Suicide Attempt - Risk Assessment Flashcards
Introduction
Wash hands, PPE
Introduction - Hello, I’m An Nakamura, a 3rd year medical student
Patient ID - Can I confirm your name and DOB
Explanation - I’ve been asked to talk to you about the events that have led you to be admitted to hospital. Anything that is said here will be kept confidential between you, me and the medical team involved in your care. If I feel another person is potentially at risk, I will need to share the information with others outside your care but I will inform you of my intention to do so beforehand. I appreciate that some questions may be difficult to answer. If there is anything you don’t want to answer right now, we can come back to it. Will that be ok?
Before
-key questions
Precipitants - were there any triggers?
Planned or impulsive?
Final acts
- suicide note
- wills
- terminating contracts
Precautions against discovery
- closing curtains, locking doors
- waiting until they knew they would be alone in the house
- going somewhere remote
Alcohol use
- amount, type
- is this pattern typical
During
-key questions
Method Where they alone? Where did they self harm What was going through your mind at the time What was the intent? What was their plan after self harming
After
-key questions
How did you get to hospital? -did patient attend themselves -were they found by others How did you feel when help arrived How do you feel now? -remorse? -still suicidal What would you do if you went home
If you feel like this again, what would you do
What would stop you from self harming again?
-how do you feel about the future?
If help was available, would you take it?
Specific questions to ask about overdose
What was the medication/s? Where did you get it from? How much? Taken with anything else What did you hope that the medication would do What made you want to take the medication Was this planned What did you do afterwards How did you get to hospital?
Specific questions about cutting
Where are the cuts Number of cuts Depth of cuts How did you feel whilst cutting How did you feel when you saw blood What did you hope cutting would do
Mental health disorders that increased suicide risk
Depression core features
- anhedonia - do you find that you no longer enjoy activities that you used to?
- low mood - how has your mood been?
- low energy - what have your energy levels been like?
Psychosis core features
- thought insertion - are the thoughts to harm yourself ever not your own?
- auditory hallucination - do you ever hear voices that others can’t seem to hear? Do they tell you to harm yourself? How can you tell that these are other people’s voices and not your own thoughts?
Anorexia core features
- eating - how would you describe your eating habits? what is your appetite like?
- weight - has your weight changed recently? are you satisfied with your current weight?
Past medical and drug history
Past self harm attempts
- method
- did they receive support afterwards?
Past psychiatric history - have you been under the care of mental health services in the past?
-past admissions?
Past physical health history - do you have any physical health conditions you’re managing?
-how are they being managed
Drug history
- prescribed, OTC, herbal, inhaled, recdrugs
- alcohol, smoking, cannabis use - frequency and amount
FHx - attempts or completed suicide?
-psychiatric/physical health conditions that run in the family?
Social history
-identification of social risk factors
Living
- where do they live
- who do they live with? Social network? Dependents and risk of neglect? Carers?
- ADLs
Occupation
-job? financial coping and debt?
Management plan
-safe to send home, no mental health input
Safety plan -support of family, friends -identify stressors, aggravators Action plan -safety contact - personal support network -GP -local support line - Samaritans -A&E, local mental health services for self referral
Signpost to appropriate agencies
Housing - housing services
Alcohol, drug dependence - GP, local chariy groups
Citizens Advice Bureau - financial, housing, relationships, legal
1 week follow up with GP
Management plan
- needs mental health team support
- unsafe to send home
Discuss with patient
- HTT in community
- voluntary admission to psych hospital?
High risk of completing suicide, self harm, lacks insight => MHA
Factors that increase suicide risk
Demographics
- older single males living alone
- low income, unemployed
- FHx of suicide
Diagnoses
- past attempts
- anorexia
- depression
- rec opiate use/dependence
- alcohol dependence
Act
- preparation - wills, research, stockpiling, precautions to being discovered, violent/lethal method
- after - evades medical intervention, downplays severity of attempt
