PS12.1 | Psychiatric Emergencies — Practice Quiz

Correct. Access to means (he was researching lethal doses) combined with intent to act is the most immediate risk determinant. Ideation without intent and accessible means carries lower acute risk. Psychiatric diagnosis and symptom duration contribute to overall risk stratification but do not directly gauge immediate lethality.

In the structured assessment, intent and means/access are the pivotal domains that convert passive ideation into high acute risk. Always clarify what the patient has access to and how close they are to acting.

The most direct determinant of immediate risk is the combination of access to means and degree of intent to act — not diagnosis, frequency of thoughts, or symptom duration alone.

Correct. Research consistently shows that asking directly about suicidal ideation does not plant the idea or increase risk. In fact, it provides relief to many patients who felt unable to raise the topic themselves. Direct inquiry is both safe and obligatory in at-risk individuals.

One governing principle of suicide risk assessment: asking about suicide does NOT increase risk. Avoiding the question, however, allows life-threatening ideation to go undetected.

The fear that asking about suicide increases risk is a common misconception. Evidence shows direct inquiry is safe, reduces stigma in the therapeutic relationship, and is a clinical obligation in at-risk patients.

Correct. A prior suicide attempt is the single strongest predictor of completed suicide across all epidemiological studies. In this vignette, the history of a prior attempt is not explicitly stated — highlighting the critical importance of always asking about past attempts, which the clinician must not assume from the information volunteered.

Always ask explicitly about prior attempts. They may not be volunteered. A prior attempt multiplies risk more than any other single variable and must drive escalation decisions.

While a specific plan and access to means both raise acute risk significantly, the single strongest predictor of completed suicide across populations is a prior suicide attempt.

Correct. Section 115 of the Mental Healthcare Act 2017 explicitly states that a person who attempts suicide shall be presumed to be under severe stress and shall not be punished. The government is obligated to provide care, treatment, and rehabilitation. This replaced the criminal liability under IPC Section 309 that existed under the Mental Health Act 1987.

MHCA 2017 Section 115 decriminalised suicide attempt in India. The predecessor statute (Mental Health Act 1987) did not provide this protection; IPC 309 was the prior mechanism for criminalisation. Clinicians must document this framework and not threaten legal consequences to patients who disclose attempts.

Under the Mental Healthcare Act 2017 (Section 115), a suicide attempt is decriminalised. The person is presumed to be under severe stress; IPC Section 309 no longer applies, and the State must provide care.

Correct. This patient meets criteria for HIGH acute risk: specific plan + accessible means + stated intent to act tonight + two prior attempts + intoxication + social isolation + male sex. Outpatient management is not safe. Emergency psychiatric admission is mandatory, and the patient must not be left unattended until transfer is completed.

Risk stratification drives disposition. High-risk features — specific plan + means + imminent intent + prior attempts + intoxication + isolation — mandate inpatient psychiatric admission. Safety plans are for low-to-moderate risk only; they do not substitute for admission in high-risk cases.

This clinical picture (specific plan, accessible means, tonight's intent, two prior attempts, intoxication, isolation) constitutes high acute risk requiring emergency admission, not outpatient or partial measures.

Correct. Means restriction has the strongest evidence base as a suicide prevention intervention. It works independently of the patient's state of mind; restricting access to lethal means during a high-risk period reduces impulsive action even when other protective factors are temporarily overwhelmed.

A safety plan is not merely a 'no-suicide contract.' Its most critical actionable component is means restriction. Firearms, medications, sharp implements, and other identified methods must be addressed with the patient and, where appropriate, with a trusted person.

While all listed elements may appear in a safety plan, means restriction — identifying and removing or restricting access to lethal methods — is the component with the strongest evidence for preventing completed suicide.

Correct. Passive death wishes with hopelessness, no current active ideation, no plan, no prior attempts, and identifiable psychosocial stressors represent low-to-moderate risk. This warrants a safety plan, close outpatient follow-up, and psychoeducation — not emergency admission. Hopelessness is an independent risk factor that justifies active monitoring.

Risk stratification requires weighing all six domains. Hopelessness is a powerful independent predictor and should never be dismissed, but in the absence of active ideation, a specific plan, or prior attempts, low-to-moderate risk management with a robust safety plan and close follow-up is appropriate.

Passive death wishes with hopelessness but no active ideation, plan, or prior attempts represent low-to-moderate rather than high risk. This requires active management with safety planning and close follow-up, but not emergency admission.

Correct. Documentation of a suicide risk assessment must be comprehensive: all six assessment domains, findings for each, the clinician's risk stratification, the reasoning behind that stratification, the safety plan details (including means restriction), any referral or admission decision, and the follow-up plan. This is both a standard of care and a medico-legal requirement.

Documentation is the final step in the assessment cycle and must be as rigorous as the assessment itself. It should record: what was asked and found across all six domains, the risk level, the rationale, the safety plan, means restriction steps taken, and follow-up arrangements.

Comprehensive documentation is a core clinical and medico-legal obligation following every suicide risk assessment. Selective or incomplete documentation is both unsafe and legally inadequate.

Correct. The validated six-domain structured sequence begins with suicidal ideation, then clarifies intent to act on that ideation, then ascertains whether there is a specific plan, then assesses access to the chosen or available means, then explores past attempts, and finally evaluates protective factors. This sequence logically builds from passive cognition to active lethality.

The six-domain sequence is not merely a mnemonic — each domain logically gates the next. Begin with ideation to establish presence; clarify intent to gauge active risk; establish plan specificity; assess means access to judge lethality; always ask about prior attempts; then explore what keeps the patient safe.

The correct structured sequence is: suicidal ideation → intent → plan → means/access → past attempts → protective factors. This order moves logically from passive suicidal thinking to active lethality markers and then to mitigating factors.