In most cases the young person with suicidal ideation or self harm will need to be assessed by the Psychiatric Liaison Nurse and/or the psychiatric registrar.
In these cases the assessment by ED staff is an abbreviated one to exclude organic pathology and should not take more than 20 minutes, including the mental state examination and physical examination.
Situational crisis may be managed in the Emergency Department with senior medical input and possibly social work involvement.
Importance of engaging with the child or adolescent
Start by making a connection with the child or young person
Inquire about how things are for the young person in a non judgemental and respectful manner
It is essential that the young person is seen on their own for part of the assessment. This will allow for sensitive matters to be discussed and also allows them the opportunity to answer questions honestly.
Ask if something stressful has happened to them in past few weeks
Follow up on what impact that has had on them
Don’t guess what they might be feeling as a result of that stress
Allow them the opportunity to speak openly
Be alert for signs of intoxication and past drug use
Neurological examination including pupil size and response
Observe for signs of personal neglect
Assess nutritional status
Assess thyroid status
Observe for signs of recent abuse
Assess whether there is any immediate need for sedation or the need for an antidote
Signs and Symptoms of Depression
Ask about sadness
Ask about the extent of sadness and how often it occurs
Are there triggers for it or does it occur “out of the blue”
Has there been any loss of interest in usual activities. e.g. not catching up with friends or attending school
Has there been any difficulty sleeping especially initiation of sleep, frequent waking or hypersomnia
Has there been a change in appetite, (reduced or over eating)
Has there been reduced energy or lassitude (especially on waking)
Has the young person been more irritable than usual?
Suicidal Ideation and Self Harm
Ask about suicidal ideation (in the context of sadness)
Ask about frequency of suicidal ideation
Ask if it was a deliberate overdose or a self harm episode which brought them to hospital on this occasion, and whether they intended to kill themselves
Ask about previous ideation or attempts
Mental State Examination
During your assessment, note the following: (largely observational)