Emergency Department attendance from patients in mental health crisis continue to rise. National hospital episode statistics 2017-18 data showed an increase in mental health attendances by 133% between 2009/10 and 2017/18.[1]

Those who have had a previous attempted suicide have an increased risk, 30-40 fold more, than the general population of completed suicide [2].

The Royal College of Psychiatry (RCP) has produced guidance relevant to ED staff which include the assessment of self-harm and safety for trainees [3].

Doctors need to familiarise themselves with safety guidance to ensure personal safety. An accurate initial assessment may include a psychiatric history and mental state examination, including risk assessment of the patient.

Disturbances in mental state may be due to organic or non-organic causes and the features which help distinguish between these groups will be discussed.

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