Table of Contents
- 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
- 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
- Current mood
- Any positive things or things they want to live for
- What might stop them committing suicide?
- 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?
- 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?)
- Living situation (living alone?)
Suicide risk factors
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?
What would you do next?
What legal powers are available for use if he tries to leave hospital?