# Situation: A nurse at a Rural Health Unit (RHU) who uses the World Health Organization Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) sees a 24-year-old man with depression. Ten months ago, after losing his job, he cut his forearm on purpose; the wound was minor and has healed. Two weeks later he is calmer and continues care at home with his family's support. Which follow-up schedule for his self-harm risk follows mhGAP-IG?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630201  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A nurse at a Rural Health Unit (RHU) who uses the World Health Organization Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) sees a 24-year-old man with depression. Ten months ago, after losing his job, he cut his forearm on purpose; the wound was minor and has healed.

Two weeks later he is calmer and continues care at home with his family's support. Which follow-up schedule for his self-harm risk follows mhGAP-IG?

## 보기

1. Weekly contact for 2 months, then less often, for 2 years **✔ 정답**
2. Weekly contact for 1 month, then monthly, for 6 months
3. Monthly contact for 3 months, then every 3 months until well
4. Contact every 2 weeks for 2 months, then as needed

**정답: 1**

## 해설

For self-harm or suicide risk, mhGAP-IG advises frequent contact at first, for example daily or weekly, for the first 2 months, then less frequent contact as the person improves, with follow-up continuing for 2 years. Suicidal thoughts and plans are assessed at every contact.

## 심화 해설

Core mhGAP-IG follow-up principle for self-harm

The mhGAP-IG treats any history of intentional self-harm as a strong marker of ongoing suicide risk, even when the wound was minor and the person now appears calmer. A brief improvement in mood or a healed injury does not cancel the need for structured, long-term monitoring. The guide therefore recommends frequent contact early—daily or at least weekly—for the first 2 months, followed by less frequent contact as the person stabilizes, with total follow-up continuing for 2 years. At every visit, the nurse must directly ask about suicidal thoughts, plans, and access to means, because risk can fluctuate even when the person denies distress at a single encounter.

Why the correct answer is option 1

Option 1 matches the mhGAP-IG schedule: weekly contact for 2 months, then less often, for 2 years. The other options shorten either the intensive phase or the total duration. For example, option 2 stops follow-up at 6 months, which is too short for a person with a self-harm history. Option 3 begins with monthly contact, which misses the high-risk window immediately after a self-harm episode. Option 4 ends with “as needed” after only 2 months, which is unsafe because the person may not return when risk rises.

| Option | Early phase | Total duration | Problem |
| --- | --- | --- | --- |
| 1 | Weekly for 2 months | 2 years | Matches mhGAP-IG |
| 2 | Weekly for 1 month | 6 months | Total follow-up too short |
| 3 | Monthly for 3 months | Every 3 months until well | Early contact too infrequent |
| 4 | Every 2 weeks for 2 months | As needed | No structured long-term monitoring |

Clinical reasoning in the RHU setting

In a Rural Health Unit, the nurse may be the only consistent provider this man sees. The mhGAP-IG is designed for exactly this non-specialized setting: it gives a clear, time-bound follow-up plan so that a busy primary care worker does not rely on subjective impressions of improvement. The man’s family support is protective, but it does not replace structured clinical follow-up. Family members may not recognize early warning signs of relapse or may hesitate to report a new self-harm plan. The nurse should involve the family in monitoring while keeping the clinical schedule fixed.

Key point! A healed self-harm wound and a calmer presentation do not reduce the mhGAP-IG follow-up requirement. The schedule is based on the history of self-harm, not on the current severity of the injury.

Watch out! Do not confuse the follow-up schedule for depression without self-harm with the schedule for self-harm risk. Self-harm triggers the longer, more intensive monitoring plan described in option 1.

What to assess at each contact

The mhGAP-IG directs the nurse to evaluate suicidal ideation, specific plans, and access to lethal means at every follow-up visit. The man’s previous method—cutting his forearm—means the nurse should ask directly about sharp objects in the home and work with the family to reduce access. The 2-year duration is not arbitrary: it covers the period when recurrence risk remains elevated after an index self-harm episode. Even when the person reports feeling well, the nurse maintains the schedule because self-harm risk can return without obvious warning, and early detection depends on regular, structured contact rather than waiting for the person to seek help.

## 임상 시나리오

Self-Harm Follow-Up per mhGAP-IGStructured long-term monitoring after intentional self-harm
Any history of intentional self-harm is a strong marker of ongoing suicide risk, even if the wound was minor and the person now appears calmer. Schedule weekly contact for 2 months, then less often as the person stabilizes, with total follow-up continuing for 2 years.

At every contact, directly assess suicidal thoughts, plans, and access to means. Risk can fluctuate even when the person denies distress at a single encounter.

CautionDo not shorten the intensive phase or total duration. Ending follow-up at 6 months or switching to as-needed after 2 months is unsafe because the person may not return when risk rises.

## 핵심 개념

- **mhGAP-IG** — WHO Mental Health Gap Action Programme Intervention Guide for non-specialized health settings
- **self-harm** — Intentional injury to oneself, a strong marker of ongoing suicide risk regardless of wound severity
- **suicide risk assessment** — Directly asking about suicidal thoughts, plans, and access to means at every contact
- **follow-up schedule** — Structured monitoring plan with frequent early contact and long-term continuation

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