Include, if a motive for intentional self-harm or attempted suicide is indicated.

Note: Is the person communicating?

Unless the patient communicates, it is very difficult to know what responses are behind the actions taken.

Examples of motives:

• Suicidal intent: “Leave me alone. I just want it to be over.”
• Ambivalent: “I’m exhausted. I thought this would be fast or easy, but I can’t even get killing myself right.”
• Cry of pain (wanting relief/escape from an unbearable state of mind): an internalized emotional response to feelings about self and life in relation to self (10)
• expressing feelings of desperation
• feelings of self-hatred
• desire to self-punish
• to feel sense of control.
• Cry for help (acting to change a life or relationship situation): an externalized emotional response to feelings about life events that impact on self (10)
• to get attention/love
• to punish
• to frighten
• to test another person’s feelings
• to express an emotion
• to get revenge.

If more than one of the above motives are communicated, then it is a case of intentional self-harm and should be recorded in the surveillance system. The case may also be a suicide attempt but sufficient information to confirm the level of suicidal intent may not be available.

 

Action  =  Include

Vignette Example – Indication of Motive (a) Admission Notes: 35-year-old man brought in by social worker. Intoxicated (C2H5OH) and suspected overdose as found with 5 empty 100ml bottles of Calpol (liquid paracetamol). HIV+. Behaviour: Sweating and nauseous, expressing suicidal intent due to HIV status*.

 

Action  =  Include

Vignette Example – Indication of Motive (b) Admission Notes: 50-year-old male farmer BIBA semi-conscious. Discovered by relative. Empty alcohol bottles and container of carbamate next to bed. Unclear how much pesticide has been consumed. Behaviour: Says no point in anything, that he is tired of living*. Intoxicated. Telling staff to go away and leave him alone.

 

Action  =  Include

Vignette Example – Indication of Motive (c) Admission Notes: 18-year-old female brought in by husband following ingestion of paraquat and chloroquine. According to husband she had argument with mother-in-law. Poured paraquat into glass with handful of chloroquine tablets before he was able to stop her. Not sure how much she drank but thinks about a quarter of a glass. Behaviour: Says that she is angry with her mother-in-law and wants to teach her a lesson*. When husband is present seems to be happy.

 

*communicated motive is underlined