Intended for healthcare professionals

Endgames Case report

A series of unfortunate events

BMJ 2010; 340 doi: (Published 25 February 2010) Cite this as: BMJ 2010;340:c429
  1. Stephen Ginn, psychiatry core training year 3
  1. 1Ladywell Unit, Lewisham Hospital, London SE13 6LH
  1. Correspondence to: stephen.ginn{at}

    A 24 year old man presented to the accident and emergency department because he had been planning to take an overdose, but had decided instead to seek help from mental health services. He had intended to take the contents of several blister packs of paracetamol, together with alcohol. He had been having suicidal thoughts for a week but they had become particularly pronounced over the past two days.

    His recent history was one of a “series of unfortunate events” that had left him feeling desperate. Four months ago his flatmate stole money from him, which meant that he was unable to repay several loans. His debtors had started to threaten him and he had been forced to move to a different city and leave his job. He had become socially isolated, and continuing financial difficulties had resulted in poor relations with his new landlord. Just before his presentation he had been awaiting a cheque for housing benefit. However, this had not arrived, and he described this as “the last straw.” He reported feelings of hopelessness and thoughts of “what’s the point?”

    He had no history of suicide attempts, self harm, or suicidal thoughts. Five years previously, however, he was admitted twice to a psychiatric ward with psychotic symptoms associated with the use of cannabis. Currently there is no evidence of psychosis, and no relevant medical history. He came to hospital on his own, but a friend provided a collateral history on the telephone. The patient says that if he goes home he is worried that he will take the large amount of paracetamol tablets that await him there.


    • 1 How would you assess his risk of suicide?

    • 2 How would you manage this patient?

    • 3 What are the general principles of suicide prevention?


    1 How would you assess his risk of suicide?

    Short answer

    The likelihood of future suicide should be …

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