Suicidal risk assessment OSCE

1. Hi, my name is Lim, I am one of the doctors, since we are meeting for the first time, do you mind
introducing yourself.
2. Lovely to meet you. How are you feeling today?
3. I am here to talk about some of the thoughts you were having about suicide, is that okay with
you?

4. Let me reassure you that the discussion today will be confidential unless i feel another person is at
risk, which i may have to tell my colleague. I appreciate some questions are difficult, if there’s
anything you don’t want to answer, we can come back to it another time, does that sound okay to
you?
4. Tell me about how you are feeling? Your sleep? Energy levels?

I can imagined if I were you, i would feel the same too.

5. How would you rate your mood today, with 1 being the lowest and 10 being the happiest.

6. Have you had any suicidal thoughts today?

- How frequent do you experience this type of thoughts?

- why? So tell me __, what are the stressors you are experiencing now in your life? (Unemployment,
isolation)

- when was the last time? Tell me more about it.

1. Was it planned?
2. Was it a violent method?

A. medication
- what, where get it from, how much, what do you think the medication will do, what made you
decide to take, what did you do afterwards?

B. Cutting
- where, how many, how deep, how did you feel while cutting, when saw blood, what was you
hoping the cutting would do?

3. Did you carry out any final acts? (Leave a written note)
4. Did you make efforts to avoid being discovered? (Locking doors for example?)
5. What do you feel afterwards? Do you regret?
6. Will you accept treatment?

Screen for depression

1. How’s your mood been
2. No longer enjoy
3. Energy levels

Psychosis
1. Thoughts to harm not your own? Some one’s putting thoughts into your mind?
2. Voices telling you to harm yourself?

Anorexia
1. Describe your appetite?

Now that we have talk about your last attempt, now i would like to move to what happened in the
past, has you ever carried out self-harm in the past? Wha method? Did you get help?

PMHx
1. Aware of any medical conditions?

2. Have you visit the mental health doctor before? Previous admissions?

3. Medications

FHx

1. Have any of your family members attempted suicide?

2. Mental ill health?

Social history

1. Who do you live with?

2. Good support network? Manage activities of your daily living?
3. Children?

Sensitive

1. Alcohol and recreational drugs

Occupation

1. What do you do for a living?

Alcohol

- have you use alcohol or drugs before?

- have you visit a mental health doctor before?
- now that we have talk about what made you feel worst, Have you found anything makes you feel
better, a reason to life for? Take your mind off those thoughts? What’s keeping you alive?

1. Family support - children at home

- how about someone that you can reach out to to talk to?
2. Religious belief

I can only imagine how difficult that must be, you are doing an amazing job keeping yourself
together though ___.

7. If you were to act on these thoughts. How would you do it?

8. I know it’s very difficult to talk about these types of things __. But i must thank you for being so
open and honest with me about how you are feeling right now, that takes a lot of courage.

9.

10.

10. Would you say you are currently feeling hopeless. Have you attempted suicide in the past?
Would you say your mum is one reason why you haven’t commit suicide in the past? I think it’s
amazing despite how difficult the current situation is for you, that you are still able to consider your
___ and her feelings, that is a true marker of strength, you are a very resilient person.

11. Thank you for spending time talking to me __. I know that this wasn’t an easy conversation to
have. But i appreciate your openness and your honesty.

12. If you were to go home today, what would you do? Do you feel like you can talk to someone if
you felt those intense thoughts again?

12. Before you leave today, hopefully we can come up with a safety plan, I will give you a list of
phone numbers that you can always reach out to when you are worry about your safety, and i would
need to commit to all the people that missed you that you will call if it becomes intense between
now and when i see you again, then I have

13. When you leave today, do you think you are able to keep yourself sav?

Low risk: limited suicidal ideation without plan/ intent. Few risk factors and many protective factors

Moderate: frequent with plans and intent, with periods of relief from ideation, multiple risk factors
and limited protective factor

High - specific plan with available means. High degree of impulsivity.

Can I do this doctor?

I don’t want to take the power away from you from controlling your own life, but I really would like
to explore options.

http://m.osce-aid.co.uk/osce.php?code=osce_suicideassessment