Assessment

Before a valid psychosocial assessment can be carried out, the patient must have had time to recover from the immediate effects of the self-harm, such as drowsiness or confusion after an overdose. Three aspects require special attention:

• whether there was serious suicidal intent, as indicated by:

- the subject claiming to have wanted to die and to regret survival

- a premeditated act preceded by making arrangements for death, leaving a suicide note, and taking precautions against discovery

- use of a method that the subject believed would be fatal

- features associated with completed suicide, such as older age and social isolation

• whether psychiatric illness requiring treatment is present

• whether social problems are present.

It is not feasible, or necessary, for all cases to be assessed by a psychiatrist. Junior medical staff, nurses, and social workers in the general hospital can be trained to identify patients needing psychiatric referral. Standardized rating scales are available to aid the interview assessment.

Although many acts of DSH do not appear 'serious' on assessment, patients who have committed such acts nevertheless have a continuing elevated suicide risk. Accordingly, assessment will particularly focus on risk factors for suicide, which include male sex, living alone, previous deliberate self-harm, the presence of chronic mental or physical disease, and substance misuse.

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