1 (E): Self-harm and suicide Flashcards
Define self-harm
intentional self-injury or self-poisoning irrespective of the purpose of the act
What gender is self-harm more common in
Female
What age do women tend to self-harm
15-25
What age do men tend to self-harm
25-35
Why may people self-harm
- Emotional dysregulation - maladaptive coping mechanism, addictive
- Communicate feelings
- Produce reaction
What is the single biggest risk factor for self-harm
Previous self-harm (50-100)
What are 6 other risk factors for self-harm
- FH - observed self-harm
- Other psychiatric illness
- Gay or bisexual
- Social deprivation
- Single, divorced or widowed
- Childhood adversity
What is the most common type of self-harm
Cutting (65%)
What are 3 other types of self-harm
- Burning
- Poisoning
- Head-banging
What needs to be cleared before psychiatric assessment is made in self-harm
Medical assessment
What are the components of psychiatric assessment
Psychiatric assessment
Risk assessment
Mental state exam
What are the 4P’s important for formulating factors contributing to self-harm
Predisposing
Precipitating
Perpetuating
Protective
How should the 4P’s be looked at in self-harm
Bio-Psycho-Social model
What other assessments should be taken for self-harm
Mental Capacity Assessment
Collateral History
What are the 3-steps to the ‘general’ management plan for self-harm
- Immediate management
- Secondary problems
- Prevention
What is part of the immediate risk management
Medical Management
Explain how self-poisoning is managed
- Take samples: urine, blood and vomit to determine sample ingested
- Gut decontamination if soon after
- Activated charcoal if in 1h and maintaining airway
Explain how cutting is managed if <5cm and superficial
Tissue adhesive or skin closure strips
Explain how cutting is managed if >5cm or deep
Exploration and surgical management
As part of immediate management, what is performed following medical assessment
Psychological assessment
What is recommended to assess emotional state in A+E following self-harm
Australian mental health triage score
How is a patient psychologically assessed following self-harm in the immediate management
- Psychiatric assessment
- Risk assessment
- Mental Status Exam
Performed by liaison psychiatrist
If severe self-harm how is patient managed
Consider detaining under mental health act (1989)
When may a patient be detained under mental health act (1989)
- feel they will be unsafe at home
- unable to assess them immediately (eg. intoxicated)
- abusive partner or unsafe home situation
How is moderate self-harm managed
Refer to crisis and resolution home treatment team (CRHT)
How is mild self-harm managed
Refer to community mental health team (CMHT)
How soon should a patient be followed up in outpatients, by community mental health or GP following the episode
1W
How are children who have self-harmed managed
Refer to CAMHS (child adolescent mental health service) and safeguarding assessment
How are individuals who have self-harmed managed in long term
- Provide information
- Involve families - if patient wants
- Assessment of needs
- Planning - escalation/crisis plan
- Implement prevention strategies
- CBT or psychodynamic therapy
7,. Manage mental health
What % of people who self-harm will go on to commit suicide in one-year
1%
What % of people who self-harm will commit suicide in 10-years
5%
Define suicide
Intentional Self-Inflicted Death
In which population is suicide the leading cause of death
Men under 35-years
What is a mnemonic to remember risk factors for suicide
SADPERSONS
What are the risk factors for suicide
Sex: Male
A: <15 or >45
Depression, other mental health conditions
Previous attempts
Ethanol
Rational thinking
Seperation/Divorce
Organised plan
No social support
State future attempts
What 5 mental health conditions have an increased risk of suicide
- Schizophrenia
- Depression
- Substance mis-use
- Bipolar
- Personality Disorder
What mental health condition is most associated with suicide
Schizophrenia
What are 4 protective factors for suicide
- Men - married
- Social support
- Religious belief
- Meaningful employment
What is one method to assess individuals following suicide attempt
‘Target ring method’
- Bullseye = feelings towards act
- Inner ring = Precipitating factors - what happened that day
- Middle ring = Background - how had the past few months been
- Outer ring = Personal + Family History
What are the 4-stages of managing a failed suicide attempt
- Agree contract - negotiating, may involve family.
- Treat co-morbid conditions (depression, anxiety)
- Problem-solving therapy
- Preventative strategies
- Samaritans
- Shift to stability
- Limit access to lethal means
How should suicide be managed
- Ensure gathered information before approaching family
- Discuss organ donation
- Bereavement counselling
What are 3 legislative factors to try and prevent suicide
- barriers on bridges
- catalytic converter (prevent inhalation)
- restriction to 2 packs paracetamol
What are 5 factors that increase chance someone will commit suicide again
- Writing a note
- Planning
- Efforts to avoid discovery
- Final acts (sort bills)
- Violent method
