Table 4 Perfect cases: gives examples of a selection of 4 of the 8 perfect cases (100% consensus see also Table 3)

Casus 20 (PD) (Home) assessment of suicide risk concerning a 20–24 year old, Muslim woman living with her parents. She presented for assessment after she threatened to cut herself, holding a knife. Mother stopped her from doing so and the police were called. Patient completed higher level education recently and had been working in the library for a week while at the same time a beloved uncle had died. 

Patient seemed to have functioned normally up to a few days prior to presentation and had since become anxious and paranoid. There is no history of substance abuse and she refused to comply with somatic investigations with her GP. We saw a woman who was lying in bed underneath the covers in a darkened room, during the day, and hardly answered (open) questions. It was not clear if she would not or did not want to answer the questions. According to the information of the family, the presentation is suspect of a first psychotic episode with paranoia whilst it is not clear what the context would be. Additionally, we saw symptoms of catatonia with mutism, negativism, staring and evidence of reduced food & fluid intake. Patient was admitted involuntarily

Casus 2 (PDC) Suicide risk assessment of a 45–49-year-old, married mother with 3 children who presented to her GP because she was concerned about not being able to resist longstanding suicidal ideation. Suicidal thoughts had been present for approximately 3 weeks and she was not aware of any triggers. In the past she was seen once by the community team for a moderate depression but refused treatment. We saw a restless, anxious woman who could not make a reliable safety plan. As a differential diagnosis we considered an anxiety disorder (GAD with symptoms of depression) or a depressive illness with secondary anxiety. Patient had not informed anyone close to her about her symptoms and initially did not want her husband to be called. In the end she agreed for him to be informed and after the arrival of her partner she had calmed down already and a reliable safety plan could be agreed. She agreed to be followed up by the community team (acute care) and admission was avoided

Casus 9 (PT) Assessment of suicide risk of a 15–19-year-old, well kempt woman without a psychiatric history who presented trough the police, after she -under the influence of alcohol- jumped in front of a car after leaving a friend’s party, resulting in her being hit though not wounded. We saw a calm, friendly girl, denying suicidality, and feeling sorry and embarrassed about what happened. Sexually explicit recordings of her with several men had been distributed. Behaviour was explained by the effects of alcohol and being informed about the recordings and consequent shock. Patient is able to agree to a safety plan and has plans for the future. There are no symptoms of any underlying depression, there is no history of suicide attempts or self-harm. She goes home with her mother. Suicide risk does not appear to be acutely increased. It was decided to refer patient to suicidality aftercare care project (SUNA)

Casus 23 (IC) Suicide assessment of a 60–64 year old male, with a previous diagnosis of schizophrenia and gambling addiction, being under the care of the community mental health team. On the day of assessment, he had been discharged from the supported living accommodation. The decision to discharge him had been agreed by the higher management and could not be reversed. Patient had not complied with agreements, and for some time already there had been problems with aggression and being a nuisance to his environment. There had been a number of warnings and meetings with the patient about his behaviour. Patient went to “sheltered housing” but did not want to share a room with others and went on to express suicidal ideas. When seen there was no evidence of psychosis, nor was there evidence of burnt-out schizophrenia affecting his behaviour. There is no history of suicide attempts, and suicidal behaviour seems to be a lever to get what he wants, this idea being supported by the information from staff of supported accommodation and his therapist. There is no indication for admission