Child and adolescent suicide and self-harm assessment — OSCE communication station

Station objectives

1. Ask directly and kindly about suicidal ideation, plan, intent and means access. [2] [1]
2. Stratify risk using the C-SSRS dimensions and weigh against protective factors. [1] [4]
3. Co-build a written safety plan and deliver means restriction counselling to a carer. [6] [5]
4. Recognise imminent risk and act — constant observation, remove means, crisis pathway, do not discharge alone. [3]

Candidate brief

You are the paediatric doctor in the emergency department. You have 8 minutes for Station A (a 15-year-old assessed after an overdose, with her mother present) and 10 minutes for Station B (a re-assessment revealing a specific plan for tonight). Examiners score direct questioning, risk reasoning, safety planning, means restriction and safety override. [3] [2]

Station A — Moderate-risk self-harm assessment

Setup: 15-year-old attended after a paracetamol overdose following a break-up. She is medically stable. Her mother is present. [3] [4]

Expected actions:

• Greet the young person; create private time; state conditional confidentiality with honest limits. [2]
• Ask directly about ideation, then plan, intent, means access and prior attempts (C-SSRS dimensions). [1]
• Distinguish the overdose (intent?) from any cutting (NSSI function?) by asking, not assuming. [7]
• Take the precipitant, screen for depression, substance use, sleep; assess protective factors. [4]
• Stratify as moderate risk; co-build a written safety plan with her. [6]
• Deliver means restriction counselling to the mother — secure medications, remove sharps. [5]
• Arrange urgent mental-health review within 24 to 72 hours; document. [3]

Station B — Re-assessment revealing imminent risk

Setup: In the same encounter she now describes a specific plan for tonight and that she can access more tablets at home. [3]

Expected actions:

• Recognise imminent risk — plan plus intent plus means access. [3] [2]
• Do not discharge; maintain constant observation; remove means within the department. [3]
• Override confidentiality ethically — tell her what must be shared and why, share the minimum necessary, involve her mother and the crisis team. [3] [2]
• Activate the crisis or admission pathway; admit if she cannot be kept safe in the community. [3]
• Document the risk reasoning, the override and the plan; safety-net explicitly. [1] [3]

Marking anchors

Clear pass: asks directly and kindly; correct C-SSRS stratification; co-built written safety plan; concrete means restriction with the carer named as agent; recognises imminent risk on re-assessment; lawful, ethical override told to the young person; no discharge alone; documents reasoning. [1] [6] [3] Borderline: good rapport but stratification vague, or safety plan generic, or means restriction delivered in the abstract without naming the carer. Fail: does not ask directly; reassures on a sudden calm; promises absolute secrecy; misses the imminent-risk re-assessment; discharges alone; or omits means restriction. [3] [5] [2]

Debrief pearls

• Lethality is not intent — ask about intent directly. [7] [3]
• A sudden calm after despair is a red flag; re-assess. [3] [4]
• Means restriction is the fastest lever and names the carer as agent. [5] [6]
• Asking directly does not increase risk. [2]