6 - Self Harm and Suicide Flashcards
How do you do a risk assessment for suicide?
- When did you first want to harm yourself?
- Any final acts?
- What were the circumstances?
- How do you feel about it now?
- Who called for help?
- Risk factors?
- Protective factors?
- Psychiatric history?
- Full history?
- Collateral history?
How do you do a risk assessment in a MSE?
- Risk to self
- Risk to others
- Risk to children (even adult saying they were abused as child)
- Drug use/Alcohol use
- Forensic History
- Driving
What is deliberate self-harm?
Does asking someone if they are suicidal increase the risk of them actually doing it?
No - if anything it decreases the risk
When is the risk of suicide highest?
As an inpatient or up to 14 days post-discharge
Should you start treatment after a suicide attempt in ED?
NO!
Start in GP or Crisis team as they can monitor
What is the definition of suicide and what is the epidemiology of this?
Intentional self-inflicted death
3rd biggest cause of death in UK
Hanging was main way followed by poisoning
What are some factors that increase a person’s risk of suicide?
(image is important)
- Male
- Age
- PMHx: Bipolar, Depression, BPD, Anorexia
- Substance abuse
- No job
- Occupation: Vets, doctors, nurses, farmers
What are some protective factors that lower the risk of suicide?
- Marriage
- Children
- Religious belief
- Responsibility for others
- Supportive community
How may someone who is suicidal present?
- Preoccupations with death
- Emotional distance from others
- Focus on the past and anticipate no future
- Withdrawal from society
- Feelings of hopelessness
How can you determine the risk of suicide following an attempt?
Note: Planned Attempt Are Very Frightening
- Note left behind
- Planned attempt
- Attempt to avoid discovery
- Afterwards help was not sought
- Violent method
- Final Acts e.g sorting finances and writing will
What are some questionnaires you can use for suicide risk?
- Tool for Assessment of Suicide Risk (TASR)
- Beck Suicide Intent Scale
How do you do a suicide risk assessment in an OSCE?
(important)
- Explore ideation
- Explore intent
- Explore risk factors
- Explore protective factors
- MSE
- Explore risk to others e.g children
After doing a suicide risk assessment who should you refer to secondary care?
SUSPicious
- Suicidal ideation
- Underlying severe psychiatric illness
- Social support lack of
- Presentation change for someone who has repeatedly self-harmed
How is suicide risk managed?
- Ensure safety e.g remove means
- Admit to hospital and consider using MHA
- Crisis and Home treatment team
- Treat any depression and psychosis