Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Imminent suicidal action or serious injury
An act in progress, recent potentially lethal self-harm, current intent with available means, inability to delay action, severe intoxication or loss of a safe environment requires immediate emergency intervention.
Action: Treat physical injury and poisoning using the relevant emergency pathway, remove access to immediate means where safe, arrange continuous proportionate observation and obtain urgent mental-health assessment. Involve emergency services when the setting cannot maintain safety, assess capacity for each decision and document the lawful basis of any restriction or non-consensual information sharing.
Synopsis
Assess suicidal thinking and self-harm through a compassionate psychosocial assessment, formulate person-specific scenarios and changing drivers, and translate evidence, strengths and uncertainty into immediate safety actions without relying on predictive scores.
Ask directly about thoughts of death, self-harm, suicide, intent, method, timing, preparation, access to means, interruption and what has prevented action so far.
Establish the function and context of any self-harm, including relief, communication, punishment, dissociation, compulsion or suicidal intent, without assuming one purpose from the method.
Build a chronology of previous acts, lethality, intent, rescue, treatment and periods of recovery; recent change and trajectory often matter more than a static factor list.
Key red flags
A specific plan, rehearsal, final arrangements, concealed preparation, available lethal means or stated inability to remain safe markedly increases immediate concern even when the person appears calm.
Investigation priorities
01
Psychosocial assessmentFirst stepPreferred
Understand the self-harm or suicidal crisis, needs, mental state, strengths, context and preferred help.
Management branches
Immediate responseTreat, contain and clarify danger
Self-harm has occurred or current suicidal action may be near.
Stabilise physical injury or poisoning, reduce immediate access to means and arrange observation matched to the actual environment and behaviour.
Ask directly about intent, method, timing, preparation and ability to collaborate with safety while obtaining urgent collateral facts when needed.
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 27 Aug 2026; clinical approval remains outstanding.