A fictional 27-year-old presents after self-poisoning, remains highly distressed and says they may harm themselves again if left alone.
Frame the danger first.
- Establish urgent physical treatment needs, emotional state, immediate safety and safeguarding concerns.
- Ask directly and compassionately about current thoughts, intent, access to means and what could help the person remain safe.
- Do not use a numerical score or global low/medium/high label to predict suicide or determine discharge.
Act, escalate, reassess.
- Treat physical consequences and arrange psychosocial assessment concurrently as soon as possible.
- Create a safe, least-restrictive environment with appropriately trained observation and clear team communication.
- Involve urgent mental-health and senior support; assess capacity, consent and duty of care where relevant.
- Collaboratively address access to means, existing plans/supports and immediate aftercare.
Red flags that change pace.
- Immediate intent, access to lethal means or inability to maintain safety
- Serious poisoning/injury, altered consciousness or escalating agitation
- Safeguarding concern, psychosis, severe intoxication/withdrawal or absent safe support
What makes care less safe.
- Using a risk score to justify discharge
- Delaying psychosocial assessment until all medical care is complete
- Punitive, stigmatising or coercive communication when a safer collaborative approach is possible
Say the concern plainly.
Following self-harm, physical treatment needs are [summary] and immediate safety concerns are [details]. Current thoughts, access to means, protective factors and capacity concerns are [summary]. I need urgent psychosocial and senior review for a collaborative safety plan.