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Self-Harm Assessment and Alcohol — MRCPsych Paper B MCQ

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EasyLiaison PsychiatrySelf-Harm Assessment and AlcoholMRCPsych Paper B

A 45-year-old man presents to the emergency department following an episode of self-harm. He has consumed alcohol but is medically stable, alert and able to engage meaningfully in conversation. Staff propose delaying his psychosocial assessment until he is sober. According to NICE NG225, what is the most appropriate action?

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Correct answer: C — Begin the assessment at the earliest opportunity without using alcohol intoxication or an alcohol level alone to delay it

NICE recommends psychosocial assessment at the earliest opportunity after self-harm and states that breath or blood alcohol levels should not be used to delay it. This man is alert and able to engage, so assessment should proceed despite intoxication. Waiting for complete sobriety or a specified alcohol concentration is inappropriate because alcohol levels do not reliably establish ability to participate. Discharge without assessment is unsafe, and medical treatment should not routinely postpone psychosocial assessment. If intoxication made him unable to participate meaningfully, he should instead receive regular reviews and undergo psychosocial assessment as soon as he became able to engage.

Reference: National Institute for Health and Care Excellence. Self-harm: assessment, management and preventing recurrence (NG225), section 1.5, recommendations 1.5.1–1.5.5. 2022. https://www.nice.org.uk/guidance/ng225/chapter/recommendations