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SUICIDAL PatientRecognise the patient who has attempted or had thoughts of suicide/self harm needing urgent attention:• Unconscious 1.• If aggressive or violent 50.• Intent to attempt suicide: suicidal thoughts; ongoing wish to commit suicide; plans have been made for suicide• Suicide attempt was serious: planned, took care against discovery; violent or potentially lethal; perhaps preceded by ‘final acts’ like leaving a note or new will.• Overdose of medication like paracetamol or ferrous sulphate or other potentially harmful substance• Exposure to carbon monoxideManagement:• If patient took an oral overdose of medication within past 2 hours and is fully conscious give 500ml water added to 100g activated charcoal via nasogastric tube.• Avoid activated charcoal if patient ingested paraffin, petrol, corrosive poisons, iron, lithium or alcohol.• If patient took opioid like codeine or morphine: give naloxone 0.4–2mg IV. If no immediate effect, repeat every 5 minutes until pupils dilate (maximum 10mg).• If exposed to carbon monoxide: give 100% face mask oxygen.• Contact local poison centre for advice backpage.• If the patient has signs of mental illness (see below) and refuses treatment or admission, consider admitting under the Mental Health Care Act 80.• Refer same day.Assess the patient who has no suicidal intent and has not had a serious suicide attempt not needing urgent attentionScreen for mental illness• If low mood or sadness, loss of interest or pleasure, feeling anxious or worrying a lot or not coping as well as before, consider depression/anxiety 81.• If hallucinations, delusions and abnormal behaviour, consider psychosis 84.• If memory problems, screen for dementia 86.• If patient takes > 21 drinks/week (man) or > 14 drinks/week (woman) and/or > 5 drinks per session or misuses illicit or prescription drugs 83.Explore possible stressors• Ask ‘Are you stressed?’ If yes 52.• Ask ‘Are you unhappy in your relationship? Has anything happened to you which changed your life?’ If yes to either 53.Make discharge and follow-up plans according to the following factors:If any 1 of the following are present:• Male and/or• ≥ 45 years and/or• Socially isolated and/or• Adolescent and/or• Family hitory of suicide and/or• Previous attempts at suicide and/or• Known mental illness and/or• Substance abuse and/or• Functioning impaired and/or• Chronic medical illness like HIV, cancerRefer same week to community psychiatric nurse or social worker.If all of the following are present:• Female and• < 45 years and• Adequate social support and• First suicide attempt and• Suicide attempt was an impulsive act in context of a crisis now resolved and• No evidence of mental illness or substance abuse and• Functioning not impaired and• Otherwise well• Discharge to family/carers.• Review within 1 week:--Reassess for suicidal intent, mental illness, stressors.--Consider referral to community psychiatric nurse.49