Table 5 Non-perfect cases. Description of the 4 (non-perfect) cases with less than 66.6% consensus

Casus 6 (≤ 0.5) (IC) Assessment of a 40–44 year old Dutch woman with a diagnosis of PTSD, dependence on cocaine, borderline personality disorder, a history of prostitution and suicide attempts. Patient lives in sheltered accommodation and is followed up by the community mental health team. She presented at the A&E department after an overdose of 20 tablets of oxazepam 50 mg and cocaine (worth 390 euros). We assessed a desperate woman who states to be tired of life and wanting to end her horrible existence. There seems to be no end to her misery and she does not know how to proceed. She indicates she will do another suicide attempt with oxazepam if we let her go because everything is useless. She regrets the failed attempt. Ultimately, she agrees to a voluntary admission to a crisis unit to avert suicide

Casus 8 (≤ 0.5) (?) Assessment of a 50–54 male, known to be alcohol dependent. Presentation is triggered by an argument with his wife and son, and he made suicidal statements under the influence of alcohol. The police were informed by the neighbours. We assessed a reasonably kempt man who states that his problems stem from financial and relationship problems. During assessment alcohol abuse seems to be paramount and it makes him impulsive, and there is no evidence of current suicidal ideation or plans. He feels his support system and people close to him do not understand him, though is feeling better now. Acute suicide risk is considered not to be increased anymore. Patient says not to want help anymore and wants to be discharged so he can work his shift in a restaurant

Casus 11 (≤ 0.5) (IC) Assessment of suicide risk of a 30–35-year-old woman with previous diagnosis of PTSD and a dissociative disorder, known to different community teams though treatment seems to stagnate after a short period because of non-attendance to appointments. Patient was referred because of a suicide attempt by ingesting 30 tablets of peppermint oil and 30–40 tablets of diazepam 5 mg, after which she called her father to say goodbye; following this an ambulance was called. During the assessment patient states she is desperate because she has been suffering for 14 years with abdominal pain of unknown origin. Her abdominal pain dominates her life, and somatic delusions cannot be excluded. She makes a tired impression and appears desperate. Initially she says she will try to kill herself again but during the course of the assessment and involvement of her family, a safe situation is created. She also has plans for the coming week. Suicide risk is assessed as not acutely increased, and an urgent referral to the mental health community team is arranged

Casus 12 (≤ 0.5) (?) Assessment of suicide risk at the A&E department of a 45–49 year old man with no previous psychiatric history. He apparently referred himself to a different mental health trust and had a first meeting with them already. Patient was found by his girlfriend at home after a suicide attempt by ingesting medication (25–29 tablets containing a benzodiazepine) and pulling a plastic bag over his head, after writing farewell letters. He was transported by ambulance to A&E. There have been several experiences of loss, and his daughter attempted suicide by jumping out of the window of the family home, later stating she did not regret the attempt. Patient appears to be suffering from a low mood and is preoccupied with his financial situation (differential diagnosis is delusion of poverty). Patient believes nothing will ever be right again and he is the culprit of all misery. He perceives himself to be rotten to the core hence his daughter not being able to do anything but die. He is persistent in his wish to die and a diagnosis of severe depression with psychotic symptoms is considered. Despite an involuntary admission being regarded, he agrees to a voluntary admission. Suicide risk is assessed as acutely increased