Assessing suicidality via interpreter

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Hi everyone,

  I'm a GP and I was talking to someone this morning through an interpreter. He has PTSD and depression and some second-person auditory psuedohallucinations. What I found really difficult through the interpreter was assessing the degree of risk. He refused urgent psychiatric assessment - should I be arranging one against his will?

  On reflection I think what I find really difficult about this, and similar cases, is that the effect of depression on capacity is one that occurs by degrees. I suppose we would say they have lost the capacity to believe and reflect on relevant information when any statement that is hopeful or positive is automatically disbelieved - because this is objectively a break from reality. But before that point, when hopeful statements just seem to the patient incredibly unlikely, or just seem to be forgotten immediately?

  Are there any useful questions you ask to assess this?

  Also I found discussing these things through a interpreter (interpreter's on the phone, patient is in the room) almost like communicating through text message - yes, you can read the general tone of what is being said at the time - but the translated words come out thirty seconds later, devoid of any inflection. It was like going back to doing those first risk assessments you did in your training and having no idea how seriously to take things.

  Any advice from the more experienced members on how to manage these?


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Well in psychiatry no two cases are similar  and every cases are varied and have its own challenges.

First and foremost , its important to establish rapport  in psychiatry, In my view it does help to shape the further assessment.

You have mentioned rightly ,capacity assessment is more important before  you carry on doing anything or prescribing medication  refer to any other support services.  and I am sure  you know capacity is time and situation specific.

Assessment of psychiatric patients has its own challenges, but with interpreter that too on the phone you can only imagine how difficult it would be ??

Regarding risks , briefly it could be classified into dynamic and static risk factors.In forensic the risk assessment is very detailed  and exploring minute details. but that does not mean we should  not be thorough in other sub-specialties

I always start risk assessment with more open questions and then  narrowing it down to closed  and direct questions.

My personal view is there is no right or wrong method of risk assessment , but we need to ascertain the risks to self to others primarily  and  then to property and other things..There are loads of  websites on risk assessment and loads of forms likes the FACE RISK

I  really appreciate you that you have taken times  and  effort to assess the patient, the easiest thing would have been to refer to a psychiatrist .


Good Luck

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