A network for anyone with an interest in
adult education and mental health

Text Size: A+ Reset A-


PHQ9 - question 9?

Can anyone tell me what they do about learners that score 3 on question 9:  'Thoughts that you would be better off dead or of hurting yourself in some way'? Is there any follow up? Do they go on your safeguarding register and if they do what are your actions from this?
I feel like I need a more tangible stratergy.


Hi Idancer

I know what you mean. We do take time to talk things through further with them to identify how at risk they are. We seek advise from our partner psychology service and this has been invaluable because all the ones we have had to date  - which are not many - are known to local services already.  I agree that a strategy is a good idea and it would help us too in delivering a consistent approach across all our partners.  

Catina's picture

Anyone else got any examples/advice for Lisa? I know other pilots have been working your way through this re:

  • Exploring with the person how they feel now /whether it is a risk now
  • Referrals
  • Signposting
  • Choice of course
  • Support
  • Safeguarding
  • ...

It's really important to assess the level of risk. MHFA or STORM training helps and this stresses the importance of broaching the question directly, rather than skirting round or avoiding it. If one of our learners answers with anything other than a '0' for this question, we ask directly whether they have already discussed their thoughts with their GP or another professional. So far the few respondents who have answered this question have had this discussion recently with a health professional, so we write a note to confirm that we have discussed it and attach it to the questionnaire. Critical questions, if the person has not already discussed it, are to ask a) whether they have tried previously to take their life (as prevous attempts are a strong indicator of a successful future attempt) and b) whether they have made any active plans to take their life (again, this shows that serious consideraton is being taken). We haven't had to take this step yet, but if someone had not discussed the matter with another health professional and seemed to be making serious plans, then we would explain that, as a result of their answers, we shall have to inform their GP, with their permission. They would have to give their permission, as ordinarily we do not ask for GP details. If they refused to give this, we would inform them that we shall have to inform our local Crisis intervention team, preferably with their permission (the fact that they have answered the question honestly implies that they want someone else to know - it would be vey easy to disguise how they are feeling by just circling '0'). Broadly speaking, for a learner to have taken the decision to embark on a programme of learning with us implies that they are  thinking more about their longevity than considering taking their life in the immediate future.

When we began the pilot in September I had a discussion with our Safeguarding lead at the College regarding question 9. I was advised that informing the individuals GP for anyone that marks higher than a '0' on that question would be the best approach. I am always very honest with individuals about this and as Nick mentions above, on most occasions, the individual has already had conversations regarding their thoughts of ending their live, with another professional. The approach we are using has been working well so far.