A 45-year-old man admitted after a suicide attempt by overdose scores 38 on the Columbia Suicide Severity Rating Scale (C-SSRS). He has a prior attempt, current suicidal ideation with intent, and access to firearms. According to validated risk stratification, which management is MOST appropriate?

• A Outpatient therapy twice weekly
• B Crisis hotline referral and safety planning only
• C Day-hospital (partial hospitalisation) with evening discharge
• D Psychiatric inpatient hospitalisation with means restriction counselling ✓

Explanation

This patient meets high-risk criteria: a prior attempt (strongest single predictor of future suicide), current active ideation with intent and plan, and access to lethal means (firearms). The combination mandates psychiatric inpatient admission to ensure safety, continuous monitoring, means restriction counselling (firearm removal), and stabilisation of underlying disorder. Outpatient or partial programmes are appropriate only for low-to-moderate risk with adequate social support and no current intent.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.