Suicide Risk and Self-harm assessment Flashcards
What is the risk?
Mental illnesses associated with suicide?
Depression: up to 70%
Personality problems 25%
Alcohol: 15-25%
Schizophrenia: up to 10%
Eating disorders
What are Suicide risk factors?
Previous attempts Current mental illness Family History of suicide Access to means for suicide Hopelessness
Special groups at high risk?
Adolescents Elderly In-patients Prisoners Those with access to suicide means e.g. doctors, vets, farmers, dentists
What is DSH stands for?
Deliberate self-harm
They:
- Failed suicidal attempt
- Ambivalence and uncertain about wish to die
Self-cutting: release tension (no suicidal intent)
What are the risk factors for DSH?
Women (this is very important!)
Adolescents
Lower socioeconomic class
Single
Social isolation
Adverse childhood experiences
Gay/bisexual/transgender
30% mental illness
What is the most substance that has been used to DSH?
Paracetamol
What is the prognosis of DSH?
(( Previous self-harm )) is the single greatest predictor of future self-harm
Following an (act of self-harm), the (rate of suicide) increases to between 50-100 times the (rate of suicide) in the general population
1 in 6 repeat with in 1 year
1 in 4 repeat within 4 years
1% will complete suicide within 1 year
5% will complete suicide within 10 years
50% suicide have history DSH
When you meet a patient with risk of suicide/self-harm, you are going to assess the (Risk assessment), it include 2 areas, what are these?
Characteristics of the person
Characteristics of the act
What are the characteristics of the person that you are going to assess?
- Sociodemographics:
Sex, age, employment - Social situation:
Housing, support network - Mental illness, including drugs/alcohol
- Hopelessness
- Continued intent?
What are the characteristics of the act that you are going to assess?
When?
What/How?
- Method
- Perceived seriousness
- Final acts
Where?
- Plans to prevent rescue
- How got to hospital
The management of suicidal patients includes 2 areas depending on the level of risk:
- Management on the ward
- Management in the community
Any points regarding management “on the ward”?
Might need to be admitted under the Mental Health Act if refusing to come in voluntarily.
There should be a regular risk assessment
Level of observation
SSRIs
Monitor when “on home leave” and “post discharge”
The management of suicidal patients includes 2 areas depending on the level of risk:
- Management on the ward
- Management in the community
Any points regarding management “in the community”?
Home treatment team
Small prescriptions
Involve relatives in safe keeping of tablets
Arrangement for immediate access to extra help
What really help in “Suicide prevention”?
2/3 give warning
2/3 saw GP previous month
40% saw GP previous week
50 % saw psychiatrist previous week
50% have history of DSH (deliberately Self-Harm)
Population strategies to reduce suicides?
Detoxifying gas
Detoxifying car exhaust fumes
Restricting amounts of analgesics
More responsible media reporting
Public education
