High suicide risk — MCCQE Part 1 MCQ

Correct answer: A — Arrange emergency psychiatric assessment and do not leave him alone

Arrange emergency psychiatric assessment and do not leave him alone is best because specific plan, means and inability to safety-plan indicate high acute risk. Provide reassurance only and arrange no follow-up is suboptimal because mental health risk often requires structured follow-up or urgent escalation; Use long-term benzodiazepine monotherapy as default treatment is suboptimal because benzodiazepine monotherapy is rarely an appropriate long-term strategy; Avoid direct risk assessment to preserve rapport is suboptimal because direct assessment of suicide, violence, capacity and substance use is clinically appropriate; Attribute symptoms to personality or culture without assessing illness is suboptimal because diagnostic overshadowing risks missing treatable mental illness. Confidentiality can be limited when there is imminent serious harm.

Reference: CANMAT; Canadian psychiatric emergency guidance