What is required to complete a Form 1 certificate for a patient with a suicide attempt?

Completing Form 1 Certificate for a Patient with Suicide Attempt

A comprehensive psychiatric evaluation is required when completing a Form 1 certificate for a patient with a suicide attempt, focusing on current suicidal ideation, risk factors, mental state, and access to means.

Essential Components of the Form 1 Assessment

Mental Status Examination

• Assess mood, level of anxiety, thought content and process, perception, and cognition 1
• Document hopelessness, which is a critical risk factor 1
• Evaluate for signs of clinical depression, mania, hypomania, or mixed states 1
• Note any irritability, agitation, threatening behavior, delusions, or hallucinations 1

Current Suicidal Ideation Assessment

• Document current suicidal ideas, plans, and attempts, including active or passive thoughts of suicide or death 1
• Assess the patient's intended course of action if current symptoms worsen 1
• Determine access to suicide methods, particularly firearms and medications 1
• Evaluate possible motivations for suicide (e.g., attention, revenge, shame, guilt, command hallucinations) 1
• Document reasons for living (e.g., responsibility to children/others, religious beliefs) 1

Risk Factor Documentation

• Note demographic risk factors: male sex, older age (particularly 50-59 years for men, 60-64 years for women) 1
• Document any previous suicide attempts, which significantly increase risk, especially in males 1, 2
• Assess for substance abuse, which often co-occurs with mood disorders and increases risk 1, 3
• Evaluate for presence of mental health disorders, particularly depression, which is present in 50-79% of youth suicide attempts 1
• Document family history of suicide, which is an independent risk factor 2

Psychosocial Assessment

• Assess presence of psychosocial stressors (financial, housing, legal, occupational, relationship problems) 1
• Review the patient's trauma history 1
• Document exposure to violence or aggressive behavior 1
• Assess cultural factors related to the patient's social environment 1
• Evaluate social support systems and living situation 1, 2

Decision-Making for Involuntary Admission

High-Risk Indicators Requiring Admission

• Persistent wish to die or clearly abnormal mental state 1
• Current mental disorder, especially when complicated by comorbid substance abuse 1
• Prior suicide attempts, particularly using lethal methods 1
• Male gender, especially ages 16-19 or older adults 1
• Lack of adequate supervision and support at home 1
• Access to lethal means that cannot be secured 1

Documentation Requirements

• Document an estimate of the patient's suicide risk, including specific factors influencing risk 1
• Provide rationale for treatment selection, including discussion of specific factors that influenced the treatment choice 1
• Include assessment information from multiple sources (patient, family, third parties) 1

Common Pitfalls to Avoid

• Do not rely solely on structured or semi-structured suicide scale questionnaires, as they have limited predictive value 1
• Never discharge a patient with irritability, agitation, threatening violence, delusions, or hallucinations without psychiatric evaluation 1
• Avoid placing excessive confidence in "no-suicide contracts," as their value is unproven and patients may not be in a mental state to understand or accept them 1
• Don't underestimate the risk of "mild" suicide attempts, as even seemingly minor attempts can precede more serious ones 1
• Ensure proper coding and follow-up, as studies show only 37% of emergency room contacts for self-harm are correctly coded 4

Follow-up Planning

• If hospitalization is not warranted, ensure adequate supervision and support will be available 1
• Confirm that a responsible adult has agreed to remove firearms and lethal medications from the home 1
• Schedule a follow-up appointment for fuller evaluation before discharge 1
• Obtain contact information for parents/caregivers and establish a procedure for staff to initiate contact if needed 1
• Be aware that compliance with outpatient treatment can be low (57% in one study), requiring assertive follow-up 4