50-year-old male with long-standing substance abuse history (alcohol, marijuana, heroin until 2009) and complex mental health issues including depression, anxiety, personality traits, and multiple prior suicide attempts. Following his brother's suicide in April 2011, he increased substance use. On 1 July 2012, he called Mercy Mental Health Crisis Assessment and Treatment Team stating he wanted to hang himself and was actively attempting to tie a noose. The psychiatric nurse appropriately assessed him, established he had no protective factors and active means, and contacted police for welfare check. Police responded within 13 minutes and found him already deceased from hanging. The coroner found the mental health response and police response both timely and appropriate. Clinical lessons include the importance of recognizing acute suicide risk with stated intent and immediate means, and the need for rapid crisis intervention, though in this case the intervention occurred too late.
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Specialties
psychiatryaddiction medicine
Drugs involved
alcoholmarijuanamethadonediazepamquetiapine
Clinical conditions
depressiongeneralized anxietycluster A and B personality traitspolysubstance abusesituational crisissuicidal ideation
Contributing factors
long-standing mental health history including depression and anxiety
substance abuse history
prior suicide attempts and self-harm
recent suicide of brother in April 2011
recent increase in alcohol and marijuana use
absence of protective factors identified during crisis assessment
active suicide intent with stated means at time of crisis call
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