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Assessing Potential for Harm: Would Your Patient Injure Himself or Others? Questions to Ask, Steps to Take When Evaluating Tendencies toward Suicide and Violence
| Content Provider | Semantic Scholar |
|---|---|
| Author | Scott, Charles L. Resnick, Phillip J. |
| Copyright Year | 2009 |
| Abstract | Police take Ms. L, age 23, to the emergency room (ER) after her fiance called them. He told the police that after a "night of drinking" they argued about a girl he had flirted with. Ms. L took out a loaded gun and threatened to shoot herself. She eventually handed the gun over to the police. [ILLUSTRATION OMITTED] In the ER, Ms. L's blood alcohol level is 0.20%. She tells the admitting emergency room nurse, "I would never hurt myself. I drank too much and was acting stupid. I just want to go home and sleep it off. I promise not to harm myself." Emergency room staff observe Ms. L smile and giggle while waiting for a psychiatric evaluation. What would you do? Hospitalize Ms. L for safety, or accept her promise not to hurt herself and send her home? What criteria would you use? Knowing how to assess patients such as Ms. L is an essential psychiatric skill, whether or not you trained in forensic psychiatry. This article includes case reports that illustrate techniques for evaluating patients who may harbor suicidal or homicidal thoughts. Evaluating danger to self Your role is to weigh an individual's risk factors for suicide against potential protective factors and to make a judgment call. Potential risk factors for suicide include (but are not limited to): * current suicidal thoughts * prior suicide attempts * presence of a comorbid psychiatric disorder (particularly depression) * intoxication or ongoing substance use * feelings of hopelessness * marked anxiety * recent stressors * family history of suicide * lack of psychosocial support. (1) Not all factors will be present or relevant in every individual. See questions in Table 1 to further evaluate suicidality in patients who report suicidal thoughts. Table 1 Evaluating suicidality: Sample questions to ask Do you wish you were dead? Do you have thoughts about harming yourself? Do you have an actual plan as to how you would harm yourself? If yes: Have you taken any steps to enact that plan? If so, what were they? Have you ever attempted suicide before? If yes: What stopped you from enacting this plan? What do you think would keep you from acting on this plan in the future? Has anyone in your family or close to you committed suicide? How close have you come to killing yourself? Also review information that is reasonably available. In the ER, records from other facilities or private psychiatric treatment notes may not be accessed easily. However, in addition to conducting a suicide risk assessment and mental status examination, consider reviewing the collateral information outlined in Table 2. Table 2 Sources of information to assess suicidality in the ER Police reports on circumstances that led the patient to come to the ER ER nursing/physician notes Family members'/friends' statements regarding reasons for the patient's visit Observations by anyone assigned to monitor the patient while awaiting your consult Laboratory and physical exam findings, particularly related to substance use and/or self-injurious behavior Psychiatric records at that facility Concerns expressed by anyone responsible for the patient if he/she is released from the hospital ER: emergency room Do not rely solely on an intoxicated patient's word that he or she will not self-harm because such statements may not represent the person's sober state of mind. Use caution in basing a release decision on an intoxicated person's statements. Furthermore, do not rely on "no-suicide" contracts. They do not guarantee that a person won't attempt suicide, and they will not provide legal protection if the patient commits suicide after being released from your care. … |
| Starting Page | 24 |
| Ending Page | 24 |
| Page Count | 1 |
| File Format | PDF HTM / HTML |
| Volume Number | 8 |
| Alternate Webpage(s) | https://mdedge-files-live.s3.us-east-2.amazonaws.com/files/s3fs-public/Document/September-2017/0807CP_Article1.pdf |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
