The patient who has attempted suicide

Attempted suicide includes all acts of intentional self-poisoning or self-injury, with most cases seen in hospitals involving self-poisoning. It is a substantial health care problem in many countries, especially in young people, hence all large general hospitals should have dedicated services for patients who have attempted suicide.

Background—attempted suicide occurs in relation to a range of factors, including psychiatric disorders, life events and problems, and difficulties in coping. Many people (12–25%) repeat the act within a year, with 1 to 2% dying by suicide within a year, and 3 to 5% within 8 to 10 years.

Management—it is imperative that patients should not only receive adequate physical care, but that their psychiatric and psychosocial problems and needs are assessed. A brief assessment of all patients should be conducted on arrival in the emergency department to assess psychiatric status and risk. Those who refuse physical care should be assessed for capacity to do so and for possible mental illness that may allow compulsory treatment. Detailed psychosocial assessment should be conducted by a member of the psychiatric service, including assessment of suicidal intent, other motives for the act, life events and problems, psychiatric disorder, risk of repetition of the attempt and of suicide, and coping resources and supports. Aftercare may include a range of pharmacological and psychosocial treatments.