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

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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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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1. Attempted suicide
2. And there’s more here