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Major depressive episode with imminent suicide risk — MCCQE Part 1 MCQ

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HardSuicidal IdeationMajor depressive episode with imminent suicide riskMCCQE Part 1

A 46-year-old man presents with low mood, insomnia and hopelessness for 2 months. He has bought a rope, written notes to his children, and says he may use it tonight. He has been drinking heavily and refuses voluntary admission. What is the most appropriate next step in management?

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Correct answer: A — Arrange emergency psychiatric assessment and involuntary hold according to provincial mental health law

A specific plan, preparations, intoxication and stated near-term intent indicate imminent suicide risk requiring emergency psychiatric assessment and, if criteria are met, involuntary detention under provincial law. A no-harm promise is not a safety plan. Outpatient SSRI initiation may be part of later care but is inadequate for immediate risk.

Reference: Canadian Psychiatric Association depression guidance; provincial Mental Health Acts