Clinical Case 2

Billy has self-presented to the Emergency Department because he is so low in mood that he is thinking of committing suicide.  He is known to both the Mental Health Service and to the Emergency Department and is a frequent attender.

In the past he has attempted suicide by deliberate overdose; on one occasion he has needed inpatient treatment as a result of an overdose.  Sometimes he claims to have taken an overdose, but blood tests have not supported his claims.  Today he denies having taken anything.

Although it’s quite a hot day. You notice that, not only is he wearing long sleeves, but that there are bloodstains on his sleeves.

He refuses to allow you to examine his arms but tells you repeatedly that he just wants to die.