Educational draft · awaiting clinical reviewThe full textbook explains uncertainty but does not replace live national or local guidance, specialist advice, or current prescribing information.
Combine toxicological care with an early psychosocial assessment, formulate ongoing safety needs and arrange a specific shared plan after intentional self-poisoning.
The aim after an overdose is to understand what happened, treat its physical consequences and reduce the likelihood of further harm. The number of tablets and the patient's stated wish to die are important but incomplete. A person may underestimate toxicity, conceal a co-ingestion, feel ambivalent about living or describe different intentions as distress changes. Ask with curiosity and directness, avoiding a moral judgement about whether the event was serious enough to deserve assessment.
The toxicological and psychosocial tracks should run together. Establish substance, formulation, estimated amount, timing, alcohol or other co-ingestion and treatment already given. Check original packets, prescriptions and collateral information where appropriate. Use the specific TOXBASE entry and NPIS advice for uncertain or complex poisoning. A general observation period or generic blood panel cannot establish safety for every substance; antidote, ECG, blood concentration and repeat-test requirements depend on the exposure.
A mental-health professional should undertake psychosocial assessment as early as the person can engage. Mild intoxication does not necessarily prevent a meaningful conversation, and a fixed alcohol threshold should not determine access. If drowsiness, severe intoxication or distress makes assessment unreliable, provide immediate care and review readiness regularly. Initial conversations, collateral evidence and supportive contact remain useful even when the full assessment must be completed later.
Current intent, preparations, inability to identify a workable short-term safety plan or reluctance to disclose access to means requires careful escalation.
A patient's description can change as fear, shame, intoxication or distress changes; explore discrepancies respectfully without assuming deception.
Coercion, violence, exploitation or inability to return safely home may become apparent only during private discussion away from accompanying people.
Chronic pain, disabling illness, pregnancy, dependence on others or limited access to care may shape both the episode and the support required afterwards.
Dose and timing depend on substance, formulation, body weight, ingestion pattern and organ function; the relevant entry must be available at prescribing. No generic antidote reverses intentional self-poisoning as a category.
A person can intend to die after a medically limited ingestion or survive a highly toxic exposure they believed harmless, so both dimensions require assessment.
A single label can hide changing circumstances and actionable needs; a formulation explains the current concerns and why particular support is being arranged.
Supportive mental-health contact during medical treatment can improve engagement and prevent the patient waiting unsupported for a sequence of artificial clearances.
A telephone number is not an effective plan if the person lacks a charged phone, privacy, language support or confidence that the service will respond.
Declining psychosocial assessment because the patient is intoxicated without assessing their actual ability to engage or arranging regular review.
Using a low score, apparent remorse or an agreement not to self-harm as the deciding reason for discharge.
Waiting for all physical treatment to finish before offering any mental-health support when parallel assessment is feasible.
Assuming the accompanying partner is safe to involve without providing a private opportunity to disclose abuse or coercion.
Providing vague follow-up instructions without a named service, timing or solution to barriers that could prevent attendance.
Your practice draft is saved in this browser.
A patient who has intentionally taken tablets has consumed alcohol but remains able to follow a conversation and explain the events clearly. Physical treatment is underway. How should the mental-health assessment proceed?
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 7 Sept 2026; clinical approval remains outstanding.
Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes
Explore the sequence before, during and after the overdose. Ask about stressors, planning, expectations of death, measures to avoid or obtain discovery, help-seeking, current regret and continuing thoughts. Include previous self-harm, mental illness, trauma, substance use, physical pain, domestic abuse, housing, debt, work and dependants. Protective relationships and future plans matter, but they do not cancel active intent. Formulate how the factors interact in this person's current situation.
Discharge requires a coherent clinical and practical plan. Confirm that the poisoning-specific observation and treatment requirements are satisfied and that psychosocial assessment and aftercare planning have taken place. The patient should know who will contact them, when, and what to do if the situation worsens. Provide written information in an accessible form, involve carers appropriately and communicate with relevant services. A promise not to self-harm is not a substitute for this work.