicide attempts/self harm (find out about the methods used and help sought)
  • Drug history
  • Family history of self-harm/suicide and psychiatric conditions
  • Social history
    • Drug/alcohol use
    • Social stresses (including financial)
    • Relationships and support network (family nearby?)
    • Jobs
    • Living situation (living alone?)
    • Hobbies

Suicide risk factors

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Why don’t you test your knowledge?

You are in the emergency department and take a history from a 18 year old male in foster care. He attempted to hang himself. He has been feeling low for months after the death of a close friend. He planned the suicide attempt over 1 week. He locked the door of his room to try to make sure nobody could find him. He left a note for his foster mother. How would you assess his risk, and why?

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What would you do next?

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What legal powers are available for use if he tries to leave hospital?

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  1. Attempted suicide
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