Suicidal ideation — urgent assessment

PLAB 2 & PRES 3 · psychiatry · hard · 8 minutes

Candidate brief

You are an FY2 doctor/SHO working in a same-day GP clinic. Ms Emma Byrne, 32, requested an urgent appointment because she feels unable to cope. Assess her mental state and immediate safety, and explain your management plan. No physical examination is required.

What examiners look for

Ask about suicide directly, calmly and without judgement. Clarify current thoughts, plan, intention, preparation, timing, access to means and whether the patient can remain safe. Do not use a risk score or the labels low, medium or high risk to predict suicide or decide management. Develop an individual clinical formulation that considers current needs, vulnerabilities, strengths, protective factors and immediate safety. A patient with a plan, access to medicines, preparation and uncertainty about remaining safe requires urgent specialist assessment and must not be left alone or discharged without safe support. Create a collaborative safety plan, reduce access to possible means, involve a trusted supporter where appropriate and ensure clear transfer to the next responsible service. Confidentiality is important but is not absolute. Explain that relevant information may need to be shared when necessary to prevent serious harm. Share only what is required and document the decision. A helpline number or promise not to self-harm must not replace urgent assessment, safety planning, clinical treatment and follow-up.

Guideline references

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