A health care practitioner who foresees the likelihood of suicide in a patient is, in most jurisdictions, required to inform an empowered agency to intervene. Failure to do so can result in criminal and civil actions. Such patients should not be left alone until they are in a secure environment. They should be transported to a secure environment (often a psychiatric facility) by trained professionals (eg, ambulance, police), never by family members or friends.
Any suicidal act, regardless of whether it is a gesture or an attempt, must be taken seriously. Every person with a serious self-injury should be evaluated and treated for the physical injury. If an overdose of a potentially lethal drug is confirmed, immediate steps are taken to prevent absorption and expedite excretion, administer any available antidote, and provide supportive treatment (see this Chapter ).
Initial assessment can be done by any health care practitioner trained in the assessment and management of suicidal behavior. However, all patients require psychiatric assessment as soon as possible. A decision must be made as to whether patients need to be admitted and whether involuntary commitment or restraint is necessary. Patients with a psychotic disorder, delirium, or epilepsy and some with severe depression and an unresolved crisis should be admitted to a psychiatric unit.
After a suicide attempt, the patient may deny any problems because the severe depression that led to the suicidal act may be followed by a short-lived mood elevation. Nonetheless, the risk of later, completed suicide is high unless the patient’s problems are resolved.
Psychiatric assessment identifies some of the problems that contributed to the attempt and helps the physician plan appropriate treatment. It consists of the following:
Understanding the suicide attempt, its background, the events preceding it, and the circumstances in which it occurred
Appreciating the current difficulties and problems
Thoroughly understanding personal and family relationships, which are often pertinent to the suicide attempt
Fully assessing the patient’s mental state, with particular emphasis on recognizing depression, anxiety, agitation, panic attacks, severe insomnia, other mental disorders, and alcohol or drug abuse (many of these problems require specific treatment in addition to crisis intervention)
Interviewing close family members and friends
Contacting the family physician