Risk assessment is also necessary. The practitioner should ask someone with depression directly about suicidal ideation and intent.
If there is a risk of self-harm or suicide, then there is a need to check whether the person has adequate social support or is aware of sources of help, and to arrange it if necessary. The person should be advised to seek further help if the situation deteriorates, but those at considerable immediate risk should have an urgent referral to specialist mental health services.3,4
Patients and their family or carer should also be encouraged to be vigilant about mood changes, agitation, anxiety, negativity and hopelessness and suicidal ideation and to contact their practitioner if concerned.
Risk assessment is also important when considering treatments. Treatment should not be withheld if the person is considered a suicide risk, but take into account potential toxicity of any prescribed medication, or the amount dispensed are important. It may be appropriate to increase the level of support such as the frequency of face-to-face or telephone contact, or for a referral to specialist mental health services.