Suicide Risk – ED

Suicide Risk

1. Given a patient presenting with suicidal ideation or psychiatric complaints, inquire specifically about risk criteria for suicide (e.g., SAD PERSONS scale, hopelessness, lack of supports, impulsivity) to assess the risk of subsequent suicidal behaviour.

  • Suicide note, sex – M
  • Age <18 or >65; Available of lethal means
  • Depression
  • Previous Suicide attempt, postpartum
  • EtOH
  • Rational thinking loss
  • Substance use, social support lacking, sickness
  • Organized plan
  • No spouse

+ Hopelesness, impulsivity, giving away personal items

2. In all patients, but especially in high-risk populations (e.g., geriatrics, post-partum, substance use), recognize subtle, atypical, or hidden presentations of suicidality (e.g., “accidental” medication errors, self-neglect, unexplained accidents or injury).

Geriatrics: Accidental medication erros, self-neglect, FTT, unexplained accidents or injury

HIgh risk population: geriatrics, postpartum, substance, male, possess lethal weapon

3. Given a patient with suicidal ideation who does not wish to stay for voluntary evaluation or treatment, assess and document the criteria required for involuntary admission, then consider the patient’s rights and the medico-legal consequences of involuntary admission before deciding the best way to proceed with care.

To certify someone, needs to meet both criteria:

  1. imminent harm to self or others
  2. due to mental health condition

4. Given a patient with suicidal ideation whose risk of future suicidal attempt has been assessed as low, negotiate with the patient to develop a suitable plan for outpatient treatment and discharge home at the appropriate time.

  1. Ensure a safe location to discharge
    1. try to discharge in the morning after SW involved
  2. confirmed follow up visit
  3. Contingency plan if a crisis arises
  4. Initial a medication for treatment
    1. SSRI – expect to observe benefits after 3-4 weeks; s/e includes N/V/D/insomnia/drowsiness/sexual s/e (erection/desire/orgasm)

5. When developing a plan for the outpatient treatment of a suicidal patient, include the following:

• Confirmed plans (time, persons, places) for subsequent visits and support

Contingency plans for extra support and rapid-contact information (e.g., crisis line) for unexpected acute situations or decompensation

Initial pharmacologic management when appropriate, with full discussion of expected effects and timelines, as well as possible side-effects

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