Handbook of Family Medicine by Bob Mash

Author:Bob Mash [Lydia Reid, Penny Lane]
Language: eng
Format: epub
Publisher: Oxford University Press Southern Africa (Pty) Ltd.

5.37 An approach to a patient who is suicidal

(Beverley Schweitzer)

People who are suicidal are often trying to escape from a situation that they see as insurmountable. Suicide may be an attempt to seek relief from overwhelming feelings of shame, guilt, rejection, loss, loneliness or feeling like a burden to others – often part of a major depressive disorder.

Asking patients about suicidal ideation does not precipitate suicide, but often provides relief to the person who is experiencing these terrifying thoughts. Every patient with depression, or other high risk conditions, should be asked about suicidal thoughts at each visit. If suicidal ideation is present, one needs to ask about plans. Examples are ‘This may be a difficult question, but does it ever become so bad that you feel you would be better off dead?’ or ‘Do you ever think of harming yourself?’ If so, one can continue with ‘Have you made any plans?’ Examples would be collecting a lethal dose of pills, organising rope, poison or pipes to carry out the suicide and writing a suicide note. If the person has access to a gun, it must be removed. If a person has threatened to use their gun on themselves or another person, the police are obliged to remove the gun, even from a licenced user. The same applies to any person who has a mental condition, tends to be violent or has a dependence on alcohol or drugs. Breach of confidentiality is superseded by the risk to the well-being of the patient or a third party.

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