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Self-Harm Management — MRCPsych Paper B MCQ

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EasyLiaison PsychiatrySelf-Harm ManagementMRCPsych Paper B

A 22-year-old woman with depression presents to the emergency department 6 hours after an intentional paracetamol overdose. N-acetylcysteine has been started. She is haemodynamically stable, alert and able to engage in conversation. The liaison psychiatry team is asked to see her. What is the most appropriate next step?

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Correct answer: EBegin psychosocial assessment now while physical treatment continues

The correct answer is E. NICE NG225 recommends psychosocial assessment at the earliest opportunity and explicitly states that it should not be delayed until medical treatment is completed. Physical healthcare and psychosocial assessment should usually proceed concurrently. This patient is stable, alert and able to participate, so treatment with N-acetylcysteine is not a reason to defer liaison assessment. Waiting for her to become “medically fit” is therefore inappropriate. Discharge should not be arranged before physical care, psychosocial assessment and aftercare planning are complete. A Mental Health Act assessment is required only if detention is being considered; it is not an automatic prerequisite following self-harm. Adult social care involvement depends on identified safeguarding or social-care needs and does not routinely precede psychosocial assessment.

Reference: National Institute for Health and Care Excellence. Self-harm: assessment, management and preventing recurrence. NICE guideline NG225, recommendations 1.5.1–1.5.5 and 1.7.2–1.7.3, 2022. https://www.nice.org.uk/guidance/ng225/chapter/recommendations