Self Harm/Suicid Attempt

Question 1

Opening

Answer 1

How are you? I heard something happened yesterday. Can you tell me a bit about it.

Question 2

Before

Answer 2

Prior events or mood- what happened that made you think you had to do this, have you been feeling like it for a while
Plan- did you plan to hurt yourself? What plans did you make. How long have you planned this for?
Precautions- did you try and make sure you wouldn’t be found eg. When family away or locking a door?
Preparation- did you write a note or make a will
Told anyone- did you tell anybody about what you were going to do or seek help afterwards

Question 3

During

Answer 3

Sequence of events- what exactly happened
Expectations- did you expect to die
Alcohol drugs- were you under the influence at the time

Question 4

After

Answer 4

How were you discovered- did you tell anybody/ phone for help
Anger/regrets- about what happened?
Lingering thoughts- do you have thoughts about doing this again?

Question 5

Patients perspective

Answer 5

Feeling
ICE
Insight

Question 6

PMH

Answer 6

Medical or psychiatric disorders
Have you tried to hurt yourself before commit suicide before

Question 7

DH

Answer 7

OTC regulars allergies
Any stores of medications at home?

Question 8

FH

Answer 8

Anyone in the family ever tried to harm themselves

Question 9

SH

Answer 9

PROTECTIVE FACTORS TO STOP YOU DOING IT AGAIN

Job- what does it involve. Impact on job
Home situation- occupants and difficulties
How is mood affecting home life
Support from family or friends
Smoke alcohol recreational drugs
Do you have dependents eg, consider safeguarding if children at home/vulnerable adults
Have you been looking after yourself and the home eg. showering and cleaning

Question 10

Follow up

Answer 10

See you again in a week

Question 11

Reasons for self harm

Answer 11

8 c’s

Coping
Control
Comfort
Cleansing (sexual abuse)
Confirmation of existence
Chastisement
Communication
Creating numbness

Question 12

Risk factors for self harm

Answer 12

16-24
Female
Recent stressful event
Personality disorder
Areas of high unemployment

NB- 10% lifetime suicide risk (highest risk in weeks following event)

NB- risk assessment should have likelihood, imminence, and severity headings. Also, are they at risk of someone else eg. Abuse

Question 13

Suicide risk factors

Answer 13

Increasing age
Male
Redundancy
Single (separated, divorced, widowed)
Depression or other mood disorder
Serious physical illness
Previous attempt- greatest RF

Question 14

Increased likelihood of future attempt

Answer 14

Sad about failing
No protective factors
Well planned ie. planned it for weeks
Violent method
Access to means

Question 15

Investigations

Answer 15

MSE physical exam
Collaborative history from family or friend

Question 16

Management

Answer 16

Identify coping mechanisms
Explore the effects the suicide would have on family and friends
Make plans for future eg, see you next week
Do they require sectioning and inpatient admission
Ensure adequate support at home and in the community eg. CMHT
Give telephone number for crisis line etc,
Remove access to means
Regular planned follow up

Question 17

When a suicidal person may need need sectioning

Answer 17

Unsure of specifics

Question 18

Psychiatric systems review (if time)

Answer 18

Psychosis- auditory hallucinations/ visual hallucinations/ altered sensations/ delusions of thought and control
Mania- energy levels/ have people said you are hyper/ spending habits/ libido
Depression- mood/anhedonia/ sleep/ future
Others- memory loss/ anxiety/ insight/ relationship with foo

NB- can focus on voices, commands, ideas of reference etc.