Exploring thoughts of suicide

We would like to thank Kruger, Clifford, Large and Caan for their helpful comments. Assessing individuals with thoughts of harming themselves is a complex and nuanced task and summarising this in an infographic proved to be very challenging. We aimed to provide practical guidance on how this could be done within the average consultation length of 11.7 minutes in UK General Practice.(1)

Clifford is quite right that intoxication with alcohol or drugs can increase the risk of acts of self-harm. We acknowleged this in the article, but it proved challenging to incorporate such complexity into the infographic. We have amended the infographic to attempt to better incorporate this. As Caan states, timing is key.

We agree with Large that risk assessment is imperfect, as discussed in detail in the excellent article by Gunnell et al.(2) Given that this was published in the BMJ so recently we purposefully avoided overlap. Nevertheless, given that up to 5% of people have had thoughts of harming themselves in the last year, (3) there has to be some means of deciding who would benefit most from, or most needs psychiatric intervention. This can be a very challenging decision for generalists, and risk assessment as part of a holistic assessment can be helpful in making this decision.

Reference List

1. The Information Centre. 2006/07 UK General Practice Workload Survey The Information Centre, Part of the Government Statistical Service; 2007 Available from: http://content.digital.nhs.uk/catalogue/PUB01028/gp-work-serv-rep.pdf.
2. Bolton JM, Gunnell D, Turecki G. Suicide risk assessment and intervention in people with mental illness. BMJ. 2015;351.
3. McManus S, Hassiotis A, Jenkins R, Dennis M, Aznar C, Appleby L. Chapter 12: suicidal thoughts, suicide attempts, and self-harm Leeds: NHS digital; 2016