A 24-year-old female is brought in by ambulance after being seen climbing over the railings of a nearby railway bridge. A bystander approached her after she had climbed over and had been told that she wished to end her own life. With the assistance of Gardai and the Ambulance Service, she was successfully retrieved and brought to the Emergency Department.

Her medical history includes depression, diagnosed aged 23 for which she takes Escitalopram.

She has not previously had any suicide attempts or deliberately harmed herself.

In conversation she tells you that she chose that particular location because she believed she wouldn’t be seen, that she has written letters at home for her family and friends and has already emptied her bank accounts in planning for today.

Her mental status exam reveals a quiet, casually dressed woman with a paucity of speech and poor eye contact. Her mood is subjectively and objectively low, thought content is pervasively negative but reveals no psychotic features and her insight appears to be retained

Answer the following questions as best you can before moving on.

Question 1

What features of this person’s history are concerning?

Question 2

How might you risk stratify this persons presentation?

Question 3

What criteria must be met in order for a person to be involuntarily admitted?