1
|
Quinlivan L, Gorman L, Littlewood DL, Monaghan E, Barlow SJ, Campbell S, Webb RT, Kapur N. ‘Wasn’t offered one, too poorly to ask for one’ – Reasons why
some patients do not receive a psychosocial assessment following
self-harm: Qualitative patient and carer survey. Aust N Z J Psychiatry 2022; 56:398-407. [PMID: 34015945 PMCID: PMC8941717 DOI: 10.1177/00048674211011262] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Psychosocial assessment following self-harm presentations to hospital is an important aspect of care. However, many people attending hospital following self-harm do not receive an assessment. We sought to explore reasons why some patients do not receive a psychosocial assessment following self-harm from the perspective of patients and carers. METHODS Between March and November 2019, we recruited 88 patients and 14 carers aged ⩾18 years from 16 mental health trusts and community organisations in the United Kingdom, via social media, to a co-designed qualitative survey. Thematic analyses were used to interpret the data. RESULTS Patients' reasons for refusing an assessment included long waiting times, previous problematic interactions with staff and feeling unsafe when in the emergency department. Two people refused an assessment because they wanted to harm themselves again. Participants reported organisational reasons for non-assessment, including clinicians not offering assessments and exclusion due to alcohol intoxication. Other patients felt they did not reach clinically determined thresholds because of misconceptions over perceived heightened fatality risk with certain self-harm methods (e.g. self-poisoning vs self-cutting). CONCLUSION Our results provide important insights into some of the reasons why some people may not receive a psychosocial assessment following self-harm. Parallel assessments, compassionate care and specialist alcohol services in acute hospitals may help reduce the number of people who leave before an assessment. Education may help address erroneous beliefs that self-injury and self-harm repetition are not associated with greatly raised suicide risk.
Collapse
Affiliation(s)
- Leah Quinlivan
- Division of Psychology and Mental
Health, Centre for Mental Health and Safety, The University of Manchester,
Manchester, UK,Manchester Academic Health
Science Centre, The University of Manchester, Manchester, UK,NIHR Greater Manchester Patient
Safety Translational Research Centre, The University of Manchester,
Manchester Academic Health Science Centre, Manchester, UK,Leah Quinlivan, Centre for Mental
Health and Safety, The University of Manchester, Jean McFarlane
Building, Oxford Road, Manchester M13 9PL, UK.
| | - Louise Gorman
- Division of Psychology and Mental
Health, Centre for Mental Health and Safety, The University of Manchester,
Manchester, UK,Manchester Academic Health
Science Centre, The University of Manchester, Manchester, UK,NIHR Greater Manchester Patient
Safety Translational Research Centre, The University of Manchester,
Manchester Academic Health Science Centre, Manchester, UK
| | - Donna L Littlewood
- Division of Psychology and Mental
Health, Centre for Mental Health and Safety, The University of Manchester,
Manchester, UK,Manchester Academic Health
Science Centre, The University of Manchester, Manchester, UK,NIHR Greater Manchester Patient
Safety Translational Research Centre, The University of Manchester,
Manchester Academic Health Science Centre, Manchester, UK
| | - Elizabeth Monaghan
- NIHR Greater Manchester Patient
Safety Translational Research Centre, The University of Manchester,
Manchester Academic Health Science Centre, Manchester, UK
| | - Stephen J Barlow
- NIHR Greater Manchester Patient
Safety Translational Research Centre, The University of Manchester,
Manchester Academic Health Science Centre, Manchester, UK
| | - Stephen Campbell
- NIHR Greater Manchester Patient
Safety Translational Research Centre, The University of Manchester,
Manchester Academic Health Science Centre, Manchester, UK
| | - Roger T Webb
- Division of Psychology and Mental
Health, Centre for Mental Health and Safety, The University of Manchester,
Manchester, UK,Manchester Academic Health
Science Centre, The University of Manchester, Manchester, UK,NIHR Greater Manchester Patient
Safety Translational Research Centre, The University of Manchester,
Manchester Academic Health Science Centre, Manchester, UK
| | - Nav Kapur
- Division of Psychology and Mental
Health, Centre for Mental Health and Safety, The University of Manchester,
Manchester, UK,Manchester Academic Health
Science Centre, The University of Manchester, Manchester, UK,NIHR Greater Manchester Patient
Safety Translational Research Centre, The University of Manchester,
Manchester Academic Health Science Centre, Manchester, UK,Greater Manchester Mental Health
NHS Foundation Trust, Manchester, UK
| |
Collapse
|
2
|
Wilson MP, Kaur J, Blake L, Oliveto AH, Thompson RG, Pyne JM, Wolf L, Walker AP, Waliski AD, Nordstrom K. Adherence to guideline creation recommendations for suicide prevention in the emergency department: A systematic review. Am J Emerg Med 2021; 50:553-560. [PMID: 34547697 DOI: 10.1016/j.ajem.2021.07.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/21/2021] [Accepted: 07/20/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Suicide rates in the United States rose 35.2% from 1999-2018. As emergency department (ED) providers often have limited training in management of suicidal patients and minimal access to mental health experts, clinical practice guidelines (CPGs) may improve care for these patients. However, clinical practice guidelines that do not adhere to quality standards for development may be harmful both to patients, if they promote practices based on flawed evidence, and to ED providers, if used in malpractice claims. In 2011, the Institute of Medicine created standards to determine the trustworthiness of CPGs. This review assessed the adherence of suicide prevention CPGs, intended for the ED, to these standards. Secondary objectives were to assess the association of adherence both with first author/organization specialty (ED vs non-ED) and with inclusion of recommendations on substance use, a potent risk factor for suicide. METHODS This is a systematic review of available suicide-prevention CPGs for the ED in both peer-reviewed and gray literature. This review followed the PRISMA standards for reporting systematic reviews. RESULTS Of 22 included CPGs, the 7 ED-sponsored CPGs had higher adherence to quality standards (3.1 vs 2.4) and included the highest-rated CPG (ICAR2E) identified by this review. Regardless of specialty, nearly all CPGs included some mention of identifying or managing substance use. CONCLUSIONS Most suicide prevention CPGs intended for the ED are written by non-ED first authors or organizations and have low adherence to quality standards. Future CPGs should be developed with more scientific rigor, include a multidisciplinary writing group, and be created by authors working in the practice environment to which the CPG applies.
Collapse
Affiliation(s)
- Michael P Wilson
- Division of Research and Evidence-Based Medicine, Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; Department of Emergency Medicine Behavioral Emergencies Research Lab, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
| | - Jaskiran Kaur
- Department of Emergency Medicine Behavioral Emergencies Research Lab, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Lindsay Blake
- Academic Affairs, UAMS Library, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Alison H Oliveto
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Ronald G Thompson
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Jeffrey M Pyne
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Lisa Wolf
- Emergency Nurses Association, Schaumburg, Illinois
| | - A Paige Walker
- Department of Emergency Medicine Behavioral Emergencies Research Lab, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Angela D Waliski
- Department of Health Services Research and Development, Central Arkansas Veteran's Healthcare System, Little Rock, AR, United States of America
| | - Kimberly Nordstrom
- Department of Emergency Medicine Behavioral Emergencies Research Lab, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; Department of Psychiatry, University of Colorado School of Medicine, Denver, CO, United States of America
| |
Collapse
|
3
|
Neurocognitive functioning predicts suicidal behaviour in young people with affective disorders. J Affect Disord 2021; 281:289-296. [PMID: 33341011 DOI: 10.1016/j.jad.2020.11.077] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/12/2020] [Accepted: 11/08/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Neurocognitive impairment is recognised as a risk factor for suicidal behaviour in adults. The current study aims to determine whether neurocognitive deficits also predict ongoing or emergent suicidal behaviour in young people with affective disorders. METHODS Participants were aged 12-30 years and presented to early intervention youth mental health clinics between 2008 and 2018. In addition to clinical assessment a standardised neurocognitive assessment was conducted at baseline. Clinical data was extracted from subsequent visits using a standardised proforma. RESULTS Of the 635 participants who met inclusion criteria (mean age 19.6 years, 59% female, average follow up 476 days) 104 (16%) reported suicidal behaviour during care. In 5 of the 10 neurocognitive domains tested (cognitive flexibility, processing speed, working memory, verbal memory and visuospatial memory) those with suicidal behaviour during care were superior to clinical controls. Better general neurocognitive function remained a significant predictor (OR=1.94, 95% CI 1.29- 2.94) of suicidal behaviour in care after controlling for other risk factors. LIMITATIONS The neurocognitive battery used was designed for use with affective and psychotic disorders and may not have detected some deficits more specific to suicidal behaviour. CONCLUSION Contrary to expectations, better neurocognitive functioning predicts suicidal behaviour during care in young people with affective disorders. While other populations with suicidal behaviour, such as adults with affective disorders or young people with psychotic disorders, tend to experience neurocognitive deficits which may limit their capacity to engage in some interventions, this does not appear to be the case for young people with affective disorders.
Collapse
|
4
|
Hurley J, Lakeman R, Cashin A, Ryan T. Mental health nurse psychotherapists are well situated to improve service shortfalls in Australia: findings from a qualitative study. Australas Psychiatry 2020; 28:423-425. [PMID: 32510981 DOI: 10.1177/1039856220924326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This paper reports the capabilities of mental health nurse (MHN) psychotherapists in Australia and their perceptions on how to best utilize their skills. METHOD An MHN is a registered nurse with recognized specialist qualifications in mental health nursing. One hundred and fifty three MHNs completed an online survey; 12 were interviewed. RESULTS Three themes were derived from a qualitative analysis of the aggregated data: psychotherapy skills of MHN psychotherapists are under-utilized; these nurses bridge gaps between biomedical and psychosocial service provision; and equitable access to rebates in the primary care sector is an obstacle to enabling access to services. CONCLUSIONS MHN psychotherapists are a potentially valuable resource to patients in tertiary and primary health care. They offer capacity to increase access to specialist psychotherapy services for complex and high risk groups, while being additionally capable of meeting patients' physical and social needs. Equitable access to current funding streams including Medicare rebates can enable these outcomes.
Collapse
Affiliation(s)
- John Hurley
- School of Health and Human Sciences, Southern Cross University, Australia
| | - Richard Lakeman
- School of Health and Human Sciences, Southern Cross University, Australia
| | - Andrew Cashin
- School of Health and Human Sciences, Southern Cross University, Australia
| | | |
Collapse
|
5
|
Moloney B, Cameron I, Baker A, Feeney J, Korner A, Kornhaber R, Cleary M, McLean L. Implementing a Trauma-Informed Model of Care in a Community Acute Mental Health Team. Issues Ment Health Nurs 2018; 39:547-553. [PMID: 29648912 DOI: 10.1080/01612840.2018.1437855] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In this paper, we demonstrate the value of implementing a Trauma-Informed Model of Care in a Community Acute Mental Health Team by providing brief intensive treatment (comprising risk interventions, brief counselling, collaborative formulation and pharmacological treatment). The team utilised the Conversational Model (CM), a psychotherapeutic approach for complex trauma. Key features of the CM are described in this paper using a clinical case study. The addition of the Conversational Model approach to practice has enabled better understandings of consumers' capacities and ways to then engage, converse, and intervene. The implementation of this intervention has led to a greater sense of self-efficacy amongst clinicians, who can now articulate a clear counselling model of care.
Collapse
Affiliation(s)
- Bill Moloney
- a Clinical Nurse Consultant, Blacktown Access & Acute Mental Health Team, Western Sydney Local Health District (WSLHD), Associate , Westmead Psychotherapy Program for Complex Traumatic Disorders, Mental Health Sciences Centre , Parramatta , New South Wales , Australia
| | - Ian Cameron
- b Consultant Psychologist, Private Practice, Associate, Westmead Psychotherapy Program for Complex Traumatic Disorders , Mental Health Sciences Centre, Parramatta , New South Wales , Australia
| | - Ashley Baker
- c Nurse Unit Manager, Blacktown Access & Acute Mental Health Team, Western Sydney Local Health District (WSLHD), Associate, Westmead Psychotherapy Program for Complex Traumatic Disorders, Complex Trauma Unit , Mental Health Sciences Centre , Parramatta , New South Wales , Australia
| | - Johanna Feeney
- a Clinical Nurse Consultant, Blacktown Access & Acute Mental Health Team, Western Sydney Local Health District (WSLHD), Associate , Westmead Psychotherapy Program for Complex Traumatic Disorders, Mental Health Sciences Centre , Parramatta , New South Wales , Australia
| | - Anthony Korner
- d Director, Westmead Psychotherapy Program for Complex Traumatic Disorders; Clinical Senior Lecturer, Sydney Medical School , University of Sydney , Camperdown , New South Wales , Australia
| | - Rachel Kornhaber
- e School of Health Sciences, College of Health and Medicine , University of Tasmania , Rozelle Campus , Sydney , Australia
| | - Michelle Cleary
- e School of Health Sciences, College of Health and Medicine , University of Tasmania , Rozelle Campus , Sydney , Australia
| | - Loyola McLean
- f Associate Professor Course Coordinator, Brain and Mind Centre, Discipline of Psychiatry, Sydney Medical School, University of Sydney; Senior Staff Specialist and Faculty member, Westmead Psychotherapy Program for Complex Traumatic Disorders, Mental Health Sciences Centre, Parramatta , WSLHD and University of Sydney; Consultation-Liaison Psychiatry, RNSH , St Leonards , New South Wales , Australia
| |
Collapse
|
6
|
Wilhelm K, Korczak V, Tietze T, Reddy P. Clinical pathways for suicidality in emergency settings: a public health priority. AUST HEALTH REV 2017; 41:182-184. [PMID: 27333074 DOI: 10.1071/ah16008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/01/2016] [Indexed: 11/23/2022]
Abstract
Rates of self-harm in Australia are increasing and constitute a concerning public health issue. Although there are standard treatment pathways for physical complaints, such as headache, abdominal pain and chest pain, in Emergency Medicine, there is no national pathway for self-harm or other psychiatric conditions that present to the emergency department. Herein we outline the difference between clinical practice guidelines and clinical pathways, discuss pathways we have identified on self-harm in Australia and overseas and discuss their applicability to the Australian context and the next steps forward in addressing this public health issue.
Collapse
Affiliation(s)
- Kay Wilhelm
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Randwick, NSW 2031, Australia
| | - Viola Korczak
- St Vincent's Urban Mental Health and Wellbeing Research Institute, St Vincent's Hospital, Victoria Street, Darlinghurst, NSW 2010, Australia.
| | - Tad Tietze
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Randwick, NSW 2031, Australia
| | - Prasuna Reddy
- St Vincent's Urban Mental Health and Wellbeing Research Institute, St Vincent's Hospital, Victoria Street, Darlinghurst, NSW 2010, Australia.
| |
Collapse
|
7
|
Quinlivan L, Cooper J, Meehan D, Longson D, Potokar J, Hulme T, Marsden J, Brand F, Lange K, Riseborough E, Page L, Metcalfe C, Davies L, O'Connor R, Hawton K, Gunnell D, Kapur N. Predictive accuracy of risk scales following self-harm: multicentre, prospective cohort study. Br J Psychiatry 2017; 210:429-436. [PMID: 28302702 PMCID: PMC5451643 DOI: 10.1192/bjp.bp.116.189993] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 10/05/2016] [Accepted: 11/13/2016] [Indexed: 11/23/2022]
Abstract
BackgroundScales are widely used in psychiatric assessments following self-harm. Robust evidence for their diagnostic use is lacking.AimsTo evaluate the performance of risk scales (Manchester Self-Harm Rule, ReACT Self-Harm Rule, SAD PERSONS scale, Modified SAD PERSONS scale, Barratt Impulsiveness Scale); and patient and clinician estimates of risk in identifying patients who repeat self-harm within 6 months.MethodA multisite prospective cohort study was conducted of adults aged 18 years and over referred to liaison psychiatry services following self-harm. Scale a priori cut-offs were evaluated using diagnostic accuracy statistics. The area under the curve (AUC) was used to determine optimal cut-offs and compare global accuracy.ResultsIn total, 483 episodes of self-harm were included in the study. The episode-based 6-month repetition rate was 30% (n = 145). Sensitivity ranged from 1% (95% CI 0-5) for the SAD PERSONS scale, to 97% (95% CI 93-99) for the Manchester Self-Harm Rule. Positive predictive values ranged from 13% (95% CI 2-47) for the Modified SAD PERSONS Scale to 47% (95% CI 41-53) for the clinician assessment of risk. The AUC ranged from 0.55 (95% CI 0.50-0.61) for the SAD PERSONS scale to 0.74 (95% CI 0.69-0.79) for the clinician global scale. The remaining scales performed significantly worse than clinician and patient estimates of risk (P<0.001).ConclusionsRisk scales following self-harm have limited clinical utility and may waste valuable resources. Most scales performed no better than clinician or patient ratings of risk. Some performed considerably worse. Positive predictive values were modest. In line with national guidelines, risk scales should not be used to determine patient management or predict self-harm.
Collapse
Affiliation(s)
- Leah Quinlivan
- Leah Quinlivan, PhD, Jayne Cooper, PhD, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, Manchester; Declan Meehan, RMN, Damien Longson, FRCPsych, Greater Manchester Mental Health and NHS Foundation Trust, Manchester; John Potokar, MRCPsych, Avon & Wiltshire Mental Health Foundation Trust, Bristol, University Hospitals Bristol, NHS Foundation Trust, Bristol and School of Social and Community Medicine, University of Bristol, Bristol; Tom Hulme, MSc, University Hospitals Bristol, NHS Foundation Trust, Bristol, Bristol; Jennifer Marsden, BA, Derbyshire Healthcare NHS Foundation Trust, Derby; Fiona Brand, RMN, Kezia Lange, MRCPsych, Oxford Health NHS Foundation Trust, Oxford; Elena Riseborough, RMN, Lisa Page, PhD, Sussex Partnership NHS Foundation Trust, Worthing; Chris Metcalfe, PhD, School of Social and Community Medicine, University of Bristol, Bristol; Linda Davies, Institute of Population Health, University of Manchester, Manchester; Rory O' Connor, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; Keith Hawton, DSc, Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford; David Gunnell, DSc, School of Social and Community Medicine, University of Bristol, Bristol; Nav Kapur, MBChB, MMedSci, MD, FRCPsych, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Carter G, Page A, Large M, Hetrick S, Milner AJ, Bendit N, Walton C, Draper B, Hazell P, Fortune S, Burns J, Patton G, Lawrence M, Dadd L, Dudley M, Robinson J, Christensen H. Royal Australian and New Zealand College of Psychiatrists clinical practice guideline for the management of deliberate self-harm. Aust N Z J Psychiatry 2016; 50:939-1000. [PMID: 27650687 DOI: 10.1177/0004867416661039] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To provide guidance for the organisation and delivery of clinical services and the clinical management of patients who deliberately self-harm, based on scientific evidence supplemented by expert clinical consensus and expressed as recommendations. METHOD Articles and information were sourced from search engines including PubMed, EMBASE, MEDLINE and PsycINFO for several systematic reviews, which were supplemented by literature known to the deliberate self-harm working group, and from published systematic reviews and guidelines for deliberate self-harm. Information was reviewed by members of the deliberate self-harm working group, and findings were then formulated into consensus-based recommendations and clinical guidance. The guidelines were subjected to successive consultation and external review involving expert and clinical advisors, the public, key stakeholders, professional bodies and specialist groups with interest and expertise in deliberate self-harm. RESULTS The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for deliberate self-harm provide up-to-date guidance and advice regarding the management of deliberate self-harm patients, which is informed by evidence and clinical experience. The clinical practice guidelines for deliberate self-harm is intended for clinical use and service development by psychiatrists, psychologists, physicians and others with an interest in mental health care. CONCLUSION The clinical practice guidelines for deliberate self-harm address self-harm within specific population sub-groups and provide up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus.
Collapse
Affiliation(s)
- Gregory Carter
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Centre for Translational Neuroscience and Mental Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia Department of Consultation Liaison Psychiatry, Calvary Mater Newcastle Hospital, Waratah, NSW, Australia
| | - Andrew Page
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Centre for Health Research, Western Sydney University, Richmond, NSW, Australia
| | - Matthew Large
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia
| | - Sarah Hetrick
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Allison Joy Milner
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Centre for Population Health Research, School of Health and Social Development, Deakin University, Burwood VIC, Australia Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Nick Bendit
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia
| | - Carla Walton
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Centre for Psychotherapy, Hunter New England Mental Health Service and Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Brian Draper
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Philip Hazell
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Sarah Fortune
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia The University of Auckland, Auckland, New Zealand University of Leeds, Leeds, UK Kidz First, Middlemore Hospital, Auckland, New Zealand
| | - Jane Burns
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Young and Well Cooperative Research Centre, The University of Melbourne, Melbourne, VIC, Australia Brain & Mind Research Institute, The University of Sydney, Sydney, NSW, Australia Orygen Youth Health Research Centre, Melbourne, VIC, Australia
| | - George Patton
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia National Health and Medical Research Council, Canberra, ACT, Australia Centre for Adolescent Health, The Royal Children's Hospital, Melbourne, VIC, Australia Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Mark Lawrence
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Tauranga Hospital, Bay of Plenty, New Zealand
| | - Lawrence Dadd
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Mental Health & Substance Use Service, Hunter New England, NSW Health, Waratah, NSW, Australia Awabakal Aboriginal Medical Service, Hamilton, NSW, Australia Pital Tarkin, Aboriginal Medical Student Mentoring Program, The Wollotuka Institute, The University of Newcastle, Callaghan, NSW, Australia Specialist Outreach NT, Darwin, Northern Territory, Australia
| | | | - Jo Robinson
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Helen Christensen
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Black Dog Institute, The University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
9
|
Martiniuk ALC, Chen HY, Glozier N, Patton G, Senserrick T, Williamson A, Woodward M, Ivers R. High alcohol use a strong and significant risk factor for repetitive self-harm in female and male youth: a prospective cohort study. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2015; 41:465-73. [DOI: 10.3109/00952990.2015.1062023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Alexandra L. C. Martiniuk
- The George Institute for Global Health, Australia,
- School of Public Health, The University of Sydney,
- Dalla Lana School of Public Health, The University of Toronto, Toronto, Ontario, Canada,
| | - Huei-Yang Chen
- The George Institute for Global Health, Australia,
- Accident Research Center, Curtin University, Perth,
| | - Nick Glozier
- School of Public Health, The University of Sydney,
| | - George Patton
- Center for Adolescent Health, Royal Children’s Hospital, Victoria, and
| | - Teresa Senserrick
- The George Institute for Global Health, Australia,
- School of Public Health, The University of Sydney,
| | | | - Mark Woodward
- The George Institute for Global Health, Australia,
- School of Public Health, The University of Sydney,
| | - Rebecca Ivers
- The George Institute for Global Health, Australia,
- School of Public Health, The University of Sydney,
| |
Collapse
|
10
|
Camargo ALLS, Maluf A, Colman FT, Citero VDA. Development of psychiatric risk evaluation checklist and routine for nurses in a general hospital: ethnographic qualitative study. SAO PAULO MED J 2015; 133:350-7. [PMID: 25424773 PMCID: PMC10876350 DOI: 10.1590/1516-3180.2013.8100711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 12/15/2013] [Accepted: 07/11/2014] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE There is high prevalence of mental and behavioral disorders in general hospitals, thus triggering psychiatric risk situations. This study aimed to develop a psychiatric risk assessment checklist and routine for nurses, the Psychiatric Risk Evaluation Check-List (PRE-CL), as an alternative model for early identification and management of these situations in general hospitals. DESIGN AND SETTING Ethnographic qualitative study in a tertiary-level private hospital. METHOD Three hundred general-unit nurses participated in the study. Reports were gathered through open groups conducted by a trained nurse, at shift changes for two months. The questions used were: "Would you consider it helpful to discuss daily practice situations with a psychiatrist? Which situations?" The data were qualitatively analyzed through an ethnographic approach. RESULTS The nurses considered it useful to discuss daily practice situations relating to mental and behavioral disorders with a psychiatrist. Their reports were used to develop PRE-CL, within the patient overall risk assessment routine for all inpatients within 24 hours after admission and every 48 hours thereafter. Whenever one item was present, the psychosomatic medicine team was notified. They went to the unit, gathered data from the nurses, patient files and, if necessary, attending doctors, and decided on the risk management: guidance, safety measures or mental health consultation. CONCLUSION It is possible to develop a model for detecting and intervening in psychiatric and behavioral disorders at general hospitals based on nursing team observations, through a checklist that takes these observations into account and a routine inserted into daily practice.
Collapse
Affiliation(s)
- Ana Luiza Lourenço Simões Camargo
- MD, MSc. Doctoral Student, Department of Psychiatry, Escola Paulista de Medicina - Universidade Federal de São Paulo (EPM-Unifesp), and Medical Coordinator of the Department of Psychosomatic Medicine and Psychiatry, Hospital Israelita Albert Einstein (HIAE), São Paulo, Brazil.
| | - Alfredo Maluf
- MD. Psychiatrist, Department of Psychosomatic Medicine and Psychiatry, Hospital Israelita Albert Einstein (HIAE), São Paulo, Brazil.
| | - Fátima Tahira Colman
- RN. Manager, Inpatient Department, Hospital Israelita Albert Einstein (HIAE), São Paulo, Brazil.
| | - Vanessa de Albuquerque Citero
- MD, PhD. Affiliated Professor, Department of Psychiatry, Escola Paulista de Medicina - Universidade Federal de Sao Paulo (EPM-Unifesp), São Paulo, Brazil.
| |
Collapse
|
11
|
Peyron PA, David M. Les outils cliniques d’évaluation du risque suicidaire chez l’adulte en médecine générale. Presse Med 2015; 44:590-600. [DOI: 10.1016/j.lpm.2014.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 11/28/2014] [Accepted: 12/10/2014] [Indexed: 11/24/2022] Open
|
12
|
de Beurs DP, de Groot MH, de Keijser J, Mokkenstorm J, van Duijn E, de Winter RFP, Kerkhof AJFM. The effect of an e-learning supported Train-the-Trainer programme on implementation of suicide guidelines in mental health care. J Affect Disord 2015; 175:446-53. [PMID: 25679199 DOI: 10.1016/j.jad.2015.01.046] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 01/16/2015] [Accepted: 01/16/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Randomized studies examining the effect of training of mental health professionals in suicide prevention guidelines are scarce. We assessed whether professionals benefited from an e-learning supported Train-the-Trainer programme aimed at the application of the Dutch multidisciplinary suicide prevention guideline. METHODS 45 psychiatric departments from all over the Netherlands were clustered in pairs and randomized. In the experimental condition, all of the staff of psychiatric departments was trained by peers with an e-learning supported Train-the-Trainer programme. Guideline adherence of individual professionals was measured by means of the response to on-line video fragments. Multilevel analyses were used to establish whether variation between conditions was due to differences between individual professionals or departments. RESULTS Multilevel analysis showed that the intervention resulted in an improvement of individual professionals. At the 3 month follow-up, professionals who received the intervention showed greater guideline adherence, improved self-perceived knowledge and improved confidence as providers of care than professionals who were only exposed to traditional guideline dissemination. Subgroup analyses showed that improved guideline adherence was found among nurses but not among psychiatrists and psychologists. No significant effect of the intervention on team performance was found. LIMITATIONS The ICT environment in departments was often technically inadequate when displaying the video clips clip of the survey. This may have caused considerable drop-out and possibly introduced selection bias, as professionals who were strongly affiliated to the theme of the study might have been more likely to finish the study. CONCLUSIONS Our results support the idea that an e-learning supported Train-the-Trainer programme is an effective strategy for implementing clinical guidelines and improving care for suicidal patients. TRIAL REGISTRATION Netherlands Trial Register (NTR3092 www.trialregister.nl).
Collapse
Affiliation(s)
- Derek P de Beurs
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
| | - Marieke H de Groot
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
| | | | - Jan Mokkenstorm
- GGZ Foundation for Mental Health Care GGZ inGeest, The Netherlands.
| | - Erik van Duijn
- GGZ Foundation for Mental Health Care Delfland, The Netherlands.
| | - Remco F P de Winter
- GGZ Foundation for Mental Health Care, Parnassia, The Hague, The Netherlands.
| | - Ad J F M Kerkhof
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
| |
Collapse
|
13
|
Hiles S, Bergen H, Hawton K, Lewin T, Whyte I, Carter G. General hospital-treated self-poisoning in England and Australia: comparison of presentation rates, clinical characteristics and aftercare based on sentinel unit data. J Psychosom Res 2015; 78:356-62. [PMID: 25623486 DOI: 10.1016/j.jpsychores.2015.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 12/30/2014] [Accepted: 01/14/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Hospital-treated deliberate self-poisoning (DSP) is common and the existing national monitoring systems are often deficient. Clinical Practice Guidelines (UK and Australia) recommend universal psychosocial assessment within the general hospital as standard care. We compared presentation rates, patient characteristics, psychosocial assessment and aftercare in UK and Australia. METHODS We used a cross sectional design, for a ten year study of all DSP presentations identified through sentinel units in Oxford, UK (n=3042) and Newcastle, Australia (n=3492). RESULTS Oxford had higher presentation rates for females (standardised rate ratio 2.4: CI 99% 1.9, 3.2) and males (SRR 2.5: CI 99% 1.7, 3.5). Female to male ratio was 1.6:1, 70% presented after-hours, 95% were admitted to a general hospital and co-ingestion of alcohol occurred in a substantial minority (Oxford 24%, Newcastle 32%). Paracetamol, minor tranquilisers and antidepressants were the commonest drug groups ingested, although the overall pattern differed. Psychosocial assessment rates were high (Oxford 80%, Newcastle 93%). Discharge referral for psychiatric inpatient admission (Oxford 8%, Newcastle 28%), discharge to home (Oxford 80%, Newcastle 70%) and absconding (Oxford 11%, Newcastle 2%) differed between the two units. CONCLUSIONS Oxford has higher age-standardised rates of DSP than Newcastle, although many other characteristics of patients are similar. Services can provide a high level of assessment as recommended in clinical guidelines. There is some variation in after-care. Sentinel service monitoring routine care of DSP patients can provide valuable comparisons between countries.
Collapse
Affiliation(s)
- Sarah Hiles
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Australia
| | - Helen Bergen
- Centre for Suicide Research, University Department of Psychiatry, University of Oxford, Warneford Hospital, Headington, Oxford, UK
| | - Keith Hawton
- Centre for Suicide Research, University Department of Psychiatry, University of Oxford, Warneford Hospital, Headington, Oxford, UK
| | - Terry Lewin
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Australia
| | - Ian Whyte
- Department of Clinical Toxicology and Pharmacology (Hunter Area Toxicology Service - HATS), Calvary Mater Newcastle, Australia; Discipline of Clinical Pharmacology, School of Medicine and Public Health, Faculty of Health, University of Newcastle, Australia
| | - Gregory Carter
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Australia.
| |
Collapse
|
14
|
Ceramidas D, Forn de Zita C, Eklund M, Kirsh B. The 2009 world team of mental health occupational therapists: a resilient and dedicated workforce. WORLD FEDERATION OF OCCUPATIONAL THERAPISTS BULLETIN 2014. [DOI: 10.1179/otb.2009.60.1.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
15
|
Goldney RD. A retrospective of publications addressing suicidal behaviour in the Australian and New Zealand Journal of Psychiatry, 1967-2012. Aust N Z J Psychiatry 2013; 47:431-4. [PMID: 23653062 DOI: 10.1177/0004867413481068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To review publications addressing suicidal behaviour in the Australian and New Zealand Journal of Psychiatry, 1967-2012. METHOD A PubMed/MEDLINE search using the words suicide, attempted suicide (and their synonyms) and Aust NZ J Psychiatr was carried out, and an examination of all tables of contents of the journal for the years 1967-2012 was performed. RESULTS In 342 (7.4%) of 4599 articles there was reference to suicidal behaviour. This ratio was consistent over time, although the nature of their content changed from broader epidemiological and clinical review studies to more focused reports. CONCLUSIONS Papers addressing suicidal behaviour have been published consistently in the Australian and New Zealand Journal of Psychiatry since its inception in 1967. Early clinical reviews remain pertinent to the present time.
Collapse
Affiliation(s)
- Robert D Goldney
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA 5005, Australia.
| |
Collapse
|
16
|
Brierley S, Baker K, Brack J, Cunningham P. Retrospective case note review of patients brought to Ipswich emergency department under mental health emergency examination orders: does intoxication alter outcome? Emerg Med Australas 2013; 22:532-6. [PMID: 21143401 DOI: 10.1111/j.1742-6723.2010.01350.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To alter staff perceptions, and to examine alternative management processes for intoxicated patients brought to Ipswich ED under mental health emergency examination orders by comparing disposition outcomes with non-intoxicated patients. METHODS Consultation-Liaison mental health nursing staff completed surveys on all patients assessed under emergency examination orders over a 6 month period in 2008. Patients were classified as intoxicated if they recorded alcometer readings of greater than 0.05%, or self-reported drug use during the events leading to their transport to the ED. Outcomes were retrospectively collated with entries in Clinical Liaison nursing logbooks. Outcome measures recorded were rates of admission, outpatient referrals to the Integrated Mental Health Service, follow up by other community services or no follow up. Differences in outcomes for intoxicated and non-intoxicated patient groups were tested for significance using χ(2) or Fisher's exact test. RESULTS One hundred and sixty-eight cases were included in the audit. No cases were excluded. Sixty patients were identified as intoxicated. The age and sex distributions were similar between intoxicated and non-intoxicated patients. There were no significant differences in admission or referral rates. The average length of assessment time in the ED was longer in the intoxicated group. DISCUSSION This audit showed similar outcomes for both patient groups contrary to the perceptions expressed by ED staff in informal surveys. The admission and referral rate for both groups indicate they are an at-risk population. The admission rate of 16% has led to this department negotiating alternative accommodation for patients while they sober up.
Collapse
Affiliation(s)
- Stephen Brierley
- Ipswich Hospital, Chelmsford Avenue, Ipswich, Queensland 4305, Australia
| | | | | | | |
Collapse
|
17
|
Kumar CTS, Tharayil HM, Kumar TVA, Ranjith G. A survey of psychiatric services for people who attempt suicide in south India. Indian J Psychiatry 2012; 54:352-5. [PMID: 23372239 PMCID: PMC3554968 DOI: 10.4103/0019-5545.104823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND AIMS Self-harm is a major public health problem in the southern parts of India. This survey was undertaken to assess the nature of psychiatric services available in hospitals attached to medical colleges for those who have attempted suicide. MATERIALS AND METHODS After reviewing the relevant literature, a questionnaire was prepared. We sent this questionnaire to 94 medical colleges in South India. RESULTS The response rate of the survey was 50%. Psychiatric assessment of suicide attempters in the casualty department are done by mental health professionals in 23 (66%) hospitals. Psychotropic medications are prescribed for appropriate patients in 33 (94%) hospitals, while talking therapies are available in 31 (89%) hospitals. Six (17%) centers have training sessions for casualty staff in mental health assessment of patients who have attempted suicide. A majority of hospitals have medical students posted in the psychiatry department. CONCLUSIONS The services available for people who have attempted suicide appear to be patchy in south Indian teaching hospitals. Training of frontline staff in the assessment and management of people who have attempted suicide is extremely important.
Collapse
Affiliation(s)
- C T Sudhir Kumar
- Department of Psychosis Studies, Section of Neurobiology of Psychosis, Institute of Psychiatry, De Crespigny Park, London, United Kingdom
| | | | | | | |
Collapse
|
18
|
Abstract
Risk assessment pervades mental health care policy, practice, and legislation. This paper aims to establish the research evidence for the effectiveness of a risk assessment approach in mental health. A search was conducted of the professional literature on risk assessment in mental health, specifically seeking any research on the effectiveness of risk assessment in reducing risk of harm to self or others. The search found limited research on the effectiveness of risk assessment. "Structured professional judgment" possibly reduces aggression risk but there is no evidence that risk assessment is effective in relation to self-harm or suicide reduction. The implications for practice are discussed and alternatives to a risk assessment approach are considered.
Collapse
Affiliation(s)
- Timothy Wand
- Royal Prince Alfred Hospital, Emergency Department, Camperdown, Australia and University of Sydney, Sydney Nursing School, Camperdown, Australia.
| |
Collapse
|
19
|
Dickinson T, Hurley M. Exploring the antipathy of nursing staff who work within secure healthcare facilities across the United Kingdom to young people who self-harm. J Adv Nurs 2011; 68:147-58. [DOI: 10.1111/j.1365-2648.2011.05745.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
20
|
Dawson AH, Buckley NA. Toxicologists in public health--Following the path of Louis Roche (based on the Louis Roche lecture "An accidental toxicologist in public health", Bordeaux, 2010). Clin Toxicol (Phila) 2011; 49:94-101. [PMID: 21370945 DOI: 10.3109/15563650.2011.554420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The global burden of clinical toxicology suggests a natural partnership with public health. This article reflects the content of a Louis Roche lecture given in 2010. HISTORICAL CONTEXT: Our practice and research in clinical toxicology has evolved from clinical cases to toxico-epidemiology to public health. This evolution in practice was initially unplanned but gained momentum and impact as we placed it more formally in a public health framework. This perspective is implicit in Louis Roche's call to "examine all aspects of the poisoning problem" and still provides a valuable starting point for any clinical toxicologist. DISCUSSION Clinical toxicology has always had a patient centered focus but its greatest successes have been related to public health interventions. Our early failures and later success in pubic health toxicology correlated with our understanding of the importance of partnerships outside our field. The most rapid dissemination and implementation of information derived from research occur through apriori partnerships with other agencies and international partners. CONCLUSION Addressing both local and global need has a number of bilateral synergies. Repositioning clinical toxicology into a public health framework increases access to strategic partnerships, research funds, and policy implementation while still addressing questions that are important to clinical practice.
Collapse
Affiliation(s)
- Andrew H Dawson
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka.
| | | |
Collapse
|
21
|
Edwards SJ, Sachmann MD. No-suicide contracts, no-suicide agreements, and no-suicide assurances: a study of their nature, utilization, perceived effectiveness, and potential to cause harm. CRISIS 2011; 31:290-302. [PMID: 21190927 DOI: 10.1027/0227-5910/a000048] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Suicide prevention contracting (SPC) procedures are often afforded clinical practice validity in the absence of evidence attesting to their efficacy and validity. AIMS This study sought to develop a contemporary profile of SPC, identifying factors associated with utilization, perceived effectiveness, and to describe potentially detrimental factors when activating SPC. METHODS A questionnaire was mailed to a sample of mental health practitioners comprising physicians, mental health nurse practitioners, and allied health practitioners to inquire about their practices and experiences with SPC. RESULTS There were 420 valid responses, a response rate of 31%. Participants confirmed three types of SPC procedures in operation: (1) 355 (85%) having used verbal no-suicide assurances (NSAs); (2) 317 (76%) using verbal no-suicide agreements (NSAg); and, (3) 154 (37%) using written no-suicide contracts (NSC). The profiled procedures and their clinical application indicate that participants perceived differences in the diagnostic, therapeutic, and medico-legal utility of all three SPC procedures. Importantly, SPC procedures were shown to have a multifaceted potential for detrimental outcomes for patients and practitioners. CONCLUSIONS Until now, SPC had represented a poorly understood and remains a questionable clinical practice intervention. Education initiatives are required that alert mental health practitioners to the dangers of SPC for patients and practitioners alike, and to present alternative interventions containing less risk.
Collapse
Affiliation(s)
- Stephen J Edwards
- Discipline of Social Work and Social Policy, University of Western Australia, Australia.
| | | |
Collapse
|
22
|
Berntsen E, Starling J, Durheim E, Hainsworth C, de Kloet L, Chapman L, Hancock K. Temporal trends in self harm and aggression on a paediatric mental health ward. Australas Psychiatry 2011; 19:64-9. [PMID: 21303279 DOI: 10.3109/10398562.2010.526212] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this paper is to describe trends in aggression and self harm on a mental health inpatient unit for children and adolescents between January 2006 and August 2009. Various ward interventions and the ward milieu were evaluated as possible explanatory factors for trends. METHOD This was a retrospective study whereby incidents of aggression, self harm and seclusion were obtained from a computerized Incident Information Management System (IIMS) database. Trends in incidents were analysed using linear regression analyses. RESULTS Over a 44-month period, 292 incidents of aggression and 139 incidents of self harm were reported. The use of seclusion and the number of aggressive incidents both significantly decreased over time. Trends suggested a positive relationship between the introduction of restraint training, changes in leadership and full staff complement, and a reduction in aggression and seclusion. CONCLUSIONS Although the findings are limited by their retrospective nature and reliance on formal records, this study suggests that different factors can contribute to decrease the incidence of adverse events on a psychiatric ward. Future prospective research is needed to assess the effectiveness of different interventions in both the prevention and management of self harm, aggression and seclusion in child and adolescent inpatient units.
Collapse
Affiliation(s)
- Ellen Berntsen
- The Vrije Universiteit, Boelelaan 1117, 1058HV Amsterdam, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
23
|
Jayasekera H, Carter G, Clover K. Comparison of the Composite International Diagnostic interview (CIDI-Auto) with clinical diagnosis in a suicidal population. Arch Suicide Res 2011; 15:43-55. [PMID: 21293999 DOI: 10.1080/13811118.2011.540208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The objective was to examine agreement between routine clinician diagnoses of DSM-IV Anxiety, Depressive, Substance-Use disorders with diagnoses generated by CIDI-Auto Version 2.1, administered by trained interviewers. Subjects were 329 deliberate self poisoning patients at a tertiary referral center in Australia. Tests of agreement were: percentage agreement, sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and Cohen's kappa coefficients, for 1 month and 12 month CIDI diagnoses. Agreement was poor (kappa <0.40) for Anxiety, Depressive and Substance-Use disorders. Since diagnosis largely determines subsequent treatment, these findings did not support the use of the less expensive CIDI-Auto procedure to replace clinical diagnosis by experienced clinicians for this group of patients exhibiting suicidal behavior.
Collapse
Affiliation(s)
- Himali Jayasekera
- Hunter New England Mental Health Services, Newcastle, NSW, Australia
| | | | | |
Collapse
|
24
|
Murphy E, Kapur N, Webb R, Cooper J. Risk assessment following self-harm: comparison of mental health nurses and psychiatrists. J Adv Nurs 2010; 67:127-39. [PMID: 20969616 DOI: 10.1111/j.1365-2648.2010.05484.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This paper is a report of a study conducted to compare risk assessments by psychiatrists and mental health nurses following an episode of self-harm. BACKGROUND Self-harm assessments by nurses and psychiatrists are similar in terms of overall content, but risk assessment may vary by professional discipline. To our knowledge previous researchers have not compared the positive predictive value of risk assessments by nurses and psychiatrists, the factors that inform those assessments in clinical practice or the management of people assessed as being at high risk. METHODS We conducted a prospective cohort study (2002-2006) of 3491 individuals presenting with self-harm to three hospitals in the North West of England. A standard assessment form including detailed demographic and clinical data was completed by the assessing psychiatrist or nurse. RESULTS The positive predictive value of risk assessments for self-harm repetition was 25% (95% CI: 20-31) among nurses and 23% (95% CI: 13-37) among psychiatrists. There was strong agreement on factors associated with high risk assessment by both professions. Following assessment of high risk, psychiatrists were much more likely than nurses to admit people for inpatient treatment (RR=5.6, 95% CI: 3.2-9.7). This difference remained highly statistically significant after controlling for case-mix differences (RR=4.3, 95% CI: 2.4-7.7). CONCLUSION Our finding that risk assessments were comparable by profession supports the provision of nurse-led assessment services. However, inpatient admission was influenced largely by assessor type rather than patient characteristics. This has important implications for equity of care and may reflect professional differences in referral practices.
Collapse
Affiliation(s)
- Elizabeth Murphy
- Centre for Suicide Prevention, Manchester Academic Health Science Centre, The University of Manchester, UK.
| | | | | | | |
Collapse
|
25
|
Murphy E, Steeg S, Cooper J, Chang R, Turpin C, Guthrie E, Kapur N. Assessment rates and compliance with assertive follow-up after self-harm: cohort study. Arch Suicide Res 2010; 14:120-34. [PMID: 20455148 DOI: 10.1080/13811111003704662] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The objectives of this study were to identify 1) the proportion of self-harm episodes that resulted in assessment by a specialist self-harm team and offers, attendance, and completion of brief therapy and 2) the factors associated with these treatment options. A prospective cohort study of 717 hospital presentations of self-harm was conducted. Rates of assessment, offers and completion of therapy ranged from 50% to 60%. Of those offered therapy, 73% attended one or more sessions. Attendance was associated with depressive psychopathology and existing treatment in primary care. These results may reflect some of the challenges of engaging this patient group. We found that receipt of treatment was determined by patient factors. Future studies might also examine the role of service-related or clinician factors.
Collapse
Affiliation(s)
- Elizabeth Murphy
- Centre for Suicide Prevention, The University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK.
| | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
PURPOSE OF REVIEW This study outlines the broad approach taken in Australia to improve the quality of mental health services, including the use of performance and outcome measures along with a range of other linked quality initiatives. RECENT FINDINGS The investment of Australia in a strategic national approach to mental health reform with a range of nationally coordinated quality initiatives has provided a firm foundation for continuing to engage governments, healthcare organizations and clinicians in the ongoing quest for quality and outcome measurement and improvement. SUMMARY Australia has adopted a strategic national approach to quality and outcome measurement and improvement of mental health services despite having a federated health system involving nine governments and tiered care across public and private sectors. A range of interconnected initiatives including national plans, standards and guidelines, performance indicators and outcomes measures and benchmarking and reporting processes are the key components of this nationally coordinated system.
Collapse
|
27
|
Williams F, Hasking P. Emotion Regulation, Coping and Alcohol Use as Moderators in the Relationship Between Non-Suicidal Self-Injury and Psychological Distress. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2009; 11:33-41. [DOI: 10.1007/s11121-009-0147-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
28
|
Killackey E, Jorm A, Alvarez-Jimenez M, McCann TV, Hides L, Couineau AL. Do we do what we know works, and if not why not? Aust N Z J Psychiatry 2008; 42:439-44. [PMID: 18465370 DOI: 10.1080/00048670802050652] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Eóin Killackey
- ORYGEN Research Centre and Department of Psychology, University of Melbourne, Parkville, Vic., 3052, Australia
| | - Anthony Jorm
- ORYGEN Research Centre, Melbourne, Victoria, Australia
| | - Mario Alvarez-Jimenez
- ORYGEN Research Centre, Melbourne, Victoria, Australia
- University Hospital Marqués de Valdecilla, Department of Psychiatry, University of Cantabria School of Medicine, Santander, Spain
| | - Terence V. McCann
- Victoria University of Technology School of Nursing and Midwifery, Melbourne, Victoria, Australia
| | - Leanne Hides
- ORYGEN Research Centre, Melbourne, Victoria, Australia
| | - Anne-Laure Couineau
- Australian Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
29
|
Hasking P, Momeni R, Swannell S, Chia S. The nature and extent of non-suicidal self-injury in a non-clinical sample of young adults. Arch Suicide Res 2008; 12:208-18. [PMID: 18576202 DOI: 10.1080/13811110802100957] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aimed to examine the nature, extent and correlates of non-suicidal self injury (NSSI) in a non-clinical sample of young adults. Two hundred and eleven participants (18-30 years) completed self-report questionnaires assessing history of NSSI, emotional regulation, coping strategies, symptoms of psychopathology, and alcohol use. Of the sample, 43.6% reported engaging in NSSI; approximately 10% engaged in moderate/severe NSSI. Those that reported NSSI reported greater psychopathology, avoidant coping and alcohol use than those who did not self-injure. The extent of these differences was magnified as the severity of NSSI increased. These findings highlight the need to consider any form of NSSI, no matter how mild, as an indication of distress and ineffective coping.
Collapse
Affiliation(s)
- Penelope Hasking
- School of Psychology, Psychiatry & Psychological Medicine, Monash University, Melbourne, Australia.
| | | | | | | |
Collapse
|
30
|
Abstract
OBJECTIVE In this paper we describe the origins of suicide prevention contracting, identify the historical factors that led to the adoption of the intervention, and describe legal tensions that have emerged during its use. CONCLUSIONS It would appear that one of the most frequently used clinical interventions for responding to suicidality has established a place in clinical practice without evidence attesting to its efficacy. We develop some propositions about how and why this clinical technique has been able to consolidate its place in mental health practice and, in so doing, suggest that the original technique was able to secure a clinical place without much apparent resistance because of the confluence of a number of emerging theories and community trends.
Collapse
Affiliation(s)
- Stephen Edwards
- University of Western Australia, Nedlands, WA, Australia. stephene@ cyllene.uwa.edu.au
| | | |
Collapse
|
31
|
Wilhelm K, Finch A, Kotze B, Arnold K, McDonald G, Sternhell P, Hudson B. The Green Card Clinic: overview of a brief patient-centred intervention following deliberate self-harm. Australas Psychiatry 2007; 15:35-41. [PMID: 17464632 DOI: 10.1080/10398560601083068] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of this study was to present an overview of the Green Card Clinic, a novel brief intervention service for patients presenting to the emergency department following deliberate self-harm (DSH) or with suicidal ideation, to examine its effectiveness in terms of service utilization, and patient and clinician feedback, and to explore the correlates of repeated DSH. METHOD The aims and structure of the Green Card Clinic are described. We highlight our patient-centred approach involving self-identification of difficulties from a list of problem areas, coupled with tailored intervention strategies. Relevant data are presented and characteristics of repeat DSH patients are compared to the first-episode group. RESULTS Between 1998 and 2005, 456 DSH patients were referred to the clinic. Of these, 75% (n = 344) attended the first session, 43% (n = 197) the second session, 26% (n = 117) the third session, and 16% (n = 73) completed a 3-15 month follow-up. Clinic attenders (mean age 31.6 years, 57% female) reported a diverse range of self-identified problems and repeat DSH patients reported worse depression, poorer health-related behaviours, and a greater number of problems than those presenting after first-episode DSH. CONCLUSIONS The clinic achieved high rates of first session attendance. This may have been attributable to the use of a few specific strategies aimed at increasing compliance, such as the green card, next-day appointments and assertive follow-up of non-attenders. For repeat self-harmers, we advocate an approach aimed at 'lifestyle change' rather than based on current psychological stressors. The Green Card Clinic service, involving a range of interventions tailored to meet the multitude of presenting needs, appears to be an acceptable and flexible approach to brief intervention for DSH.
Collapse
Affiliation(s)
- Kay Wilhelm
- School of Psychiatry, University of NSW, Sydney, NSW, Australia.
| | | | | | | | | | | | | |
Collapse
|
32
|
Fortune S, Clarkson H. The role of child and adolescent mental health services in suicide prevention in New Zealand. Australas Psychiatry 2006; 14:369-73. [PMID: 17116074 DOI: 10.1080/j.1440-1665.2006.02306.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We consider the role of child and adolescent mental health services (CAMHS) in the prevention of suicide by young people in New Zealand by examining the conflicting demands placed on CAMHS as a result of public expectation, health-care policy and structures, the current focus in the health sector on risk assessment and the inability of CAMHS to see all the young people who may consider suicide in any given year. CONCLUSIONS We suggest that CAMHS are currently under significant pressures which are inadvertently leading to distortions of clinical practice away from the clinical needs of suicidal children, adolescents and their families towards risk assessment and risk management strategies. The inability of CAMHS to offer comprehensive services to all young people considering suicide may be addressed by greater provision of consult-liaison activities, better understanding between clinicians and health managers, and improvements in clinical skills.
Collapse
Affiliation(s)
- Sarah Fortune
- University of Oxford Centre for Suicide Research, Oxford, England, UK.
| | | |
Collapse
|
33
|
Keene J. A cross sectional study of assessed need and multiple service use among a self harm population: informing the development of inter-agency integrated care. Int J Integr Care 2006; 5:e22. [PMID: 16773163 PMCID: PMC1395520 DOI: 10.5334/ijic.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To examine assessed need and wider health and social care service contact for a total Deliberate Self Harm (DSH) population in the UK. METHODS The study first recorded assessed needs and referrals for this population, then used a new method of identifying and describing all other agency contacts for this population by combining the total anonymised DSH population data with total mental health, health and social care agency populations for one geographical area. RESULTS For a DSH unit population of 427, half (53%) were assessed with mental health and 18% with drug or alcohol problems; two thirds were referred to appropriate services. Wider service contact for a total DSH population (n=2,205 over three years) confirmed that 53% had contacted mental health (compared to 2.9% of the geographical area population (n=646,239) and 7.4% of the total hospital Emergency population (n=91,911). The DSH population was three times more likely to contact social care agencies (21.1%: 7.2%) and ten times more likely to attend drug (7.3%: 0.7%) and alcohol agencies (8.8%: 0.8%) CONCLUSIONS This new method described the wider service use of one vulnerable shared care population, it is suggested that the method could be used to inform the development of integrated care initiatives in different areas.
Collapse
Affiliation(s)
- J Keene
- Centre for Primary Care and Public Health, School of Health and Social Care, University of Reading, Bulmershe Court, Reading, RG6 1HY.
| |
Collapse
|
34
|
Carter GL, Safranko I, Lewin TJ, Whyte IM, Bryant JL. Psychiatric hospitalization after deliberate self-poisoning. Suicide Life Threat Behav 2006; 36:213-22. [PMID: 16704325 DOI: 10.1521/suli.2006.36.2.213] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The decision for psychiatric hospitalization after deliberate self-poisoning (DSP) is not well understood. This study, a longitudinal cohort study of 3,148 consecutive DSP patients found 920 (29.2%) subjects were referred for psychiatric hospitalization, 576 (18.3%) on involuntary basis. A logistic regression analysis showed increased risk for: age 25 or older, homelessness, unemployment, previous self-harm, psychiatric inpatient treatment within 12 months, earlier psychiatric inpatient treatment, suicidal ideation or plan, mood or psychotic disorders, and lower clinician experience; and lower risk for being married/defacto, and after hours presentation. Recommendation for psychiatric hospitalization was based on complex decision making. These findings have implications for clinical practice guidelines, service costs, and service organization.
Collapse
Affiliation(s)
- Gregory L Carter
- Suicide Prevention Research Unit, Centre for Mental Health Studies at the University of Newcastle and Hunter and New England Area Health Service, Australia.
| | | | | | | | | |
Collapse
|