1. 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

2. 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.

3. 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

4. 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

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

6. 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

7. 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

8. Crisis Care Out of Hours
Safe Haven
CYP Haven: year olds drop in
The Annex, The Redhill Centre, Station Road, Redhill, Surrey RH1 1ET
Crisis Line

9. 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

10. Thank you!
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