DEPRESSION AND CHRONIC

PHYSICAL ILLNESS: THE NEED

FOR CONTINUED AND
INTEGRATED CARE

Policies on Depressive
Mood Disorder and
Suicidality

Policies

ASSESSMENT FOR
SUICIDALITY
(PSYIPP-002)

Assessment for Suicidality

(PSYIPP-002)
Definitions
The suicidal patient is more often than not
a very depressed patient. This may be
obvious because the patients mood is one
of depression. In addition, the patient may
complain or admit to a number of
symptoms which include poor sleep, poor
appetite, loss of weight, loss of interest in
self or usual activities and inability to
enjoy life.
Very depressed patients may be gloomy
about the future or hopeless. They may
have contemplated suicide.

Assessment for Suicidality

(PSYIPP-002)
Some suicidal patients may not look
particularly depressed but are full of somatic
complaints. The importance of this is that
the doctor must not shy away from asking
the patients whether they have thought that
life was not worth living anymore and if so
whether they have made plans or have
actually tried to take off their lives.
However it is important to stress that it
may not be immediately obvious that the
patient is potentially suicidal, hence the
need to note the following risk factors:

Assessment for Suicidality

Risk factors:

Assessment for Suicidality

(PSYIPP-002)
Policy
Always, early detection of deliberate self-harm is the
best prevention of suicide.
Procedure
Upon admission to the ward, every patient will be
evaluated for suicidality. The assessment will include:
o Presence of suicidal thoughts.
o Plan for suicide or attempts, as available.
o History of suicidal gestures
o History of recent suicide attempts including
dates
and the precipitating events leading to the attempt.

Assessment for Suicidality

(PSYIPP-002)
All patients admitted to the wards following
any suicide attempt will be considered high
risk, kept on suicide precautions and
assessed every 24 hours.
Suicide precautions are to be ordered by the
responsible psychiatrist. Nursing personnel
will implement suicide precautions while
awaiting the order.
o The physicians order will specify level of
observation. The level defines the degree
of
staff to patient supervision.

Assessment for Suicidality

(PSYIPP-002)

All patients on suicide precautions will be

restricted to the ward unless it is medically or
clinically necessary, wherein the patient will
be accompanied, by staff, to his/her
destination.
This is an ongoing assessment since patient
in a behavioral health setting may regress at
any time. Orders for suicide precautions will
be renewed every 24 hours and discontinued
only by order of the responsible psychiatrist.
Other policies regarding suicidal patients are
complementary to this policy.

ESSENTIALS OF CARE AND

MANAGEMENT WHILE
DEALING WITH A PATIENT
WITH DEPRESSION

Definitions
According to DSM V, a patient with major
depressive disorder (MDD) possess 5 or
more symptoms
There MUST be presence of at least one
asterixed symptom.
It should cause impairment in the social,
occupational and other areas of
functioning.
Symptoms must not be due to the physical
effects of a substance (drugs, alcohol,
medication) or a medical condition.

Symptoms of depressive mood

disorder

Case Identification and

Recognition
All patients admitted to the medical ward
with a history of chronic illness must be
screened for depression with PHQ 2
If the client answers 'Yes' to either of the
depression identification questions, the RN
must review the persons mental state and
associated functional, interpersonal and
social difficulties with PHQ 9

Case Identification and

Recognition
For patient with significant language or
communication difficulties, e.g. people with
sensory impairment or a learning disability,
consider using the distress thermometer
and/or asking a family member or carer
about the person's symptoms to identify
possible depression. If a significant level of
distress is identified, investigate further.
Grade the level of depression as mild,
moderate or severe according to the
scoring obtained in PHQ 9.

Case Identification and Recognition

For patients already diagnosed with depression
and under management/treatment, review the
drugs and dosages as current admission and
diagnosis is a further stressor.
Inform the mental health team or clinical
liaison. Pager no. 0841
Mental health specialist begins treating the
patient and communicates response and
recommendations back to the primary care
clinician. They communicate and coordinate
patient treatment until problems are resolved.

Provide Information and Support,

and Obtain Informed Consent

Risk Assessment and

Monitoring
If the patient is having moderate or severe
depression in PHQ 9, screen the patient for
suicidal intent
If a person with depression presents
considerable immediate risk to themselves
or others, refer them urgently to specialist
mental health services.
Note: The Registered Nurse must address
the comprehensive bio-psychosocial needs
of the patient

Biologic Domain
The person experiences a self care deficit and self
esteem disturbance and therefore:

Patient

Antidepressant Side Effects

Psychological domain

Enhance the Self-esteem of the

Client and Improve the Social
Interactions

Ensure Safety of the Patient by

Preventing Any Self Harm or
Suicidal Behavior

Thank You