The suicidal patient. The primary care physician's role in evaluation and treatment

Evaluation of the suicidal patient involves careful consideration of risk factors, including attention to subtle clues from the history, and mental status examination. The most urgent decision for the physician to make is whether or not to insist on hospitalization. If the need for inpatient care is uncertain, a "no suicide" contract can be a helpful adjunct to management. Although suicidally depressed or psychotic patients require psychiatric consultation, many "suicidal" patients are simply experiencing a crisis and respond well to supportive crisis intervention counseling.