Ben, aged 16, who is brought in by his mother because she is concerned about his anxiety. Over the last 2 years he has become more anxious about going to school and social events. He was performing well in school but now he is leaving school early and having panic attacks. These are “bringing me down”, and make him enjoy his skateboarding less and he is becoming depressed. His sleep is poor because he is up ruminating for hours about the next day. He denies any hallucinations and there is no thought disorder or delusions evident. He reports he has had suicidal thoughts for the past 3 months. He has no other past medical history, His mother and father are divorced when he was young. His father has major depression disorder.
What further assessment do you want to make to clarify his suicide risk? List 6
- Suicidal intention
- Suicide plans
- Past history of suicide attempt
- Family history of suicide attempt
- Substance abuse
- Past child abuse
- Access to lethal means
RACGP – this case was answered well with candidates identifying the risk factors in the given scenario
Case continued…Ben reports he has frequent suicidal ideation and has been considering various plans. He has been researching panadol doses on the internet and has stockpiled some. He is really afraid of suicide but thinks it is the only way out. His father has one attempt of suicide about 2 years ago which aligns with the onset of his anxiety. He denies any substance abuse or past child abuse.
What are the key components in a suicide safety management plan? List 6
- Identifying signs that the person is deteriorating
- Creating a list of personalised internal coping strategies
- Involving friends and family in distracting the adolescent from suicidal ideation
- Involving the family in problem solving in a crisis
- Contacting mental health clinicians
- Restricting the adolescent’s access to lethal means
- Given crisis phone number for professional agencies
- Arrange follow up in 1-7 days
RACGP – The main issues in this case were the number of extra responses, with candidate giving lists of answers; trying to justify their answers with examples, giving broad non-specific answers or providing answers that were already in the case/scenario. The risk in providing examples is that you may get an example wrong and you may introduce more answers
GPCC – “all safety plans have six key components:” – https://www.racgp.org.au/afp/2014/june/suicidal-adolescents/
RACGP Feedback
This case focussed on the presentation of a 16 year old boy who is brought by his mother because she is concerned about his mental health. The scenario requires the appropriate assessment of suicide risk and the subsequent development of a suicide safety plan management of the situation presented.
This case was answered well with candidates identifying the risk factors in the given scenario and the appropriate management including the safety plan. The main issues in this case were the number of extra responses, with candidate giving lists of answers; trying to justify their answers with examples, giving broad non-specific answers or providing answers that were already in the case/scenario. The risk in providing examples is that you may get an example wrong and you may introduce more answers This is a key feature and paper as such it is important to given the key answers which are focussed and critical to this case.
Further Reading
- Murtaghs Ch 12 – Mental Health – http://murtagh.mhmedical.com/content.aspx?bookid=1914§ionid=142127051
- Murtaghs Ch 97 – Adolescent Health – http://murtagh.mhmedical.com/content.aspx?bookid=1914§ionid=142127051
