The classification is imminent risk
According to the mhGAP Intervention Guide (mhGAP-IG), imminent risk of self-harm is considered likely in two situations: when a person has current thoughts or plans of self-harm, or when a person with thoughts or plans in the past month or an act of self-harm in the past year is now extremely agitated, violent, distressed, or lacks communication. His forearm cutting 10 months ago falls within the past year, and he is now extremely agitated and not communicating, so imminent risk is likely even though he denies current thoughts.
Why denial of current thoughts is not enough
A person in crisis may deny thoughts of self-harm because he is distressed, unwilling to talk, or unable to engage, which is exactly what is happening here: he refuses to answer most questions. The mhGAP-IG design recognizes this. It does not rely only on what the person says; it combines recent history with present behavior. Extreme agitation, distress, violence, or lack of communication in someone with recent self-harm history signals that the person may act suddenly, and his word alone cannot rule out risk.
| Element | Time window in mhGAP-IG | This client |
|---|
| Current thoughts or plans | Now | Denied |
| Past thoughts or plans | Within the past 1 month | Not reported |
| Act of self-harm | Within the past 1 year | Yes, 10 months ago |
| Present state | Extremely agitated, violent, distressed, or not communicating | Agitated, shouting, refuses to answer |
Why the other classifications are wrong
Watch out! The 1-month window applies to past thoughts or plans, not to acts. For an act of self-harm the window is 1 year, so calling his risk non-imminent because the act was more than a month ago misapplies the rule. Classifying him as unlikely risk ignores the combination of past-year act and current agitation. The medical seriousness of the past act is also not a requirement; mhGAP-IG assesses a medically serious act of self-harm as a separate, earlier step that calls for urgent medical treatment, and he has no injury or poisoning today.
What the nurse does next
With imminent risk likely, mhGAP-IG directs the health worker to remove access to means of self-harm, create a secure and supportive environment, avoid leaving the person alone, and assign someone to stay with him while arranging consultation with a mental health specialist. The nurse also addresses the agitation, involves the family as support, and documents the assessment carefully. Once the crisis settles, depression and other priority conditions are assessed and treated.
Exam takeaway
Key point! mhGAP-IG imminent risk: current thoughts or plans, or past-month thoughts or plans or past-year act plus current extreme agitation, violence, distress, or lack of communication. A denial of current thoughts does not lower the risk when the history and present state meet these criteria.