Title: Questions to ask someone who has self-harmed
Course: Non-Communicable Diseases, Emergency Care and Mental Health Part 2 - Ethiopia (Full)

Questions to ask someone who has self-harmed

You need to be both sensitive and direct when you ask about suicide. Suicide is a difficult or 'taboo' issue which many people find difficult to talk about, particularly in public. You should talk to the person alone and question them gently. If you are talking to the person after they have just attempted suicide, they are likely to be feeling a range of powerful emotions, including shame and despair. Other people may make these feelings worse by criticising them for being cruel and/or selfish. It is important that you counteract this. Tell the person that things must have been tough for them to try to end their life. After listening carefully to their response, you can proceed to ask them direct questions about the suicide attempt. Asking about suicide does not increase the risk of suicide. In fact, some people feel relieved they are being asked.

Activity 10.1 Posing questions based on the self-harm risk indicators

Read the risk indicators for self-harm in Box 10.4 once again. Then write down some appropriate questions to ask a person who has self-harmed, based on each of the five indicators highlighted in the bullet points. Then compare your questions with our suggestions below.

You may have suggested equally good (or better) questions than those below:

Preparation: What triggered this action? How long did it take you to attempt it from the time you actually thought about it? Did you worry that people might find out? Did you say goodbye to your loved ones?

Method: At this stage you would know what method they used but you would not necessarily know the details. Ask about these details. If you did not know the method, you should also ask: what did you use to injure yourself? You can then ask if they required treatment for the injury, and if so, what it was. You may also ask if the person has ever done something similar in the past. This assesses the history of self-harm (see Box 10.3).

Current mental illness: Has anyone ever discussed the possibility that you might have a mental health problem?

Factors causing loss of control: Were you drinking alcohol or chewing khat before you tried to injure yourself?

Ongoing difficulties: Are there stresses or difficulties in your life, for example, problems at home or not having enough money?

Additionally, ask them about their intention when they self-harmed. You can, for example, ask: What did you hope would happen when you cut yourself with a knife? Now that you have survived, what do you think about what you did? Are you relieved that you did not die? If the person tells you that they are disappointed that they survived, this indicates a continuing high risk.

Study Session 18 (Section 18.4) includes practical advice on how to reduce the risk of suicide.