• 5000 deaths/year in the UK
  • Increasing in young males
  • In men <35, suicide is the greatest cause of death
  • At all ages, men are at greater risk than women
    • In those >35, they are likely to have seen their GP within the last month
    • Those <35 are not
  • Methods
    • Men more likely to use violent methods (shooting, hanging)
    • Women more likely to take prescribed/OTC drug overdoses
  • Causes
    • About 90% of suicide patients are mentally ill
    • Most common illnesses are depression, bipolar disorder, and substance abuse

Self Harm

  • Increasing in the last few decades
  • 300 to 400 per 100 000
  • In women – most common cause of acute admission
    • Peak age – 15-24
    • In the UK, women of south Asian origin 2.5x risk than general population
  • In men – second most common cause
    • Peak age – 25-34
  • Roughly equal rates in men and women (women used to be higher)
  • Causes – Bipolar, depression, eating disorders, personality disorders
  • Repetition
    • 15% of cases will have further self harm episodes in the next year
    • Most of these occur soon after the initial incident
    • Suicide after self harm – there is a 1% suicide rate in the next year in those who have committed self harm. This rises to 3% in 5 years and 7% in 10 years. Those who commit suicide tend to be: Older, Male, Have a mental illness, Have poor physical health

Assessing Suicide Risk

Assessing suicide is an important part of any psychiatric exam.
Talking about suicide DOES NOT increase the risk of a self harm
This is even true when a patient is ‘in crisis’ (i.e. just after a suicide attempt). Infact, often the reverse is true, and the individual may feel relief at being able to talk about these issues.

Assessing a patient in crisis

Talk to the patient – but remember they may still be drowsy after any drugs they have taken (both in the suicide attempt, and afterward at hospital)

Get a thorough collateral history

  • Look for evidence of continued suicide intention
  • is the patient happy to still be alive?
  •  If they took an overdose, What did they take?
  • Did they think this would be enough to die?
  • What did they take it with? (e.g. water, alcohol)
  • Did they want to be found?
  • Who found them? Was this person expected home? In the house? Did they phone them?
  • Did they leave a note?
  • Have they been planning it?
  • E.g. giving away possessions
  • Stocking up on pills over several weeks/days/months


  • If the patient tries to leave before the assessment is complete…you may need to detain them – if you believe they pose a risk to their own (or anybody else’s) safety
  • Some patient may be fine to go home (usually with care of a relative…e.g. a girl who takes 10 paracetomol infront of her girlfriend after a row. She says she has no intention to kill herself, and seem upset by the incident.
  • When discharging it is VITAL that you inform community care representatives..e.g. the GP, communit mental health team etc etc. You should phone as well as sending a letter. Usually, there is a follow-up clinic appointment made as well.
  • Don’t prescribe any potentially lethal drugs for the patient to take home with them!
  • You may need to get a psychiatrist to advise you in other cases/cases where patients may need detaining…e.g. an old man who has been stockpiling paracetomol for a long time. He lives alone, and took an overdose whilst in his shed. He was discovered by chance by a neighbour. He had left a note, and had been giving away his belongings.
Pathos score – mainly used in adolescents (age 13-18) who present with an overdose. It is used to asses
  • P – Problems – have you had problems for more than 1 month?
  • A – Alone – were you alone at the time?
  • T – Time – have you planned it for more than 3 hours?
  • Ho – Hopeless – are you feeling hopeless about the future
  • S – Sad – were you feeling sad for most of the time before the overdose?
Each ‘Yes’ answer is an indicator of greater risk of future harm, and intent.

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