Speaking to a patient about self-harm & suicide
Important questions you need to address in your consultation
🔪 Self-harm & suicide:
It is a sensitive topic. It is a very uncomfortable thing to ask someone. However, it needs to be done to get a full proper history from the patient but also to assess risk slightly (self-harm & suicide is part of the risk assessment, not the full thing - look up the whole thing if you are interested).
You want to make sure you ask them about whether they have thought about self-harm or harming other people before. If they say yes, you then proceed to ask how long these thoughts have been happening for, ask about the details, and make sure to ask about whether they have followed through.
Ask how many times they have followed through, if they talk about self-harm, get the details, how many times, what did they do? punch themselves? cut themselves? where did they cut? what happened after - make sure you get all the details.
When they say yes to suicidal thoughts, you need to ask how long and also whether they have ever attempted. Ask them about each experience. What they did, did they set it up and back out, or did they not get that far. Did they go through with it? but someone found them and rushed them to the hospital and they were saved? If so, how did they feel when they woke up in the hospital? Relieved? Upset that they didn’t die?
There are some questions that you want to generally also ask after self-harm and suicide attempts. These will help you slightly understand what the patient is going through.
What was going through your head before you did it?
Was your main aim to kill yourself?
Was your main aim to seek attention?
Did you just want to harm yourself?
The answers to these questions will really help in giving you a better picture of what the patient is going through.
Finally, one thing you don’t want to do is be rude or too straightforward (sometimes it may be necessary). However, if you and the patient are having a consultation, and the patient is coping with the conversation well, answering well, following instructions etc, you don’t want to just randomly ask about self-harm and suicide. You want to sign-post.
“Hey, is it okay if I ask you some questions about self-harm and suicidal thoughts? they will help me understand your situation more”
Once they do tell you about any experience, you can then ask to explore them in a nice way
“Would it be okay if we spoke about some of your suicide attempts? I understand that it is a sensitive topic and you can stop anytime you feel uncomfortable, but again, this will help me understand your situation more”
What I’m trying to say is, communication skills is a BIG thing in psychiatry so make sure to brush up on it before your rotation.
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