Assessing Low Mood and Suicidal Thoughts
Your Role — Doctor
General Practice
Your 45-year-old patient has attended saying they 'can't go on like this'. They have low mood, poor sleep, and have withdrawn from family. You need to assess their mood sensitively, ask directly about self-harm and suicidal thoughts, evaluate risk and safety, and agree an initial support and safety plan.
- •Build rapport and create a safe, unhurried space for the patient to talk about how they've been feeling.
- •Explore the low mood: onset, sleep, appetite, enjoyment, energy, and impact on daily life and relationships.
- •Ask directly and calmly about thoughts of self-harm or suicide, including plans, intent and protective factors.
- •Assess immediate safety and risk, and respond appropriately (crisis support, involving others, follow-up).
- •Agree an initial plan collaboratively (treatment options, support, safety-netting) and ensure the patient does not leave without a clear next step.
The Interlocutor
Played by the actor / assessor
You are 45. You've felt low for months since losing your job and your marriage struggling. You barely sleep, have lost interest in everything, and have pulled away from your family. You've had thoughts that they'd be better off without you, but you have not made a specific plan. You feel ashamed and find it hard to open up.
- •Start guarded and quiet; open up gradually if the doctor is warm and unhurried.
- •Describe months of low mood, waking at 4am, no appetite, and no enjoyment in anything.
- •If asked directly and gently, admit you've thought your family would be better off without you, but you haven't planned anything specific.
- •Say you feel ashamed to be here and worried about being judged or 'locked away'.
- •If the doctor is compassionate and offers a clear plan and support, agree to accept help, a safety plan, and a follow-up.
Sample Role-play
Hello, thank you for coming in today. I'm Dr Mensah. I can see you're going through something difficult — take your time, there's no rush. Can you tell me a little about how things have been for you?
I don't really know where to start. I just… can't go on like this.
I'm really glad you came and said that out loud — it takes courage. When you say you can't go on like this, that tells me you've been struggling a lot. How long have you been feeling this way?
Months. Since I lost my job. I barely sleep, I wake at four in the morning, and nothing feels worth doing anymore.
That sounds exhausting and really painful — losing your job, your sleep, and any sense of enjoyment all at once. Has this been affecting things at home, with people close to you?
I've pushed everyone away. My marriage is falling apart. I feel like I'm just a burden to them all.
Thank you for trusting me with that. When people feel as low and burdened as you're describing, they sometimes have thoughts that life isn't worth living, or that others would be better off without them. Have you had any thoughts like that?
…Yes. I've thought they'd be better off without me. But I haven't planned anything, if that's what you mean.
I'm really grateful you told me — that was hard to say, and it helps me help you. Can I ask a bit more, so I understand: have you thought about how you might act on those thoughts, or is it more that the feeling is there but you haven't gone further than that?
No plan. It's more that some days I just wish I could stop existing. But I wouldn't want to do that to my kids.
That love for your children is really important — it's a strong reason to keep you safe, and we'll build on it. I want to be honest: what you're describing sounds like depression, and it's treatable. You don't have to feel like this. Are you worried about being judged or what happens next?
I am. I was scared you'd think I was crazy or lock me away.
Not at all — you're not crazy, and this is about supporting you, not taking control away from you. I'd like us to agree a plan together today: options like talking therapy and possibly medication, a crisis number you can call any time, and to see you again very soon. And I'd like to know there's someone at home you can be with tonight. Can we do that?
My sister could stay with me. And yes… I think I'd like to try. Thank you for listening.
That's a really positive step, and involving your sister is a good idea. I'll arrange things today, give you the crisis line, and see you in a few days. If things feel worse or unsafe before then, please call the crisis number or come straight back. You've done the hardest part just by coming in.
Useful Phrases
Clinical Background
Assessment of depression should cover core symptoms (low mood, anhedonia) and biological features (sleep, appetite, energy, concentration) and functional impact. Suicide risk assessment must ask directly about ideation, plan, intent, means, and protective factors — asking does not increase risk. Evaluate immediate safety and arrange proportionate support: crisis contacts, involving trusted others, urgent follow-up or specialist referral if high risk. Initial management may include psychological therapy and/or antidepressants. Always ensure a safety plan before the patient leaves.
Common Mistakes to Avoid
- ✕Avoiding or hinting around the topic of suicide instead of asking clearly and directly.
- ✕Reacting with alarm or judgement to disclosure, which shuts the patient down.
- ✕Letting the patient leave without a concrete safety plan, crisis contact, and follow-up.