Psych CASC / OSCE · Emergency psychiatry — suicide risk
Assess and safety-plan after suicidal ideation — CASC communication station
MRCPsych/FRANZCP-style CASC: direct suicide enquiry, empathic formulation, means restriction, Stanley-Brown safety plan, involve supports, and clear safety-net without graphic method coaching or no-suicide contracts.
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Target exams
Station brief
Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in the community clinic. [1]
Candidate instructions. Assess the person’s suicidal thoughts, intent, plan, and means. Explore recent stressors and supports. Collaboratively create a safety plan including means restriction. Agree follow-up and crisis contacts. Do not use a no-suicide contract. Avoid graphic method coaching. Check understanding. The examiner plays the patient. [1][2]
Candidate scenario
Your patient, age 35, has recurrent depression. Today they say: "I keep thinking everyone would be better off if I weren’t here. I’ve thought about taking all my tablets. I haven’t done it. I lost my job last week. I live with my brother but haven’t told him." Current medications include sertraline 100 mg daily; a month’s supply is at home. [3]
Marking domains
- Empathy, calm pace, non-stigmatising language
- Direct enquiry about ideation, intent, plan, timeline, and means
- Exploration of protective factors and reasons for living
- Collaborative safety plan (warning signs, coping, people, professionals, means)
- Means restriction for stockpiled medication; involve brother with consent
- Clear follow-up and crisis pathway; summarises and checks understanding
- Avoids no-suicide contract and graphic method detail [1][2]
Reveal assessor key
Open. Thank them for telling you; name time; normalise that talking about suicide is part of good care and does not make things worse. [3]
Assess. "Have you had thoughts of ending your life?" Map frequency/intensity. "Do you intend to act on those thoughts?" "Have you thought about how or when?" "What tablets, how many, where are they?" Explore job loss, sleep, alcohol, hopelessness, prior attempts. Quote content in your mind for documentation later. [2]
Protective. Reasons for living; relationship with brother; future goals; what has stopped them so far. [1]
Safety plan. Co-write: warning signs of rising risk; what they can do alone first; who/where for distraction; brother and others to call; clinic/crisis/ED pathway with local numbers; means — reduce tablets at home (pharmacy return, brother holding meds, limited supply). Give them the written plan. [1]
Close. Summarise risk and plan; book rapid review; invite questions; confirm they know how to get help overnight. If intent escalates or means cannot be secured, escalate to crisis team/ED/admission pathway. [1]
References
- [1]Stanley B, Brown GK, Brenner LA, et al. Comparison of the Safety Planning Intervention With Follow-up vs Usual Care of Suicidal Patients Treated in the Emergency Department JAMA Psychiatry, 2018.PMID 29998307
- [2]Posner K, Brown GK, Stanley B, et al. The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults Am J Psychiatry, 2011.PMID 22193671
- [3]Turecki G, Brent DA Suicide and suicidal behaviour Lancet, 2016.PMID 26385066