21-year-old man Mike Jones presented to the Emergency Department last night semiconscious following an overdose of unknown substances. He was found in his university bedsit by a friend who thinks he may have taken some sleeping tablets. The bedsit door had been locked, and a suicide note had been left.
Paracetamol and salicylate levels were undetectable, and laboratory investigations were all normal. Management was supportive. He has now woken up and is asking to take his own discharge. His parents have apparently been informed of his admission but have not visited. He has no other medical history listed in his notes.
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Good candidates will have a systematic approach identifying the following specific points: • time of overdose (single time or staggered) • medication used • dose of each tablet • number of tablets taken.
It is also vital the candidate performs a risk assessment and is aware of high-risk behaviour: • active plans • suicide notes • actively planned not to be found • previous suicide attempts • successful suicide in family or friends • lives alone • substance misuse.
The candidate should also enquire about protective factors: • supportive family/friends • co-habiting • making plans for the future.
The candidate will explore the patient’s past psychiatric history including: • any mental health diagnoses • any contact with mental health services • previous suicide attempts.
It is important the candidate is honest with the patient. If there are high-risk factors, the candidate should state they are concerned and a referral to the Crisis Team/Psychiatrist/ etc. is needed.
This is a case of a patient who has intentionally overdosed and left a suicide note. He is very high risk and has tried to take his life previously. He has a family history of suicide and is clearly very depressed. It is important to recognise that although the patient has suffered no medical complications, in order to be discharged it is paramount he receives formal psychological assessment. This is because the patient is at high risk of repeating his suicide attempt, and it is a legal obligation to perform a full psychological assessment.
If he tries to leave the hospital, he could be detained under the Mental Health Act as it has been clearly demonstrated that he has a mental health disorder, i.e. depression. At this point in time, this is not needed as he is willing to stay.
Following on from this, mental capacity needs to be assessed. The patient needs to be able to understand, retain, weigh things up, and communicate back to us.
In this case, the patient may lack mental capacity because of his depression. Therefore, the Mental Health Team has a very important role to play following the initial medical assessment.