Appendix 1 Suicide and self-harm inventory

This instrument is designed to ensure accurate collection of data about

attempted acts of suicide and incidents of self-harm. For the purposes of the

research project the instrument is categorical. The interviewer should note that a trained rater will assess if a particular episode meets the criteria for either a

suicide attempt or self-harm. The instrument is not a measure of severity.

The aim of the interview is to assess the frequency of attempts of both suicide and self-harm over a six-month time period.

Criteria for suicidal acts

The criteria for suicidal acts are:

(I) deliberate

This means that the act could not be construed as an accident and there was

planning involved. The subject accepts ownership of the act e.g. claiming not

to have read the indications on a bottle of medications before taking it in

excess would not be considered as a suicidal act.

(2) life-threatening The subject's life was seriously at risk as a consequence of the act. Even if the

subject considered, at the time of the attempt, that their life was at risk as a

consequence of the act, but in reality it was not, the gesture would not be con­

sidered suicidal but as an act of self-harm (if other criteria were met).

(3) have resulted in medical intervention

The subject must have either sought medical intervention or medical interven­

tion was sought on their behalf. Medical intervention need not be treatment but

Anthony W. Bateman, Peter Fonagy Psychotherapy for borderline personality disorder: Suicide and self-harm inventory.© 2004 by Oxford University Press

Oxford Clinical Psychology | Oxford University Press

at the minimum a physical examination is implied. If a doctor is not able to

confirm the attempt you should not consider it under this heading. Confirmation consists of a note in the medical records, a letter to the RMO or some other service. It requires more than the patient's claim of medical inter­vention for this criterion to be met.

( 4) medical assessment was consistent with a suicide attempt The medical record must provide evidence that medical opinion was consistent with the patient's act being deliberate, potentially lethal, and requiring medical

attention. Please ensure that the records are carefully searched. A positive find­

ing is necessary if an act is to be coded as suicidal.

Attempted suicide

Over the past 6 months have you attempted to kill yourself? (The interviewer should describe to the patient the definition of an attempt at suicide given above).

On how many occasions can you recall trying to kill yourself?

List in chronological order: Date/Method

The interviewer should assess the accuracy of this statement at the end of the interview Accurate/reasonably accurate/questionable/inaccurate

Anthony W. Bateman, Peter Fonagy Psychotherapy for borderline personality disorder: Suicide and self-harm inventory.© 2004 by Oxford University Press

Oxford Clinical Psychology | Oxford University Press

The interviewer should then elicit the following information for each act com­

mencing with the earliest attempt over the last 6 months:

Suicidal act 1

Date of the event:

Overdose/Self-laceration/Burning/Head banging/Swallowing razor blades/

Hanging/Shooting/Jumping from height or under train/Other-please specify

(Only include life threatening self-induced injury here e.g. overdose necessi­

tating hospital assessment or admission, self-laceration leading to severe loss

of blood requiring transfusion, head banging resulting in sub-dural

haematoma, razor blade ingestion leading to surgical intervention, etc)

How long before the act did the patient know that he was going to harm himself?

Anthony W. Bateman, Peter Fonagy Psychotherapy for borderline personality disorder: Suicide and self-harm inventory.© 2004 by Oxford University Press

Oxford Clinical Psychology | Oxford University Press

Were plans made? If so, what were those plans

Did the patient contact anyone about the possible attempt? Mother/Father/ Partner/ Other patient/Mental health worker/General practitioner

Did the patient leave a note indicating that the act was suicidal?

Did anyone try and help the patient? i.e. friend, carer, professional, patient

Anthony W. Bateman, Peter Fonagy Psychotherapy for borderline personality disorder: Suicide and self-harm inventory.© 2004 by Oxford University Press

Oxford Clinical Psychology | Oxford University Press

Was anyone present at the time of the attempt?

Did the patient expect anyone to visit?

Was the attempt associated with alcohol or illicit drugs? Yes/No Alone or with other?

If so, with whom was the patient drinking or taking drugs prior to the act and where?

Anthony W. Bateman, Peter Fonagy Psychotherapy for borderline personality disorder: Suicide and self-harm inventory.© 2004 by Oxford University Press

Oxford Clinical Psychology | Oxford University Press

What were those drugs or alcohol and in what quantity?

If found, how was the patient found and by whom?

Who arranged for the patient to go to hospital?

Anthony W. Bateman, Peter Fonagy Psychotherapy for borderline personality disorder: Suicide and self-harm inventory.© 2004 by Oxford University Press

Oxford Clinical Psychology | Oxford University Press

How did the patient get to hospital?

Which hospital was the patient admitted to?

Is there evidence for admission? If so, are there medical notes?

Anthony W. Bateman, Peter Fonagy Psychotherapy for borderline personality disorder: Suicide and self-harm inventory.© 2004 by Oxford University Press

Oxford Clinical Psychology | Oxford University Press

Please enter here the details of those medical notes e.g. Patient Identification Number

Do they confirm the stated act?

Is there a note to state that the act was potentially life-threatening? Please copy

verbatim the statement suggesting that the act was a suicide attempt.

Anthony W. Bateman, Peter Fonagy Psychotherapy for borderline personality disorder: Suicide and self-harm inventory.© 2004 by Oxford University Press

Oxford Clinical Psychology | Oxford University Press

What medical and nursing action was taken?

How long was the patient in hospital?

To whose care was the patient discharged and was follow-up given?

Anthony W. Bateman, Peter Fonagy Psychotherapy for borderline personality disorder: Suicide and self-harm inventory.© 2004 by Oxford University Press

Oxford Clinical Psychology | Oxford University Press

Criteria for acts of self-harm

( 1) deliberate This means that the act could not be construed as an accident and that the sub­ject accepts ownership of the act. Planning may have been involved. Common examples include the purchase of razor blades, carrying them around in a bag,

and, in an organized fashion, cutting the wrists or other areas of the body; lighting a cigarette and burning oneself. In other instances, planning may not occur. The individual may harm himself in an emotional crisis. Often head­

banging occurs under these circumstances but self-laceration may also happen at these times and frenzied cutting results. Under these circumstances the fren­zied self-harm only counts as one act as long as other criteria are met. Similarly, if a patient reports events that occur within hours of each other, these are to be considered as one event. ONLY when 48 h has passed between

events are they to be considered as separate acts.

(2) resulting in visible tissue damage

Clear tissue damage should be present. Common examples are recent scars, bruises, and bums. The interviewer should make a note of where the tissue damage is so that an interviewer in 6 months time can ask for evidence of new damage. Please note that it may be impossible to ask the patient to show the tis­sue damage either because of sensitivity in the interview or because of the site of the damage. In this case it is adequate to make a note of the type, site, and time of the self-harm BUT in all cases there must be evidence under criterion 3.

(3) nursing or medical intervention required

It is important that the information is collected as accurately as possible. The

rater will decide whether or not a patient scores positively based on the infor­

mation that you collect. The subject must have either sought medical or nursing intervention or medicaVnursing intervention was sought on their behalf. For example the arms may have required bandaging following self-laceration. MedicaVnursing intervention need not be treatment but at the minimum a phys­ical examination is implied. If a doctor or nurse is not able to confirm the attempt you should not consider it under this heading. Confirmation consists of a note in

the medical records, a letter to the RMO or some other service. It requires more than the patient's claim of medical intervention for this criterion to be met.

Acts of self-harm

Have you harmed yourself in any other way over the last 6 months? For exam­ple by cutting or burning yourself, banging your head?

(The interviewer should describe to the patient the definition of self-harm

given above).

Yes/No

Anthony W. Bateman, Peter Fonagy Psychotherapy for borderline personality disorder: Suicide and self-harm inventory.© 2004 by Oxford University Press

Oxford Clinical Psychology | Oxford University Press

How many times have you harmed yourself in any of these ways over the last 6 months? (Interviewer should assess the accuracy of this statement at the end of the interview).

Date/Method

Accurate/reasonably accurate/questionable/inaccurate

Date/Method

Accurate/reasonably accurate/questionable/inaccurate

Date/Method

Accurate/reasonably accurate/questionable/inaccurate

The interviewer should then elicit the following information for each act com­mencing with the earliest attempt over the last 6 months:

Anthony W. Bateman, Peter Fonagy Psychotherapy for borderline personality disorder: Suicide and self-harm inventory.© 2004 by Oxford University Press

Oxford Clinical Psychology | Oxford University Press

Date of act:

Self laceration, head banging, burning, Other-specify

If possible and clinically appropriate please ask the patient to show the results

of the act of self-harm e.g. is there clear tissue damage of self-laceration/burns to the wrists and arms. Is there bruising to the face? Describe the evidence.

(Do not embarrass or shame the patient. If in doubt DO NOT ASK)

Please document the site of self-harm in such a way that an interviewer will be

clear in 6 months time where the previous acts were sited e.g. upper arm,

breasts, face, genitals.

Was the act part of a frenzied process or a single act e.g. some patients cut

themselves many times over a short period of time or head bang for a period

of hours.

Is the patient clear that all the acts were part of the same incident?

If multiple acts were committed please indicate over what period of time

Was there a period of over 48 h between the multiple acts (acts occurring

within 48 h of each other are counted as one incident)

How long before the act did the patient know that he was going to harm him­

self?

Anthony W. Bateman, Peter Fonagy Psychotherapy for borderline personality disorder: Suicide and self-harm inventory.© 2004 by Oxford University Press

Oxford Clinical Psychology | Oxford University Press

If so what were the warning signs as described by the patient?

Were plans made? If so what were those plans e.g. did the patient go out and

buy razor blades, did he lay them out before hand?

Did the patient contact anyone prior to the act?

Did anyone try and help the patient? i.e. friend, carer, professional

Was anyone present at the time of the act?

Was the attempt associated with alcohol or illicit drugs?

Was the patient with someone? If so with whom was the patient drinking or

taking drugs prior to the act and where?

Estimate the quantity and list the substances used

Did the result of self-harm require medical or nursing intervention?

If so, by whom and where?

Anthony W. Bateman, Peter Fonagy Psychotherapy for borderline personality disorder: Suicide and self-harm inventory.© 2004 by Oxford University Press

Oxford Clinical Psychology | Oxford University Press

Notes ID number:

What intervention was given? e.g. cleaning, dressing, observation on medical in-patient ward

Is there evidence in the medical notes of the medical or nursing intervention? Yes/No

Copy verbatim the entry made by the nurse or doctor.

If no evidence in the notes, do you have corroboration of the self-harm from an independent witness, for example a health care worker.

Please confirm that you have reviewed the medical notes. Yes/No

Anthony W. Bateman, Peter Fonagy Psychotherapy for borderline personality disorder: Suicide and self-harm inventory.© 2004 by Oxford University Press

Oxford Clinical Psychology | Oxford University Press