Asking about self-harm and suicide in primary care

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We’ve been reading a very useful report about the sensitive topic of asking about suicide and self-harm when a patient is in primary care. You can read the full report from Ford et al here and we have pulled out some of the key points below.

1. When asking about self-harm or suicide, the wording of the clinician’s question is very frequently framed for a “no” response.

For example, they may ask, “You’re not having any thoughts of harming yourself or suicide or anything like that?” This can make it difficult for service users to answer “yes”.

2. The wording of the question can affect not only the service user’s immediate response (i.e. “no” versus “yes”), but the trajectory of the entire interaction.

For example, when service users answer negatively – even when their negative response is delayed, hesitant, or ambiguous – clinicians tend not to pursue further discussion on the topic.

3. Service users who answer “yes” when asked about thoughts of self-harm or suicide often downplay the seriousness of their thoughts.

It’s unclear why this is, but it is likely related to both the negative framing of the clinicians’ questions and/or the stigma associated with self-harm and suicide.

4. Clinicians often focus their questions on the risk assessment of actions and behaviours.

The level of distress caused by thoughts of self-harm is not typically addressed or acknowledged.

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