Table of Contents
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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