Introduction
W ash hands
I ntroduce self
Ask P atientβs name, DOB and what they like to be called
E xplain and obtain consent
The event – Before
Events leading up to suicide attempt
Planning (e.g. βHow long was there between thinking of overdosing and doing it?β)
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 β 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?
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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. βIf you were to go home now, what would happen?β
If theyβve 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
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 legal powers are available for use if he tries to leave hospital?
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A patient presents to ED with chest pain and this trace. What would you do?
Interpretation management
Covered in OSCE Stations
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Attempted suicide
And there’s more here