Suicide Risk Assessment
Suicide Risk Assessment
Suicide Risk Assessment
geekymedics.com/suicide-risk-assessment-osce-guide
16 February 2017
The ability to carry out a suicide risk assessment is an important skill that is often
assessed in the OSCE setting. It’s particularly important to have a systematic approach to
ensure you don’t miss any key information. This guide provides a framework to perform a
comprehensive suicidal risk assessment in an OSCE setting.
Download the suicidal risk assessment PDF OSCE checklist, or use our interactive OSCE
checklist.
It’s important to try and establish rapport with the patient early in the consultation to allow
you to perform an accurate assessment of their mental health.
Introduce yourself and explain why you are reviewing the patient: “Dr Y from A&E has
asked me to see you. My name is Dr Smith and I’m a psychiatrist. I’m here to talk about
the events that have led you to be admitted to hospital.”
Explain that some of the questions you ask may be difficult to answer and reassure the
patient that what they tell you will be kept confidential (unless there is a risk to another
person e.g. a child at home).
“Anything that’s said here today will be confidential unless I feel another person is
potentially at risk. In that case, I would need to share some information. I appreciate that
some questions may be difficult to answer – if there’s anything you don’t want to answer
right now, we can come back to it another time. Does that all sound ok?”
1/8
Assess the seriousness and perceived seriousness of their attempt
Assess how they feel about the attempt at the time of assessment
In order to try and establish intent, it can be useful to start off with the day in question
and obtain a narrative/autobiographical timeline of what happened. It’s best to start with
open questions, and then later use closed questions for clarification.
You might also be interested in our OSCE Flashcard Collection which contains over
2000 flashcards that cover clinical examination, procedures, communication skills
and data interpretation.
It’s best to think about this in terms of before, during, and after…
Before
Closing curtains
Locking doors
2/8
Waiting until they knew everyone would be out of the house and not be back for
several hours
Going somewhere very remote
During
After
Did the patient call anyone? How did they get to A&E? Who were they found by?
How does the patient feel about the attempt now? Do they regret it?
If the patient were to go home today, what would they do? (make sure you cover the
next few days)
If the patient were to feel like this again, what might they do differently?
What does the patient think might prevent them from doing this again in the future?
Does the patient feel there is anything to live for? (i.e. protective factors)
3/8
How much of the medication did the patient take?
What did the patient think that amount of medication would do?
What made the patient decide to take the medication/how long had they been thinking
about taking an overdose for?
Screen for other mental health disorders which increase the risk of
suicide
Depression
Anhedonia: “Do you feel that you no longer enjoy activities that you previously used to?”
Psychosis
Thought insertion: “Are the thoughts to harm ever not your own?”
Auditory hallucinations: “Do you ever feel like there are voices that you can hear telling
you to harm yourself, that no one else can hear?” “How do you know these are other
peoples voices and not your own worries in your head?”
Anorexia
4/8
“What’s your appetite like at the moment?”
Did they get any help from their support network or other agencies as a result of their
self-harm?
Chronic pain and chronic illness are also risk factors for suicide.
Drug history
It’s important to take a thorough drug history as this may be relevant to the current
episode of self-harm (e.g. anticoagulants/overdose/interactions).
Family history
Have any of the patient’s family members ever attempted or completed suicide?
Social history
Taking a thorough social history allows identification of social risk factors for suicide.
Living situation
5/8
Who does the patient live with?
Is the patient able to manage all their activities of daily living independently?
If the patient has children you also need to consider if the children are being neglected
and if the patient has thoughts of harm towards the children.
Note: if you do elicit risks then it is important to do something about it (e.g. if there is a
child safeguarding concern this needs to be shared with a senior nurse or your consultant
to allow the safeguarding concerns to be addressed).
Occupation
Alcohol
Recreational drugs
How often and how much of the drugs does the patient use?
Closing the consultation
Thank the patient for taking the time to speak with you.
In most cases, you will have a conversation to agree on a management plan. In some
cases, however, this may not be appropriate.
6/8
If the patient is not suicidal and you intend to send them home with no
follow-up
If a patient is felt to be low risk, you may be discharging them home with no follow up with
mental health services. In these cases, it’s essential to formulate a safety plan with the
patient and also signpost to appropriate agencies.
Safety plan
Seek the support of their family and friends (clarify who they have already told ).
Ask the patient who they could tell if they felt like this again.
Suggest that if the patient feels like this again, they can seek help from a number of
places including:
Signpost the patient to agencies which may be able to address some of their sources of
stress/risk factors:
GP
Housing services
Citizen’s Advice Bureau
Alcohol and drugs services
Domestic violence services
Counselling services
Some patients may require support from the local mental health team. Have a
discussion about whether the patient could manage safely at home with the support of
an intensive home treatment team or will accept voluntary admission to a psychiatric
hospital.
7/8
For some patients, it may be clear that they are at high risk of completing suicide or
further self-harm and lack insight. In these cases, a Mental Health Act assessment will
need to be carried out.
Demographics
Male
Older
Widowed/separated/single
Living alone/social isolation
Low income/unemployed
Certain occupation (e.g. doctor, farmer)
Family history of suicide
Diagnoses
8/8