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Dilemma: Suicidal patient

A middle aged man is brought to the surgery by his distraught sister. He has just discovered that his wife is having an affair and has decided that life is no longer worth living – in fact, he was half way through writing a suicide note when his sister interrupted him

Dr Ian Walton online

This is a challenging but familiar scenario for primary care, this patient has no psychiatric diagnosis, however he would potentially meet the requirements to be referred and even sectioned, if there were no other services available to him. The GP would explain that most people who feel suicidal do not want to kill themselves, but can’t stand the pain of living at that moment and this will show empathy  and understanding of how is feeling now.

Further explanation that he is unlikely to continue feeling like this forever and that with the combined help of his  supportive family and primary care mental health resources he should be able to get through this difficult time.

Examining reasons for him to want to live, such as his family, employment and friends would remind him of positive aspects within his life and it would be worth pointing out the devastation it would cause to his loved ones should he kill himself.

In Sandwell primary care mental health and wellbeing services would see him urgently and offer an alternative to the medical psychiatry service with the stigma it entails. If negotiation could re-assure his GP  that he would not kill himself until seen again in a few days time, the services will closely support  his sister, family and him. Without this reassurance and local access to primary care mental health services there would be no option but to urgently refer him to psychiatry where he may or may not fit the criteria for assessment and potentially fall between services with devastating results.

Dr Ian Walton is a PRIMHE trustee and a GP in Sandwell.


Jane Harris online

In the first instance, we would advise the GP to consider seeking a second opinion from a colleague as to whether this man is showing signs of mental illness. They could also think about contacting an approved mental health professional to ask for their views on using the Mental Health Act to detain the man for assessment.

However, if even after a second opinion, it’s he is still assessed as not having a mental disorder and having mental capacity, it is ultimately up to him to decide whether he wants to engage with support. You could tell him and his sister that if he changes his mind about needing help, they could get in touch with Rethink Mental Illness for more information about the kinds of services available and whether there are any local peer support groups in the area. Talking to others who have been through mental illness can sometimes help people to open up about symptoms that otherwise can be difficult to talk about.

The GP could also signpost him to the Samaritans, if he’d like to speak to someone about how he’s feeling.

In terms of more general advice for the practice, we would recommend they do the free training at or book a face to face training session. The GP might also want to consider whether the practice could benefit from bringing in mental health experts to work in the practice long-term – in Leicestershire, we have worked with 84 GP practices to provide more specialist support. GPs in these practices say the service has improved QOF scores as well as meeting patient needs and avoided CMHT referrals.

In the longer term, the sister may well need support too. The GP might want to suggest she gets in touch with our Siblings Network, which provides advice, information and support both online and through a network of support groups, for the brothers and sisters of people with a mental health problems.

Jane Harris is the associate director at Rethink Mental Illness.

For more information about the support Rethink can provide, go to

Readers' comments (7)

  • " it would be worth pointing out the devastation it would cause to his loved ones should he kill himself."
    Could someone comment on this sentence by Dr Ian Walton about the possibility of piling on more guilt on this man than he has already? I'm not convinced this is an appropriate strategy

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  • The fact that his sister has persuaded him to see the GP is a major step. Most suicidal men never get to the GP and have not used Mental Health Services.
    It is essential that what he and his Carer says is taken seriously the ripple effect of a suicide is traumatic for friends, family & work colleagues and life lasting. Action/counselling needs to be immediate not left for a follow up weeks later. Support for the Carer and family is essential other wise another suicide will take place in the future.There are also a number of charities now which specialise in this area and can give advice and are more knowledgable than GP's

    Carer of husband who attempted suicide 37 years ago and left himself with brain damage to long & short term memory.

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  • I agree, pointing out how devastating it would be for the people left behind is not helpful at such a time of crisis. If you've got to the point of seriously considering and/or attempting suicide then you have on more than one occasion thought long and hard about the people who would be left behind. Rather than laying on the guilt, prompt referral to the appropriate support - be that a charity or healthcare - is essential. If they have presented to a GP there is an opportunity to get them the support they so desperately need. One thing you can be sure of is that getting as far as the GP surgery (or in fact any healthcare service or charity) was an enormous challenge for them and/or there family/friends - sadly a completed suicide is a permanent solution to what is often a temporary state of extreme distress. As anonymous points out even uncompleted suicide attempts can have permanent implications for the patient and their families.

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  • ajaz siddique

    Your engagement with patient will determine appropriate course of action.A crisis team input seems most appropriate at this stage. This amalgamated with empathy would be my way of proceeding.
    i am unsure of couple of Dr Walton's points.

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  • Agree Crisis Teams and CMHTs are appalling and disgusting in the way they treat suicidal patients.

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