self_harm_suicide_management Flashcards
How should physical injuries be treated in self-harm cases?
Examine any physical injuries. For overdoses: use naloxone for opioid overdoses, activated charcoal within 1 hour of ingestion to decrease intestinal absorption of some substances (e.g., antidepressants), and specific antidotes like N-acetylcysteine for paracetamol overdose. For lacerations: use sutures or Steristrips for superficial cuts and consult plastic surgery for deep cuts. Ensure adequate analgesia is given.
What should be assessed in risk assessment for self-harm and suicide?
Thoughts about hurting themselves again, thoughts of hurting others, concerns about being hurt by others. Specific features of increased risk include: careful planning, final acts in anticipation of death (e.g., writing wills), isolation at the time of the act, precautions taken to prevent discovery (e.g., locking doors), writing a suicide note, definite intent to die, believing the method to be lethal (even if it wasn’t), violent methods (e.g., shooting, hanging, jumping in front of a train), and ongoing wish to die/regret that the attempt failed.
What should be done if a patient is insistent on leaving after self-harm?
You need to assess their capacity.
What are the immediate interventions for high-risk suicide patients?
If at high risk of suicide and lacking capacity, they need to be admitted to a psychiatric ward for their own safety. Patients at lower risk may be managed at home depending on home circumstances, such as having a supportive family. A crisis plan should be made to deal with future suicidal ideation or thoughts of self-harm, including who they will tell and how they will get help (e.g., coming straight to hospital).
What follow-up interventions are recommended for self-harm patients?
Follow-up within 1 week of the self-harm or discharge from the inpatient ward. This could be with the community mental health team, outpatient clinic, GP, or counsellor. Underlying disorders (e.g., depression) should be treated with safe medications like SSRIs, and prescriptions should be short and reviewed regularly to prevent stockpiling for overdose. Psychological therapies such as CBT-based therapies, mentalisation-based treatment, and transference-focused psychotherapy are recommended.
What is the significance of the 3-month period after discharge from psychiatric wards?
30% of suicides occur within 3 months of discharge from psychiatric wards.
What harm minimisation techniques can be used if stopping self-harm is unrealistic in the short-term?
Agreed with MDT, techniques include using ice cubes, rubber bands.
What coping strategies can be suggested to self-harm patients?
Distraction techniques, mood-raising activities (e.g., exercise, writing), and strategies to decrease or avoid self-harming, such as putting tablets and sharp objects away, avoiding triggers (e.g., photos online), staying in public places or with supportive people when tempted to self-harm, calling a friend or support line, avoiding drugs and alcohol, squeezing ice cubes, snapping a rubber band around their wrist, and biting into something strongly flavoured (e.g., lemon).
What support should be offered to relatives/carers of self-harm patients?
Offer emotional support if possible.
