Suicide Risk and Crisis Intervention in Adolescents

Summary:This scenario involves the assessment and management of a 16-year-old patient presenting with suicidal ideation. The focus is on evaluating suicide risk, addressing psychological distress, and providing resources for crisis intervention.

Key Points:

Primary Concerns and Risk Assessment

• Establish rapport and a safe environment to encourage the patient to open up about their feelings.

• Evaluate the patient's suicide risk by asking direct, non-judgmental questions about their thoughts and any prior attempts.

• Enquire about factors contributing to the crisis, such as recent stressors or lack of support.

Management Approach

• Safety Netting:

  • Emphasize the importance of a crisis plan, discussing what actions the patient should take if suicidal feelings arise again.

  • Mention resources like a 24-hour Good Samaritan helpline and encourage the patient to reach out to supportive individuals.

• Discharge Planning:

  • Confirm that the patient is medically stable before discharge. The primary focus should be on psychological support and safety.

Physical Examination

• Perform a wound examination if the patient has any visible injuries, as this demonstrates attention to both physical and emotional wellbeing.

• Conduct a urine pregnancy test (UPT) if pregnancy is a concern, addressing any anxieties the patient may have around this.

Important Considerations:

• Confidentiality and Consent:

  • Start by explaining confidentiality, particularly if the patient is hesitant to share sensitive information. Assure them that their information will remain confidential within the medical team, unless there is a risk of harm to themselves or others​.

• Building Trust and Rapport:

  • Use active listening and empathetic language to create a supportive environment where the patient feels understood.

  • Encourage the patient to express their concerns and validate their feelings without minimizing them.

Diagnostic Approach:

1. Data Gathering:

   • Obtain a detailed history of current feelings and any past mental health issues.

   • Discuss the patient's social support network, including family dynamics, school, and friendships.

2. Risk Factors and Protective Measures:

   • Ask about recent stressors, use of substances, or any other potential contributing factors.

   • Gauge understanding of the contraceptive pill, which the patient might misuse.

3. Physical Health Considerations:

   • Perform relevant examinations (e.g., wound examination, UPT) based on the patient’s presentation and concerns.

Management:

• Immediate Crisis Management:

  • Reassure the patient of available resources and emphasize the crisis plan.

  • Provide the crisis helpline number and discuss when and how to use it.

• Support and Follow-Up:

  • Offer information on mental health resources such as counseling services.

  • Encourage the patient to maintain open communication with trusted individuals, including family members if feasible, respecting their comfort with involving them.

Communication Skills:

• Empathy and Non-judgmental Language:

  • Use simple, clear language to explain any medical processes, avoiding jargon that could increase the patient’s anxiety.

  • Reflect active listening through verbal cues and appropriate body language to show understanding.

• Patient Education:

  • Clarify misconceptions about pregnancy risks and contraceptive methods, especially given the patient’s young age and lack of knowledge about these topics​.

  • Discuss safe sexual practices, including the importance of protected intercourse to reduce STIs.

Ethical Considerations:

• Confidentiality vs. Safety:

  • If the patient discloses intent to self-harm, consider confidentiality limits and involve appropriate resources while respecting the patient's autonomy​​.

• Involving Family Members:

  • Assess the patient’s comfort level with involving family in her care plan, but suggest the possibility if it may offer additional support​.

Additional Resources:

• GMC Good Medical Practice provides guidelines on handling patients sensitively and supporting at-risk individuals in medical settings​.

• Mental Health Crisis Helplines and emergency contacts should be readily accessible and provided to patients at risk.