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Suicidal self-poisoning is a medical emergency but it is also a psychiatric one. Yet before a psychiatrist can be engaged it is often necessary for a physician or paediatrician to set the scene. Young people who have just taken a massive risk with their lives are in a turmoil of rage, fear, grief and shame. Though some will be keen to talk, others may be harder to reach. ‘The fact that young people who have self-harmed arrive at A&E feeling like ‘rubbish’ may predispose them to perceive staff attitudes and behaviours as hostile and punitive, even when staff do not intend them as such.’1 An attentive and careful medical assessment conveys that the problem is taken seriously by the hospital, for which patients will often in time be grateful.
Whether or not a mental health practitioner will be seeing the patient soon after admission, I argue that a medical assessment is therapeutic in its own right. You should enquire about the dosage and timing of overdose, and about the motive and the context. This practice both enriches medical clinical skills and also fosters a spirit of collaboration between mental and physical medicine, a benefit to patients who experience it.
Making sense of the story: ‘Here to help’
The most important first step is to acknowledge the distress that the young person is in, and to say that you are here to help. This indicates that you do not view what the young person and you are doing together as a waste of time. On the contrary, you can say that it is a unique opportunity to try to make sense of the crisis. Despite …
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