During his SSC to develop a psychiatry teaching video, fourth year medical student John Hayton, chose to look at the topic of deliberate self harm. The result is a video entitled, “I can’t stop thinking about it…” In the film, a role-player and John talk about her recent suicide attempt.
The following is from John.
As medical students undertaking rotations in mental health medicine, on other wards, and in our future careers as doctors we will come across individuals who have recently attempted suicide. As the film describes, despite a recent decline in the suicide rate, it is still the third largest contributor to premature mortality in the UK. So considering how we would approach taking a history from patients following a suicide attempt is an important skill to learn.
It’s useful when talking to patients in a new and unfamiliar situation, to use communication skills that have already been learned. For example; remember to find a private environment to speak to the person, to establish good rapport, and to be gentle in your questioning.
Taking a history of a suicide attempt does not differ from taking a history of presenting complaint in any standard medical history. There are critical questions which are important to ask when establishing suicidal intent:
What did the person do/take, and how? Did they believe that what they did would prove lethal? Did they intend to kill themselves? How long had they thought about it? What preparations had they made? What precautions did they take to prevent themselves being discovered? Had they let anyone know what they were doing? And finally, how did they feel about surviving?Such questions can be difficult, not just for the patient, but also for the medical student. So it’s important to remember a few key things: don’t offer false reassurance; don’t avoid the word suicide; mentioning suicide does not cause suicide; and don’t be afraid to return to questions later, depending on responses.
Finally, it’s very important to monitor your own feelings and attitudes. Suicide and deliberate self harm are tough emotional problems to deal with. You should not be worried if they bring up strong emotions in you. You can always discuss this with more experienced colleagues.