What is the initial phase of intervention for patients with suicidal behaviors?

Updated: Sep 25, 2018
  • Author: Stephen Soreff, MD; Chief Editor: Glen L Xiong, MD  more...
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Answer

Answer

In many cases, swift, decisive intervention can prevent a person from committing suicide. Because of this preventable aspect of suicide, recognizing and taking action if the potential arises is critical. Based on the clinical assessment and all of the information available, if the person is indeed suicidal, the intervention should consist of multiple steps.

The individual must not be left alone. In the ED, such a recommendation is handled easily by hospital security personnel. In other settings, summon assistance quickly. In an isolated place, call 911. Involve family or friends; they can remain with the patient while treatment arrangements are made.

Remove anything that the patient may use to hurt or kill him or herself. Remove sharp or potentially dangerous objects. Ask the patient for any weapon, such as knives or pills, and secure them away from the patient.

The suicidal patient should be treated initially in a secure, safe, and highly supervised place. Inpatient care at a hospital offers one of the best settings. Most managed care companies recognize the medical necessity of hospitalization in situations in which the suicide danger is acute.

A study of the association between the provision of mental health services and suicide rates found that removing ligature points (places where things like ropes could be attached to) was associated with significant reductions in the overall psychiatric inpatient suicide rate and in the rate of inpatient suicide by hanging. [119] Similarly, assessing other available sources of self-destructive implements such as pills and guns is critical.

Patients who attempt to commit suicide with prescribed medications represent one of the greatest clinical challenges. The dilemma involves balancing the fact that psychotropic drugs alleviate mental illness symptoms with the reality that some patients will use the very same medications to commit suicide. Gjelsvik et al highlight this conundrum in their study in which patients who engage in deliberate self-poisoning had a greater prescribed medication load compared with the general population, and that this medical load is more important in determining self-poisoning episodes than the timing of collection of prescribed medication prior to an episode. [120] This study points out the need to pay attention to the amount of stockpiled medications available to the potentially self-destructive patient.


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