Suicide risk in a GP surgery Dr Deepa Deo Associate Medical Director Liaison, Perinatal and Forensic services Consultant Liaison Psychiatrist for WAA, St Peter’s Hospital

Case A 66 year old man not previously known to MH Services. Occasional alcohol consumption. 3 week history of persecutory thoughts and concerned GCHQ and HMRC would arrest him and reclaim large amounts of money. On 25th June consumed large amounts of alcohol and a few lorazepam. The following day told his wife he had tried to hang himself overnight and noose found in the stable. Family contacted ambulance but he refused to attend believing they were special branch officers.

Case A His wife drove him to the GP surgery for an urgent appointment Assessed in presence of wife, he had now sobered up and felt better. He denied he had tried to hang himself. Apologised for any inconvenience. Referral to CMHOP: patient refused A&E laiison services: suicidal thoughts were secondary to alcohol. If his paranoid ideation returned, to come back to A&E

Case A He saw accountant the following day who thought he seemed unwell. There were no tax issues. The following day he drank anti-freeze and fell from 2nd floor balcony hitting his head. His hands were in his pockets during the fall. He was taken to St Georges and died in ICU a few weeks later

Formulation and risk Depression With psychotic symptoms Alcohol abuse/ dependence Stressors? Actuarial risk

Risk Assessment Important to assess suicide risk in all patients presenting with self harm Explore ideas, intent and planning Explore previous suicide and DSH attempts as well as psychiatric history If concerned about the risk urgent referral to mental health team

Patients might conceal symptoms and suicidal intent THEMES Patients might conceal symptoms and suicidal intent Alcohol is everyone’s business Think co-morbidity Carers and Confidentiality

Crisis Care Out of Hours Safe Haven CYP Haven: 10-18 year olds drop in The Annex, The Redhill Centre, 132-138 Station Road, Redhill, Surrey RH1 1ET Crisis Line

NCISH: National Confidential Inquiry into Suicide & Safety in Mental Health About 6000 suicides/ year About a quarter in MH services: in 2016 there were 1612 patient suicides Fall in recent years Almost half: hanging/ strangulation Almost quarter: self-poisoning Low Risk Paradox - Immediate suicide risk judged by clinicians as low or not present in the majority of patients who died by suicide

Thank you! Questions?

Upon completion, a certificate of attendance will be emailed to you. Please take a few minutes to complete an online evaluation of the event. Upon completion, a certificate of attendance will be emailed to you. https://www.smartsurvey.co.uk/s/D6JBU/ Thank you.