MDU advice when treating patients at risk of suicide

Be alert to the possibility of depression in patients with a history of mental illness, chronic health conditions and vulnerable groups. This might include those who are elderly or young, socially or geographically isolated, or in prison.
If you can't discuss all of a patient's mental health concerns in one short appointment, ask them to come back for a longer appointment. Try to book this before they leave the surgery/clinic.
Document discussions with patients carefully. If they are seen by a colleague at the next appointment, it should be clear from the notes that the patient has had depressive symptoms or suicidal thoughts and that they may need to ask specifically about them.
Make sure you document any risk factors for suicide, such as alcohol or substance misuse, previous suicide attempts, or a family history of suicide. Other risk factors include being a victim of sexual or physical abuse and keeping firearms at home.
If the patient fails to attend a follow-up appointment, try to contact them to find out why. Don't rely on the patient to take action; if they are suffering from depression, they may be less able to ask for help. The MDU is aware of cases where opportunities may have been missed to review a patient.
Encourage the patient to let you involve close family members or friends, who may be able to offer additional support. Remember your duty of confidentiality and do not discuss the patient with friends or relatives without their permission. The GMC is clear that it is not a breach of confidentiality to listen to the concerns of a relative or friend, as they can often provide important information that might alert you to a risk of imminent suicide. Warning signs that a loved one might be aware of include the patient talking a lot about death, making comments about being helpless or worthless, losing interest in life, putting their affairs in order, contacting people to say goodbye, or passing on their possessions.
Keep up to date with best practice in mental health treatments, and mental health services available in your area. Knowing what extra help is on offer can make it easier when trying to arrange referral or crisis help for a patient.
If you're making an urgent referral in a crisis, track the referral to make sure it is actioned as you intended.
Don't be afraid to ask a patient about depressive symptoms or suicidal thoughts if you have concerns. A sensitive enquiry might encourage the patient to discuss feelings they otherwise felt unable to express.
It's a good idea to document objective measurements of mood in the records using standardised questionnaires.
Have a system in place to audit or review all patients on long-term anti-depressants.
Explain patients' options to them clearly, including talking therapies, the risks or side effects of medications and details of crisis team or out of hours help.

Learning lessons from complaints and claims about suicide

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Learning lessons from complaints and claims about suicide