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Fontao MI, Bulla J, Ross T. Prison and forensic mental health staff after suicides in their care. A narrative review of international and German national evidence. Front Psychiatry 2024; 15:1400604. [PMID: 38938459 PMCID: PMC11209187 DOI: 10.3389/fpsyt.2024.1400604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/30/2024] [Indexed: 06/29/2024] Open
Abstract
There is a growing body of international research investigating the impact of patient suicide on mental health professionals. The experience of losing a patient to suicide can have a significant and, in some cases, long-lasting (negative) impact on mental health professionals. However, the nature and extent of the impact on prison staff or forensic mental health professionals in particular is less clear. This narrative review summarises both quantitative and qualitative studies and key findings in this area, focusing on the above professions. A literature search was conducted using PsychInfo and Google Scholar, covering the period from 2000 onwards. The vast majority of findings relate to mental health professionals in general. We were unable to identify any published reports on the responses of forensic psychiatric staff. The majority of identified studies in the prison context are qualitative. Studies from German-speaking countries are particularly scarce in both the prison and mental health contexts. We conclude that there is a profound lack of knowledge about the impact of client/patient suicide on the subgroups of (German) prison and forensic psychiatric staff. Clearly, more research is needed on both the nature and extent of the impact, as well as on the specific organisational and supportive factors that help to mitigate the negative effects of suicide.
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Affiliation(s)
| | - Jan Bulla
- Forensic Psychiatry and Psychotherapy, Reichenau Psychiatric Center, Reichenau, Germany
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Thomas Ross
- Forensic Psychiatry and Psychotherapy, Reichenau Psychiatric Center, Reichenau, Germany
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
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Causer H, Spiers J, Chew-Graham CA, Efstathiou N, Gopfert A, Grayling K, Maben J, van Hove M, Riley R. Filling in the gaps: A grounded theory of the experiences and needs of healthcare staff following a colleague death by suicide in the UK. DEATH STUDIES 2024:1-12. [PMID: 38602818 DOI: 10.1080/07481187.2024.2337202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Health-workers are more likely to die by suicide than their counterparts in other occupational groups. The suicide of a staff member can be widely felt by colleagues, leading to complex emotional and cognitive responses. Exposure to suicide heightens the risk of dying by suicide. We investigated the impact of a colleague suicide on National Health Service (NHS) staff. Twenty-nine staff were interviewed; all participants were white British, and so not representative of the ethnic make-up of the NHS. Data were analyzed using grounded theory methods. A theory, "filling in the gaps" was developed. Staff experiences gave rise to needs that were not always met. Staff endeavored to "fill in the gaps" in support; however, sometimes fell through those gaps. Organizational and professional contexts shaped their experiences and responses. Recommendations include skilled and targeted support and compassion for affected staff. Cultural change is needed to challenge suicide stigma and unhelpful narratives.
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Affiliation(s)
- Hilary Causer
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Johanna Spiers
- School of Health Sciences, University of Surrey, Guildford, UK
| | | | - Nikolaos Efstathiou
- School of Nursing and Midwifery, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Anya Gopfert
- Department of Public Health and Sports Sciences, University of Exeter, Exeter, UK
| | | | - Jill Maben
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Maria van Hove
- Department of Public Health and Sports Sciences, University of Exeter, Exeter, UK
| | - Ruth Riley
- School of Health Sciences, University of Surrey, Guildford, UK
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Tamworth M, Tekin S, Billings J, Killaspy H. What Are the Experiences of Mental Health Practitioners Involved in a Coroner's Inquest and Other Inquiry Processes after an Unexpected Death of a Patient? A Systematic Review and Thematic Synthesis of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:357. [PMID: 38541356 PMCID: PMC10970210 DOI: 10.3390/ijerph21030357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 04/05/2024]
Abstract
Grief after suicide or patient-perpetrated homicide can be complex for those involved in the patient's care. Mental health practitioners with patients who die unexpectedly may be called to assist in the formal investigation processes that follow. The aim of this study was to examine the experience of mental health practitioners called to attend a coroner's inquest or other forms of formal inquiry. A protocol for a systematic review was prospectively registered on PROSPERO (CRD42023400310). A thematic synthesis of existing literature was conducted. We identified six articles for inclusion and constructed three themes from our analysis: Blame and enduring hostility, In the dark, and Limited learning. We found mental health practitioners may construct narratives of self-blame. These can be reinforced by the investigatory processes that follow. Feedback from inquiries is often delivered haphazardly and may not reflect the realities of clinical work. The support given to assist practitioners through inquiry processes varied-both in amount and how helpful it was. The research conducted on this topic is limited. More qualitative research should be conducted to understand the factors that make this experience more or less difficult as well as well as what support is needed for whom.
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Affiliation(s)
- Millie Tamworth
- Division of Psychiatry, University College London, London W1T 7NK, UK; (S.T.); (J.B.); (H.K.)
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Hussain Q, Killaspy H, McPherson P, Gibbons R. Experiences and support needs of consultant psychiatrists following a patient-perpetrated homicide. BJPsych Bull 2024; 48:5-11. [PMID: 37042298 PMCID: PMC10801412 DOI: 10.1192/bjb.2023.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 01/24/2023] [Accepted: 02/27/2023] [Indexed: 04/13/2023] Open
Abstract
AIMS AND METHOD To investigate the experiences and support needs of consultant psychiatrists following a patient-perpetrated homicide, an anonymous online survey was sent to all consultant psychiatrists registered as members of the UK's Royal College of Psychiatrists. RESULTS Of the 497 psychiatrists who responded, 165 (33%) had experienced a homicide by a patient under their consultant care. Most respondents reported negative impacts on their clinical work (83%), mental and/or physical health (78%) or personal relationships (59%), and for some (9-12%) these were severe and long lasting. Formal processes such as serious incident inquiries were commonly experienced as distressing. Support was mainly provided by friends, family and colleagues rather than the employing organisation. CLINICAL IMPLICATIONS Mental health service providers need to provide support and guidance to psychiatrists following a patient-perpetrated homicide to help them manage the personal and professional impact. Further research into the needs of other mental health professionals is needed.
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Affiliation(s)
| | - Helen Killaspy
- University College London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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Daly KA, Segura A, Heyman RE, Aladia S, Slep AMS. Scoping Review of Postvention for Mental Health Providers Following Patient Suicide. Mil Med 2024; 189:e90-e100. [PMID: 36661225 DOI: 10.1093/milmed/usac433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/19/2022] [Accepted: 12/28/2022] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION As suicides among military personnel continue to climb, we sought to determine best practices for supporting military mental health clinicians following patient suicide loss (i.e., postvention). MATERIALS AND METHODS We conducted a scoping review of the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Our initial search of academic databases generated 2,374 studies, of which 122 were included in our final review. We categorized postvention recommendations based on the socioecological model (i.e., recommendations at the individual provider, supervisory/managerial, organizational, and discipline levels) and analyzed them using a narrative synthesizing approach. RESULTS Extracted recommendations (N = 358) comprised those at the provider (n = 94), supervisory/managerial (n = 90), organization (n = 105), and discipline (n = 69) levels. CONCLUSIONS The literature converges on the need for formal postvention protocols that prioritize (1) training and education and (2) emotional and instrumental support for the clinician. Based on the scoped literature, we propose a simple postvention model for military mental health clinicians and recommend a controlled trial testing of its effectiveness.
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Affiliation(s)
- Kelly A Daly
- Family Translational Research Group, New York University, New York, NY 10010, USA
| | - Anna Segura
- Family Translational Research Group, New York University, New York, NY 10010, USA
- Faculty of Education, Translation, Sport and Psychology, Universitat de Vic-Universitat Central de Catalunya, Catalunya 08500, Spain
| | - Richard E Heyman
- Family Translational Research Group, New York University, New York, NY 10010, USA
| | - Salomi Aladia
- Family Translational Research Group, New York University, New York, NY 10010, USA
| | - Amy M Smith Slep
- Family Translational Research Group, New York University, New York, NY 10010, USA
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Groves S, Hawley M, Lascelles KM, Hawton K. News reporting of suicide in nurses: A content analysis study. Int J Ment Health Nurs 2022; 31:1513-1522. [PMID: 36008915 PMCID: PMC9804535 DOI: 10.1111/inm.13057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2022] [Indexed: 01/05/2023]
Abstract
Media impact on suicide is well-established. Groups at heightened risk of suicide, such as nurses, may be particularly influenced by poor news reporting. This study aimed to examine UK newspaper reporting of suicide of nurses and student nurses, including during the COVID-19 pandemic. Print and online newspaper reports about suicide in nurses (including students) published in the UK between January 2018 and August 2021 were obtained and data extracted for analysis in collaboration with Samaritans' media advisory team. Content and quality of newspaper reports were examined using a content analysis approach. The study was compliant with the STROBE checklist. Nurse or student nurse suicides were reported in 134 articles, including 50 individual suicides. Most articles were acceptable against Samaritans' media guidelines. However, common problems included absence of signposting to support organizations and lack of suicide prevention messages. A minority of articles included methods of suicide within article headlines (18, 13.4%) and sensationalist or romanticizing language (14, 10.7%). Most contained occupation-related content. Many named the individual's specific hospital or university and a substantial proportion included occupation-related images. Working on the frontline was the most reported link between COVID-19 and nurse suicide. While reporting on suicide among nurses and students was largely acceptable, quality of reporting was variable. Occupation was often discussed, and most articles published during COVID-19 linked suicide to the pandemic. The research findings can help shape guidance on reporting of suicide in specific professions and occupations, including nursing, to encourage responsible reporting and reduce inadvertent promotion of suicide.
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Affiliation(s)
- Samantha Groves
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | | | | | - Keith Hawton
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.,Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
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Tamworth M, Killaspy H, Billings J, Gibbons R. Psychiatrists' Experience of a Peer Support Group for Reflecting on Patient Suicide and Homicide: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114507. [PMID: 36361387 PMCID: PMC9654625 DOI: 10.3390/ijerph192114507] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 05/13/2023]
Abstract
There is a lack of support for mental health professionals who experience a patient suicide or homicide. This is despite a high likelihood of such an occurrence and the heavy professional and personal toll the experience can take. We conducted 15 interviews with members of a facilitated peer support group run for consultant psychiatrists who have experienced a patient homicide or suicide. Our interviews explored the trauma of the experience as well as the effectiveness of the group in helping the clinician heal. Our results echoed previous research that the experience can be profoundly traumatic. A professionally facilitated, consultant-only peer group specifically dedicated to suicide and homicide were the key components helping participants to process their grief. Mental health trusts should consider setting up facilitated peer support groups for clinicians who experience patient suicide or homicide.
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Affiliation(s)
- Millie Tamworth
- Division of Psychiatry, University College London, London W1T 7NF, UK
- Correspondence:
| | - Helen Killaspy
- Division of Psychiatry, University College London, London W1T 7NF, UK
- Camden & Islington NHS Foundation Trust, London NW1 0PE, UK
| | - Jo Billings
- Division of Psychiatry, University College London, London W1T 7NF, UK
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Rheinberger D, Wang J, McGillivray L, Shand F, Torok M, Maple M, Wayland S. Understanding Emergency Department Healthcare Professionals' Perspectives of Caring for Individuals in Suicidal Crisis: A Qualitative Study. Front Psychiatry 2022; 13:918135. [PMID: 35770060 PMCID: PMC9234140 DOI: 10.3389/fpsyt.2022.918135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/10/2022] [Indexed: 11/29/2022] Open
Abstract
Help seekers regularly present to Emergency Departments (EDs) when in suicidal crisis for intervention to ensure their immediate safety, which may assist in reducing future attempts. The emergency health workforce have unique insights that can inform suicide prevention efforts during this critical junction in an individual's experience with suicide. This paper explores the treatment and care delivery experiences of 54 health professionals working in EDs within one of the LifeSpan suicide prevention trial sites in Australia. Data was collected via six focus groups and six interviews. Thematic analysis resulted in three themes: (1) physicality of the emergency department, (2) juggling it all-the bureaucracy, practicalities, and human approach to care, and (3) impact of care delivery on ED staff. Findings highlight the need for workplace training that incorporates responding to the uncertainty of suicidal crisis, to compliment the solution-focused medical model of care. Broader policy changes to the ED system are also considered to ensure better outcomes for health professionals and help-seekers alike.
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Affiliation(s)
- Demee Rheinberger
- Black Dog Institute, University of New South Wales, Randwick, NSW, Australia
| | - Jessica Wang
- Black Dog Institute, University of New South Wales, Randwick, NSW, Australia
| | - Lauren McGillivray
- Black Dog Institute, University of New South Wales, Randwick, NSW, Australia
| | - Fiona Shand
- Black Dog Institute, University of New South Wales, Randwick, NSW, Australia
| | - Michelle Torok
- Black Dog Institute, University of New South Wales, Randwick, NSW, Australia
| | - Myfanwy Maple
- Faculty of Medicine and Health, University of New England, Armidale, NSW, Australia
| | - Sarah Wayland
- Faculty of Medicine and Health, University of New England, Armidale, NSW, Australia
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O'Keeffe S, Suzuki M, Ryan M, Hunter J, McCabe R. Experiences of care for self-harm in the emergency department: comparison of the perspectives of patients, carers and practitioners. BJPsych Open 2021. [PMCID: PMC8485342 DOI: 10.1192/bjo.2021.1006] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background Each year, 220 000 episodes of self-harm are managed by emergency departments in England, providing support to people at risk of suicide. Aims To explore treatment of self-harm in emergency departments, comparing perspectives of patients, carers and practitioners. Method Focus groups and semi-structured interviews with 79 people explored experiences of receiving/delivering care. Participants were patients (7 young people, 12 adults), 8 carers, 15 generalist emergency department practitioners and 37 liaison psychiatry practitioners. Data were analysed using framework analysis. Results We identified four themes. One was common across stakeholder groups: (a) the wider system is failing people who self-harm: they often only access crisis support as they are frequently excluded from services, leading to unhelpful cycles of attending the emergency department. Carers felt over-relied upon and ill-equipped to keep the person safe. Three themes reflected different perspectives across stakeholders: (b) practitioners feel powerless and become hardened towards patients, with patients feeling judged for seeking help which exacerbates their distress; (c) patients need a human connection to offer hope when life feels hopeless, yet practitioners underestimate the therapeutic potential of interactions; and (d) practitioners are fearful of blame if someone takes their life: formulaic question-and-answer risk assessments help make staff feel safer but patients feel this is not a valid way of assessing risk or addressing their needs. Conclusions Emergency department practitioners should seek to build a human connection and validate patients’ distress, which offers hope when life feels hopeless. Patients consider this a therapeutic intervention in its own right. Investment in self-harm treatment is indicated.
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Amit Aharon A, Fariba M, Shoshana F, Melnikov S. Nurses as 'second victims' to their patients' suicidal attempts: A mixed-method study. J Clin Nurs 2021; 30:3290-3300. [PMID: 33969556 DOI: 10.1111/jocn.15839] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/19/2021] [Accepted: 04/15/2021] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To understand the effects of patients' suicidal attempts and events on nurses' second victim symptoms and to explore the association between these experiences and nurse absenteeism and turnover. BACKGROUND The term 'second victim' is when a healthcare professional expresses psychological symptom following adverse patient event. This has been previously shown to be associated with absenteeism and higher staff turnover. DESIGN A mixed-methods study with a sequential exploratory approach. METHODS A qualitative approach was used for nurses to relate their experiences of their patients' suicidal attempts. A cross-sectional quantitative study was conducted in 150 nurses who worked in internal departments. The Second Victim Experience and Support Tool was used to substantiate and measure second victim related distress of nurses who treated suicidal patients. The qualitative data were analysed by a constant comparative analysis method. The analytic analysis of the quantitative study included Pearson's correlations and hierarchical linear regression model to assess the explanatory variables to absenteeism and staff turnover. The study adhered to the STROBE checklist for cross-sectional studies and the COREQ guidelines for qualitative studies. RESULTS The qualitative part identified three themes and nine sub-themes, including the new variable 'sense of being alone'. The quantitative part of the study found that nurses expressed a medium level of second victim related distress. After controlling for demographic variables, second victim distress and the sense of being alone following patients' suicidal events may explain nurse absenteeism and turnover. CONCLUSIONS Nurses who experience suicidal attempts of their patients react as second victims. These symptoms lead to nurse absenteeism and turnover. RELEVANCE TO CLINICAL PRACTICE Nurses who experience suicidal attempts of their patients need treatment and support as second victims, the same as in any other medical adverse event. The nursing leadership should emotionally support these nurses and prevent consequential staff organisational problems.
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Affiliation(s)
- Anat Amit Aharon
- Nursing Department, Steyer School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | | | | | - Semyon Melnikov
- Nursing Department, Steyer School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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