Psychotic patients tend to have a higher suicide rate, especially early in their onset and during their recovery. This is mainly due to the emotional instability brought on by the more realistic delusions and hallucinations during those stages. Also, most patients would be foreign to these symptoms when they first got them, which makes them scared, anxious, or even desperate, thus having suicidal thoughts when they feel helpless; therefore it is crucial to seek medical help as soon as possible. During the early stages of recovery, even though psychotic symptoms may be in remission, some of the patients may still be pessimistic about their condition, worry about their progress, possibility of relapse, stigma of mental illness, lack of support, unemployment etc., these may upset the patient and lead to suicidal thoughts.

If we notice the following in the patient, they may be at risk for suicide:

• Written or verbal expression of suicidal tendency
• Giving away property or complete personal matters
• Change in eating or sleeping pattern
• Sudden change of personality or appearance
• Loss of interest for the future
• Express helplessness or despair
• Excessive guilt or shame
• Aberrant behaviours

 
We can deal with the situation by:

• Gently ask them if they have thought about committing suicide; direct enquiry will not lead to them committing suicide
• Do not downplay what the patient is going through or express that you can easily overcome these experiences 
• Do not think that it denotes weakness, and acknowledge their feelings
• If they can talk about when they are going to commit suicide and plan on buying the required instrument, try to spend more time with them
• Seek help from professionals or the Integrated Community Centre for Mental Wellness (ICCMW) with the patient
• If the situation is urgent, seek help from the emergency department or call the police by dialing 999¹

If the patient appears to be very emotionally unstable, poses as threats to themselves or others, we must call an ambulance immediately. We can be prepared for the situation by keeping the phone number of nearby ambulance/emergency medical services handy, so that we can call an ambulance when the above signs are showing. The ambulance staff would usually ask for basic information regarding the situation and then call the police for backup if necessary. If we don’t have the contact information for ambulances then, we can also call 999 directly and seek help from the police. It is important to remain calm, give your name, location, phone number, the patient’s emotional state and relevant problems etc. clearly on the phone.

If you would like to seek help from the Integrated Community Centre for Mental Wellness (ICCMW), please click here.

Also, hospital authority has a 24/7 hotline; if you would like to learn more about it, please click here.