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Cantrell A, Sworn K, Chambers D, Booth A, Taylor Buck E, Weich S. Factors within the clinical encounter that impact upon risk assessment within child and adolescent mental health services: a rapid realist synthesis. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-107. [PMID: 38314750 DOI: 10.3310/vkty5822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Background Risk assessment is a key process when a child or adolescent presents at risk for self-harm or suicide in a mental health crisis or emergency. Risk assessment by a healthcare professional should be included within a biopsychosocial assessment. However, the predictive value of risk-screening tools for self-harm and suicide in children and adolescents is consistently challenged. A review is needed to explore how best to undertake risk assessment and the appropriate role for tools/checklists within the assessment pathway. Aims To map research relating to risk assessment for child and adolescent mental health and to identify features that relate to a successful risk assessment. Objectives To review factors within the clinical encounter that impact upon risk assessments for self-harm and suicide in children and adolescents: i. to conduct a realist synthesis to understand mechanisms for risk assessment, why they occur and how they vary by context ii. to conduct a mapping review of primary studies/reviews to describe available tools of applicability to the UK. Data sources Databases, including MEDLINE, PsycINFO®, EMBASE, CINAHL, HMIC, Science and Social Sciences Citation Index and the Cochrane Library, were searched (September 2021). Searches were also conducted for reports from websites. Review methods A resource-constrained realist synthesis was conducted exploring factors that impact upon risk assessments for self-harm and suicide. This was accompanied by a mapping review of primary studies/reviews describing risk-assessment tools and approaches used in UK child and adolescent mental health. Following piloting, four reviewers screened retrieved records. Items were coded for the mapping and/or for inclusion in the realist synthesis. The review team examined the validity and limitations of risk-screening tools. In addition, the team identified structured approaches to risk assessment. Reporting of the realist synthesis followed RAMESES guidelines. Results From 4084 unique citations, 249 papers were reviewed and 41 studies (49 tools) were included in the mapping review. Eight reviews were identified following full-text screening. Fifty-seven papers were identified for the realist review. Findings highlight 14 explanations (programme theories) for a successful risk assessment for self-harm and suicide. Forty-nine individual assessment tools/approaches were identified. Few tools were developed in the UK, specifically for children and adolescents. These lacked formal independent evaluation. No risk-screening tool is suitable for risk prediction; optimal approaches incorporate a relationship of trust, involvement of the family, where appropriate, and a patient-centred holistic approach. The objective of risk assessment should be elicitation of information to direct a risk formulation and care plan. Limitations Many identified tools are well-established but lack scientific validity, particularly predictive validity, or clinical utility. Programme theories were generated rapidly from a survey of risk assessment. Conclusions No single checklist/approach meets the needs of risk assessment for self-harm and suicide. A whole-system approach is required, informed by structured clinical judgement. Useful components include a holistic assessment within a climate of trust, facilitated by family involvement. Study registration This study is registered as PROSPERO CRD42021276671. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR135079) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 1. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Anna Cantrell
- Health Economics & Decision Science (HEDS) School of Health and Related Research (ScHARR), Regent Court, Sheffield, UK
| | - Katie Sworn
- Health Economics & Decision Science (HEDS) School of Health and Related Research (ScHARR), Regent Court, Sheffield, UK
| | - Duncan Chambers
- School of Health and Related Research (ScHARR), Regent Court, Sheffield, UK
| | - Andrew Booth
- Health Economics & Decision Science (HEDS) School of Health and Related Research (ScHARR), Regent Court, Sheffield, UK
| | | | - Scott Weich
- School of Health and Related Research (ScHARR), Regent Court, Sheffield, UK
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Leather JZ, Keyworth C, Kapur N, Campbell SM, Armitage CJ. Examining drivers of self-harm guideline implementation by general practitioners: A qualitative analysis using the theoretical domains framework. Br J Health Psychol 2022; 27:1275-1295. [PMID: 35416355 PMCID: PMC9790562 DOI: 10.1111/bjhp.12598] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/29/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES This study aimed to (1) examine barriers and enablers to General Practitioners' (GP) use of National Institute for Health and Care Excellence (NICE) guidelines for self-harm and (2) recommend potential intervention strategies to improve implementation of them in primary care. DESIGN Qualitative interview study. METHODS Twenty-one telephone interviews, semi-structured around the capabilities, opportunities and motivations model of behaviour change (COM-B), were conducted with GPs in the United Kingdom. The Theoretical Domains Framework was employed as an analytical framework. Using the Behaviour Change Wheel, Behaviour Change Techniques (BCTs), intervention functions and exemplar interventions were identified. RESULTS GPs valued additional knowledge about self-harm risk assessments (knowledge), and communication skills were considered to be fundamental to high-pressure consultations (cognitive and interpersonal skills). GPs did not engage with the guidelines due to concerns that they would be a distraction from patient cues about risk during consultations (memory, attention and decision processes), and perceptions that following the guidance is difficult due to time pressures and lack of access to mental health referrals (environmental context and resources). Clinical uncertainty surrounding longer term care for people that self-harm, particularly patients that are waiting for or cannot access a referral, drives GPs to rely on their professional judgement over the guidance (beliefs about capabilities). CONCLUSIONS Three key drivers related to information and skill needs, guideline engagement and clinical uncertainty need to be addressed to support GPs to be able to assess and manage self-harm. Five intervention functions and ten BCT groups were identified as potential avenues for intervention design.
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Affiliation(s)
- Jessica Z. Leather
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchester Academic Health Science CentreManchesterUK,Manchester Centre for Health PsychologyDivision of Psychology and Mental HealthSchool of Health SciencesUniversity of ManchesterManchesterUK
| | | | - Nav Kapur
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchester Academic Health Science CentreManchesterUK,Centre for Mental Health and SafetyUniversity of ManchesterManchester Academic Health Science CentreManchesterUK,Greater Manchester Mental Health NHS Foundation TrustManchester Academic Health Science CentreManchesterUK
| | - Stephen M. Campbell
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchester Academic Health Science CentreManchesterUK,Centre for Primary Care and Health Services ResearchSchool of Health SciencesUniversity of ManchesterManchesterUK
| | - Christopher J. Armitage
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchester Academic Health Science CentreManchesterUK,Manchester Centre for Health PsychologyDivision of Psychology and Mental HealthSchool of Health SciencesUniversity of ManchesterManchesterUK,Manchester University NHS Foundation TrustManchester Academic Health Science CentreManchesterUK,NIHR Manchester Biomedical Research CentreManchester University NHS Foundation TrustManchester Academic Health Science CentreThe Nowgen CentreManchesterUK
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Saving lives by asking questions: nurses' experiences of suicide risk assessment in telephone counselling in primary health care. Prim Health Care Res Dev 2022; 23:e65. [PMID: 36285522 PMCID: PMC9641664 DOI: 10.1017/s146342362200055x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIM To explore nurses' experiences of suicide risk assessment in telephone counselling (TC) in primary health care (PHC). BACKGROUND Globally, priority is given to developing suicide prevention work in PHC. However, suicide risk assessments in TC are not included in these interventions even though these are a common duty of nurses in PHC. More expertise in the field can contribute to knowledge important for developing nurses' tasks within PHC. METHODS A qualitative interview study was conducted with 15 nurses. Data were analysed using conventional content analysis. FINDINGS As suicide risk assessment in TC is a common duty for nurses in PHC, they need to be listened to and given the right conditions to perform this work. The nurses lack training in how to carry out suicide risk assessments and are forced to learn through experience. Intuition guides them in their work. A prerequisite for making correct assessments over the telephone is that the nurses are given time as well as the right competence. The PHC organisation needs to create these conditions. Furthermore, interventions to support suicide prevention need to include strategies to help nurses perform suicide assessment in TC.
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Pouquet M, Niare D, Guerrisi C, Blanchon T, Hanslik T, Younes N. [Suicide prevention: How to act?]. Rev Med Interne 2022; 43:375-380. [PMID: 35606205 DOI: 10.1016/j.revmed.2022.03.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 03/04/2022] [Accepted: 03/26/2022] [Indexed: 11/17/2022]
Abstract
Although being complex, suicide is a phenomenon considered as preventable, and its prevention has been made as a public health priority. Some interventions to prevent suicide have been evaluated, such as the education of the healthcare workers, especially in the suicidal assessment (suicidal risk and suicidal emergency/dangerousness), the diagnosis and management of common mental disorders, the care provided after a suicide attempt, the restriction access to common means of suicide, the use of websites to educate the public, or the appropriate reports of suicide in media. Other interventions, even not rigorously evaluated, are implemented in France as in many parts of the world. It is the case of interventions among identified high-risk groups. To be efficient, prevention programs should simultaneously include different strategies targeting several known risk factors for suicide. Clinicians play a crucial role in the suicide prevention strategies.
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Affiliation(s)
- M Pouquet
- Sorbonne université, Inserm, institut Pierre-Louis d'épidémiologie et de santé publique, (IPLESP), 75012 Paris, France.
| | - D Niare
- Sorbonne université, Inserm, institut Pierre-Louis d'épidémiologie et de santé publique, (IPLESP), 75012 Paris, France
| | - C Guerrisi
- Sorbonne université, Inserm, institut Pierre-Louis d'épidémiologie et de santé publique, (IPLESP), 75012 Paris, France
| | - T Blanchon
- Sorbonne université, Inserm, institut Pierre-Louis d'épidémiologie et de santé publique, (IPLESP), 75012 Paris, France
| | - T Hanslik
- Sorbonne université, Inserm, institut Pierre-Louis d'épidémiologie et de santé publique, (IPLESP), 75012 Paris, France; Service de médecine interne, hôpital Ambroise-Paré, Assistance publique-Hôpitaux de Paris, AP-HP, 92100 Boulogne-Billancourt, France; UFR des sciences de la santé Simone-Veil, université de Versailles-Saint-Quentin-en-Yvelines, 78280 Versailles, France
| | - N Younes
- UFR des sciences de la santé Simone-Veil, université de Versailles-Saint-Quentin-en-Yvelines, 78280 Versailles, France; Université Versailles-Saint-Quentin, université Paris Saclay, CESP, Team DevPsy, 94807 Villejuif, France; Centre hospitalier Versailles, service hospitalo-universitaire de psychiatrie de l'adulte et d'addictologie, 78157 Le Chesnay, France; Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
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Rudenstine S, Schulder T, Bhatt KJ, McNeal K, Ettman CK, Galea S. Suicidal ideation during COVID-19: The contribution of unique and cumulative stressors. Psychiatry Res 2022; 310:114475. [PMID: 35219267 PMCID: PMC8858638 DOI: 10.1016/j.psychres.2022.114475] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 02/05/2022] [Accepted: 02/19/2022] [Indexed: 12/23/2022]
Abstract
The link between large-scale disasters and population-level risk of suicide remains unclear. The present study sought to investigate suicidal ideation (SI) in relation to COVID-19 related stress, including material and social stress, in a predominantly low-SES ethno-racially diverse sample in New York City during a peak in COVID-19 cases in April 2020. Using binary logistic regressions of data collected with self-report surveys, we found that individuals who identified as Asian, as well as those with high total, material, and social stress levels, and persons without access to primary care providers had significantly higher adjusted odds of SI. These results indicate the specific burden faced by Asian participants due to increases in targeted racism, the importance of cumulative stress and specific stressor type, as well as the role of healthcare access on SI during the pandemic. Such findings suggest the need for specific interventions that target individuals who may be at higher risk of suicide after large-scale traumatic events and during the ongoing pandemic.
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Affiliation(s)
- Sasha Rudenstine
- Department of Psychology, City College of New York, 160 Convent Avenue, New York, NY 10031.
| | - Talia Schulder
- Department of Psychology, City College of New York, 160 Convent Avenue, New York, NY 10031
| | - Krish J. Bhatt
- Mailman School of Public Health, Columbia University, 722W 168th St, New York, NY 10032
| | - Kat McNeal
- Department of Psychology, City College of New York, 160 Convent Avenue, New York, NY 10031
| | | | - Sandro Galea
- School of Public Health, Boston University, 715 Albany St, Boston, MA 02118
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Chiang A, Paynter J, Edlin R, Exeter DJ. Suicide preceded by health services contact - A whole-of-population study in New Zealand 2013-2015. PLoS One 2021; 16:e0261163. [PMID: 34928994 PMCID: PMC8687551 DOI: 10.1371/journal.pone.0261163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/27/2021] [Indexed: 01/20/2023] Open
Abstract
New Zealand’s rate of suicide persistently exceeds the global average. The burden of suicide in New Zealand is disproportionately borne by youth, males and Māori (NZ indigenous people). While the demographic characteristics of suicide decedents are established, there is a need to identify potential points of contact with health services where preventative action could take place. This paper aims to determine if suicide deaths in New Zealand were likely to be preceded by contact with health services, and the type and time frame in which these contacts took place. This study utilised a whole-of-population-cohort of all individuals age 15 years and over, who were alive on March 5th 2013, followed up to December 2015. Associations between the odds of suicide, demographic factors, area-based deprivation, and the timing of last contact with primary, secondary, and tertiary services were analysed using univariate and multivariate logistic regression. Contact with a health service in the 6 Months prior to death was associated with the highest odds of suicide. Over half of the suicide decedent population (59.4%) had contacted primary health services during this period. Large proportions of the suicide decedent population contacted secondary and tertiary services in the 6 Months prior to death, 46.5% and 30.4% respectively. Contact with primary, secondary and tertiary services in the prior 6 Months, were associated with an increased odds of suicide of 2.51 times [95% CI 2.19–2.88], 4.45 times [95% CI 3.69–4.66] and 6.57 times [95% CI 5.84–7.38], respectively, compared to those who had no health services contact.
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Affiliation(s)
- Annie Chiang
- Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand
- * E-mail:
| | - Janine Paynter
- General Practice and Primary Healthcare, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Richard Edlin
- Health Systems, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Daniel J. Exeter
- Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand
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Bellairs-Walsh I, Byrne SJ, Bendall S, Perry Y, Krysinska K, Lin A, Michail M, Lamblin M, Li TY, Hetrick S, Robinson J. Working with Young People at Risk of Suicidal Behaviour and Self-Harm: A Qualitative Study of Australian General Practitioners' Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12926. [PMID: 34948536 PMCID: PMC8701929 DOI: 10.3390/ijerph182412926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 11/25/2022]
Abstract
General Practitioners (GPs) play a crucial role in the identification and support of young people at risk of suicidal behaviour and self-harm; however, no studies have explored GPs' perspectives, approaches, challenges, and resource needs when working with this cohort in an Australian setting. This was a qualitative study where fifteen GPs (Mage = 45.25 years) from multiple clinics in Western Australia took part in semi-structured interviews, and data were analysed thematically. Seven main themes were identified: (1) working with young people has its unique challenges; (2) screening and assessment tools can help to manage uncertainty and discomfort; (3) going beyond tools-the dialogue and relationship are most important; (4) there are limits to what we can offer in the time available; (5) the service access and referral pathways lack clarity and coordination; (6) the provision of mental health support should not fall on GPs alone; and (7) more comprehensive training in suicide and self-harm is needed. The findings highlight a number of opportunities to enhance care and better assist GPs working with young people who present with suicidal behaviour and self-harm, including considerations for conducting assessments, targeted resources such as training, and system and service improvements.
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Affiliation(s)
- India Bellairs-Walsh
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
| | - Sadhbh J. Byrne
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
- Centre for Global Health, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Sarah Bendall
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
| | - Yael Perry
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, WA 6009, Australia; (Y.P.); (A.L.)
| | - Karolina Krysinska
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
- Centre for Mental Health, School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, WA 6009, Australia; (Y.P.); (A.L.)
| | - Maria Michail
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham B15 2TT, UK;
| | - Michelle Lamblin
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
| | - Tina Yutong Li
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Townsville University Hospital, Douglas, QLD 4814, Australia
| | - Sarah Hetrick
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1010, New Zealand
| | - Jo Robinson
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
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Chopra J, Hanlon CA, Boland J, Harrison R, Timpson H, Saini P. A case series study of an innovative community-based brief psychological model for men in suicidal crisis. J Ment Health 2021; 31:392-401. [PMID: 34643159 DOI: 10.1080/09638237.2021.1979489] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To conduct a 1-year evaluation of James' Place, a suicidal crisis centre delivering a clinical intervention in a community setting. DESIGN A case series study, following men entering the service during the first year of operation. PARTICIPANTS Men experiencing a suicidal crisis referred to the service (N = 265), with N = 176 going on to engage in therapy. INTERVENTION The James' Place Model is a therapeutic intervention offered to men who are in a suicidal crisis. Trained therapists provide a range of therapeutic approaches and interventions, focusing on decreasing suicidal distress and supporting men to develop resilience and coping strategies. MAIN OUTCOME MEASURES CORE-34 Clinical Outcome Measure (CORE-OM). RESULTS For all subscales of the CORE-OM there was a significant reduction in mean scores between assessment and discharge (p < 0.001), with all outcomes demonstrating a large effect size. All reductions illustrated a clinically significant change or a reliable change. CONCLUSIONS Our results support the use of the James' Place Model for men in suicidal distress to aid in potentially preventing suicides in this high-risk group of the population.HighlightsEvaluates a brief psychological clinical intervention delivered in the community.Model effectively reduces suicide risk and findings can inform future services.Accessed men receiving an innovative intervention at the time of suicidal crisis.
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Affiliation(s)
- J Chopra
- Department of Psychology, Liverpool John Moores University, Liverpool, UK
| | - C A Hanlon
- Department of Psychology, Liverpool John Moores University, Liverpool, UK
| | | | - R Harrison
- Public Health Institute, Exchange Station, Liverpool John Moores University, Liverpool, UK
| | - H Timpson
- Public Health Institute, Exchange Station, Liverpool John Moores University, Liverpool, UK
| | - P Saini
- Department of Psychology, Liverpool John Moores University, Liverpool, UK
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9
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Lawn S, Kaine C, Stevenson J, McMahon J. Australian Mental Health Consumers' Experiences of Service Engagement and Disengagement: A Descriptive Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910464. [PMID: 34639765 PMCID: PMC8508315 DOI: 10.3390/ijerph181910464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/03/2021] [Accepted: 09/30/2021] [Indexed: 12/11/2022]
Abstract
Mental health issues are a severe global concern with significant personal, social, and economic consequences and costs. This paper reports results of an online survey disseminated across the Australian community investigating why people with mental health issues choose particular mental health services over others, what causes them to disengage from services, and what factors and qualities of services are important to consumers to support their continued engagement or re-engagement with mental health services. The importance of GPs was evident, given their key role in providing mental healthcare, especially to those referred to as “the missing middle”—consumers with mental health issues who fall through the gaps in care in other parts of the healthcare system. The study found that many respondents chose to engage with mental healthcare providers primarily due to accessibility and affordability, but also because of the relational qualities that they displayed as part of delivering care. These qualities fostered consumers’ sense of trust, feeling listened to, and not being stigmatized as part of help seeking and having their mental health needs met. Implications for education and practice are offered.
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Affiliation(s)
- Sharon Lawn
- Lived Experience Australia Ltd., Adelaide, SA 5070, Australia; (C.K.); (J.M.)
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia;
- Correspondence: ; Tel.: +61-459-098-772
| | - Christine Kaine
- Lived Experience Australia Ltd., Adelaide, SA 5070, Australia; (C.K.); (J.M.)
| | - Jeremy Stevenson
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia;
| | - Janne McMahon
- Lived Experience Australia Ltd., Adelaide, SA 5070, Australia; (C.K.); (J.M.)
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Murch BJ, Cooper JA, Hodgett TJ, Gara EL, Walker JS, Wood RM. Modelling the effect of first-wave COVID-19 on mental health services. OPERATIONS RESEARCH FOR HEALTH CARE 2021; 30:100311. [PMID: 36466119 PMCID: PMC9701315 DOI: 10.1016/j.orhc.2021.100311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 05/20/2021] [Accepted: 08/09/2021] [Indexed: 06/17/2023]
Abstract
During the first wave of the COVID-19 pandemic it emerged that the nature and magnitude of demand for mental health services was changing. Considerable increases were expected to follow initial lulls as treatment was sought for new and existing conditions following relaxation of 'lockdown' measures. For this to be managed by the various services that constitute a mental health system, it would be necessary to complement such projections with assessments of capacity, in order to understand the propagation of demand and the value of any consequent mitigations. This paper provides an account of exploratory modelling undertaken within a major UK healthcare system during the first wave of the pandemic, when actionable insights were in short supply and decisions were made under much uncertainty. In understanding the impact on post-lockdown operational performance, the objective was to evaluate the efficacy of two considered interventions against a baseline 'do nothing' scenario. In doing so, a versatile and purpose-built discrete time simulation model was developed, calibrated and used by a multi-disciplinary project working group. The solution, representing a multi-node, multi-server queueing network with reneging, is implemented in open-source software and is freely and publicly available.
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Affiliation(s)
- B J Murch
- Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group, UK National Health Service, South Plaza, Marlborough St, Bristol, BS1 3NX, UK
| | - J A Cooper
- Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group, UK National Health Service, South Plaza, Marlborough St, Bristol, BS1 3NX, UK
- Bristol Medical School, University of Bristol, Beacon House, Queens Rd, BS8 1QU, UK
| | - T J Hodgett
- Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group, UK National Health Service, South Plaza, Marlborough St, Bristol, BS1 3NX, UK
| | - E L Gara
- Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group, UK National Health Service, South Plaza, Marlborough St, Bristol, BS1 3NX, UK
| | - J S Walker
- Research and Development, Avon and Wiltshire Mental Health Partnership, Newbridge Hill, Bath, BA1 3QE, UK
| | - R M Wood
- Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group, UK National Health Service, South Plaza, Marlborough St, Bristol, BS1 3NX, UK
- University of Bath, School of Management, Claverton Down, Bath, BA2 7AY, UK
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Solin P, Tamminen N, Partonen T. Suicide prevention training: self-perceived competence among primary healthcare professionals. Scand J Prim Health Care 2021; 39:332-338. [PMID: 34340646 PMCID: PMC8475147 DOI: 10.1080/02813432.2021.1958462] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objective: The aim is to report the outcomes of the suicide prevention training in terms of the self-perceived impact on the participants.Design: The three-hour training consisted areas of risk and protective factors, screening and evaluating suicide risk, raising concerns and confronting suicidal patients, and treating suicidal ideation in primary healthcare and the associated referral processes.Subjects: The studied participants consisted of general practitioners, nurses, public health nurses and social work professionals.Main outcome measures: Participants assessed their own competence on online form regarding four training areas prior to and two weeks after the training.Results: The response rate was 25%. The self-perceived competence of the healthcare professionals increased in all training areas and in all occupational groups. The healthcare professionals' competence regarding the risk and protective factors training area saw the greatest increase across all professional groups except nurses. There were, however, differences between the groups.Conclusion: Suicide prevention training for primary healthcare professionals did increase the self-perceived competence of the participants in all areas covered by the training. Regular follow-up training is required in order for these improvements to be further developed and retained.Key pointsAfter the suicide prevention training all participants self-perceived increase in their competence in all training areas.The GPs self-perceived most increase in risk and protective factors and nurses in raising concerns and confronting suicidal patients.The GPs' lowest increase was in the area of treating suicidal ideation in primary health care and the referral processes.
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Affiliation(s)
- Pia Solin
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- CONTACT Pia Solin Finnish Institute for Health and Welfare, Mannerheimintie 166, Helsinki00271, Finland
| | - Nina Tamminen
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Timo Partonen
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
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12
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Saini P, Chopra J, Hanlon CA, Boland JE. A Case Series Study of Help-Seeking among Younger and Older Men in Suicidal Crisis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147319. [PMID: 34299773 PMCID: PMC8307966 DOI: 10.3390/ijerph18147319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/28/2021] [Accepted: 07/02/2021] [Indexed: 11/20/2022]
Abstract
Due to the continuing high suicide rates among young men, there is a need to understand help-seeking behaviour and engagement with tailored suicide prevention interventions. The aim of this study was to compare help-seeking among younger and older men who attended a therapeutic centre for men in a suicidal crisis. In this case series study, data were collected from 546 men who were referred into a community-based therapeutic service in North West England. Of the 546 men, 337 (52%) received therapy; 161 (48%) were aged between 18 and 30 years (mean age 24 years, SD = 3.4). Analyses included baseline differences, symptom trajectories for the CORE-34 Clinical Outcome Measure (CORE-OM), and engagement with the therapy. For the CORE-OM, there was a clinically significant reduction in mean scores between assessment and discharge (p < 0.001) for both younger and older men. At initial assessment, younger men were less affected by entrapment (46% vs. 62%; p = 0.02), defeat (33% vs. 52%; p = 0.01), not engaging in new goals (38% vs. 47%; p = 0.02), and positive attitudes towards suicide (14% vs. 18%; p = 0.001) than older men. At discharge assessment, older men were significantly more likely to have an absence of positive future thinking (15% vs. 8%; p = 0.03), have less social support (45% vs. 33%; p = 0.02), and feelings of entrapment (17% vs. 14%; p = 0.02) than younger men. Future research needs to assess the long-term effects of help-seeking using a brief psychological intervention for young men in order to understand whether the effects of the therapy are sustainable over a period of time following discharge from the service.
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Affiliation(s)
- Pooja Saini
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool L3 3AF, UK; (J.C.); (C.A.H.)
- Correspondence: ; Tel.: +44-151-231-8121
| | - Jennifer Chopra
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool L3 3AF, UK; (J.C.); (C.A.H.)
| | - Claire A. Hanlon
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool L3 3AF, UK; (J.C.); (C.A.H.)
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13
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Mughal F, Gorton HC, Michail M, Robinson J, Saini P. Suicide Prevention in Primary Care. CRISIS 2021; 42:241-246. [PMID: 34184574 DOI: 10.1027/0227-5910/a000817] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Faraz Mughal
- School of Medicine, Keele University, Staffordshire, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, UK.,Unit of Academic Primary Care, University of Warwick, Coventry, UK
| | | | - Maria Michail
- Institute for Mental Health, School of Psychology, University of Birmingham, UK
| | - Jo Robinson
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Pooja Saini
- Faculty of Health, School of Psychology, Liverpool John Moores University, UK
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14
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Engaging primary care professionals in suicide prevention: A qualitative study. PLoS One 2020; 15:e0242540. [PMID: 33253178 PMCID: PMC7704003 DOI: 10.1371/journal.pone.0242540] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 11/04/2020] [Indexed: 01/06/2023] Open
Abstract
In health systems with strongly developed primary care, such as in the Netherlands, effectively engaging primary care professionals (PCPs) in suicide prevention is a key strategy. As part of the national Suicide Prevention Action Network (SUPRANET), a program was offered to PCPs in six regions in the Netherlands in 2017–2018 to more effectively engage them in suicide prevention. This implementation study aimed to evaluate to what extent SUPRANET was helpful in supporting PCPs to apply suicide prevention practices. From March to May 2018, 21 semi-structured interviews have been carried out with PCPs and other non-clinical professionals from SUPRANET regions in the Netherlands. Verbatim transcripts were analysed using the grounded theory approach. Data was structured using the Consolidated Framework for Implementation Research, which enabled identifying facilitating and challenging factors for PCPs to carry out suicide prevention practices. An important challenge included difficulties in assessing suicide risk (intervention characteristics) due to PCPs’ self-perceived incompetence, burdensomeness of suicide and limited time and heavy workload of PCPs. Another important limitation was collaboration with mental health care (outer setting), whereas mental health nurses (inner setting) and SUPRANET (implementation process) were facilitating factors for applying suicide prevention practices. With regard to SUPRANET, especially the training was positively evaluated by PCPs. PCPs expressed a strong need for improving collaboration with specialized mental health care, which was not provided by SUPRANET. Educating PCPs on suicide prevention seems beneficial, but is not sufficient to improve care for suicidal patients. Effective suicide prevention also requires improved liaison between mental health services and primary care, and should therefore be the focus of future suicide prevention strategies aimed at primary care.
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15
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Mughal F, Troya MI, Dikomitis L, Chew-Graham CA, Corp N, Babatunde OO. Role of the GP in the management of patients with self-harm behaviour: a systematic review. Br J Gen Pract 2020; 70:e364-e373. [PMID: 32041771 PMCID: PMC7015161 DOI: 10.3399/bjgp20x708257] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/16/2019] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Self-harm is a serious risk factor for suicide, a major public health concern, and a significant burden on the NHS. Rates of self-harm presentation in primary care are rising and GPs interact with patients both before and after they have self-harmed. There is significant public and political interest in reducing rates of self-harm, but there has been no robust synthesis of the existing literature on the role of GPs in the management of patients who self-harm. AIM This study aimed to explore the role of the GP in the management of patients with self-harm behaviour. DESIGN AND SETTING A systematic review and narrative synthesis of primary care literature. METHOD This systematic review was conducted and is reported in line with PRISMA guidance. Electronic databases systematically searched were MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, and AMED. Two independent reviewers conducted study screening and selection, data extraction, and quality appraisal of all included studies. Thematic analysis was conducted. RESULTS From 6976 unique citations, 12 studies met eligibility criteria and were included. These 12 studies, published from 1997-2016, of 789 GPs/family medicine physicians from Europe, the US, and Australia were of good methodological quality. Five themes were identified for facilitating GP management of self-harm: GP training, improved communication, service provision, clinical guidelines, and young people. Four barriers for GP management of self-harm were identified: assessment, service provision, local, and systemic factors. CONCLUSION GPs recognise self-harm as a serious risk factor for suicide, but some feel unprepared for managing self-harm. The role of the GP is multidimensional and includes frontline assessment and treatment, referral to specialist care, and the provision of ongoing support.
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Affiliation(s)
- Faraz Mughal
- School of Primary, Community and Social Care, Keele University, Keele, UK; honorary clinical research fellow, Unit of Academic Primary Care, University of Warwick, Coventry, UK
| | - M Isabela Troya
- National Suicide Research Foundation, University College Cork, Cork, Republic of Ireland
| | - Lisa Dikomitis
- Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Carolyn A Chew-Graham
- School of Primary, Community and Social Care, Keele University, Keele, UK; honorary professor of primary care mental health, Midlands Partnership NHS Foundation Trust, St George's Hospital, Stafford, UK
| | - Nadia Corp
- Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Opeyemi O Babatunde
- Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Keele, UK
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16
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Gentil L, Huỳnh C, Grenier G, Fleury MJ. Predictors of emergency department visits for suicidal ideation and suicide attempt. Psychiatry Res 2020; 285:112805. [PMID: 32035375 DOI: 10.1016/j.psychres.2020.112805] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/09/2020] [Accepted: 01/19/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES This study investigated predictors of emergency department (ED) visits for suicidal ideation and suicide attempt in 2014-15 among patients at six Quebec emergency departments (ED), using administrative data. METHODS Participants (n = 11,778) used ED for suicidal ideation (30.4%); suicide attempt (7.0%); or other reasons (61.7%). A multinomial logistic regression was performed using variables described by the Andersen Behavioral Model. RESULTS The odds of ED visits for suicidal ideation or suicide attempt was high for adjustment disorders, personality disorders, and prior ED consultations for mental health (MH) reasons, but lower for schizophrenia spectrum and other psychotic disorders, illness acuity levels 3-5 (low severity), and 3+ consultations with outpatient psychiatrists. The odds of visiting ED for suicidal ideation increased in depressive disorders, and in the 12-17 year age range, but decreased in association with 1-2 outpatient psychiatrist consultations. The odds of suicide attempt also increased with alcohol use disorders and drug-induced disorders, but decreased with specific MH interventions at local community health services centers. CONCLUSION increasing access to ambulatory care, and care continuity in outreach programs for acute MH disorders, including substance-related disorders, may reduce ED visits for suicidal ideation and suicide attempt, while improving overall service delivery.
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Affiliation(s)
- Lia Gentil
- Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada; Institut universitaire sur les dépendances, 950 Louvain East, Montréal, Québec H2M 2E8, Canada; Psychiatry Department, McGill University, Canada
| | - Christophe Huỳnh
- Institut universitaire sur les dépendances, 950 Louvain East, Montréal, Québec H2M 2E8, Canada; School of Psychoeducation, Université de Montréal, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada; Institut universitaire sur les dépendances, 950 Louvain East, Montréal, Québec H2M 2E8, Canada; Psychiatry Department, McGill University, Canada.
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17
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Parker D, Byng R, Dickens C, McCabe R. "Every structure we're taught goes out the window": General practitioners' experiences of providing help for patients with emotional concerns'. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:260-269. [PMID: 31621140 PMCID: PMC6916159 DOI: 10.1111/hsc.12860] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 08/13/2019] [Accepted: 09/03/2019] [Indexed: 06/10/2023]
Abstract
Up to 40% of general practitioners (GP) consultations contain an emotional component. General practitioners (GPs) have to provide care with limited time and resources. This qualitative study aimed to explore how GPs care for patients experiencing emotional concerns within the constraints of busy clinical practice. Seven GPs participated in three focus groups. Groups were recorded, transcribed and analysed thematically. Three themes were identified. (a) Collaboratively negotiated diagnosis: How patients' emotional concerns are understood and managed is the result of a negotiation between patient and GP belief models and the availability of treatments including talking therapy. (b) Doctor as drug: Not only is a continuous relationship between GPs and patients therapeutic in its own right, it is also necessary to effectively diagnose and engage patients in treatment as patients may experience stigma regarding emotional concerns. (c) Personal responsibility and institutional pressure: GPs feel personally responsible for supporting patients through their care journey, however, they face barriers due to lack of time and pressure from guidelines. GPs are forced to prioritise high-risk patients and experience an emotional toll. In conclusion, guidelines focus on diagnosis and a stepped-care model, however, this assumes diagnosis is relatively straightforward. GPs and patients have different models of psychological distress. This and the experience of stigma mean that establishing rapport is an important step before the GP and patient negotiate openly and develop a shared understanding of the problem. This takes time and emotional resources to do well. Longer consultations, continuity of care and formal supervision for GPs could enable them to better support patients.
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18
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Horrocks M, Michail M, Aubeeluck A, Wright N, Morriss R. An Electronic Clinical Decision Support System for the Assessment and Management of Suicidality in Primary Care: Protocol for a Mixed-Methods Study. JMIR Res Protoc 2018; 7:e11135. [PMID: 30530459 PMCID: PMC6303673 DOI: 10.2196/11135] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 12/17/2022] Open
Abstract
Background Suicide is a global public health concern, but it is preventable. Increased contact with primary care before the suicide or attempted suicide raises opportunities for intervention and prevention. However, suicide assessment and management are areas that many general practitioners (GPs) find particularly challenging. Previous research has indicated significant variability in how GPs understand, operationalize, and assess suicide risk, which subsequently has an impact on clinical decision making. Clinical decision support systems (CDSS) have been widely implemented across different health care settings, including primary care to support practitioners in clinical decision making. A CDSS may reduce inconsistencies in the identification, assessment, and management of suicide risk by GPs by guiding them through the consultation and generating a risk assessment plan that can be shared with a service user or with specialized mental health services. Objective Our aim is to co-develop and test with end users (eg, GPs, primary care attendees, mental health professionals) an electronic clinical decision support system (e-CDSS) to support GPs in the identification, assessment, and management of suicidality in primary care. Methods Ours is an ongoing embedded mixed-methods study with four phases: (1) qualitative interviews with GPs to explore their views on the content, format, and use of the e-CDSS, as well as consultation with two service-user advisory groups (people aged ≤25 and people aged ≥25) to inform the content of the e-CDSS including phrasing of items and clarity; (2) participatory co-production workshops with GPs, service users, and clinical experts in suicidality to determine the content and format of the e-CDDS; gain consensus of the relevance of items; establish content validity and identify pathways to implementation, using the Consolidated Framework for Implementation Research; (3) building the e-CDSS so that it guides the GP through a consultation; and (4) usability testing of the e-CDSS with GPs and service users in one primary care practice involving a nonlive and a live stage. Results The study was funded for four years, to take place between 2015 and 2019, and is currently completing phase 4 data collection. The first results are expected to be submitted for publication in June 2019. The findings will enable us to evaluate the feasibility, acceptability, and usability of a suicide-specific, electronic, guided decision support system in primary care. Conclusions This study will be the first to explore the feasibility, acceptability, and usability of an electronic, guided decision support system for use in primary care consultations for the improved assessment and management of suicidality. International Registered Report Identifier (IRRID) RR1-10.2196/11135
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Affiliation(s)
- Matthew Horrocks
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Maria Michail
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Aimee Aubeeluck
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Nicola Wright
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Richard Morriss
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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19
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Grigoroglou C, Munford L, Webb RT, Kapur N, Doran T, Ashcroft DM, Kontopantelis E. Association between a national primary care pay-for-performance scheme and suicide rates in England: spatial cohort study. Br J Psychiatry 2018; 213:600-608. [PMID: 30058517 DOI: 10.1192/bjp.2018.143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pay-for-performance policies aim to improve population health by incentivising improvements in quality of care.AimsTo assess the relationship between general practice performance on severe mental illness (SMI) and depression indicators under a national incentivisation scheme and suicide risk in England for the period 2006-2014. METHOD Longitudinal spatial analysis for 32 844 small-area geographical units (lower super output areas, LSOAs), using population-structure adjusted numbers of suicide as the outcome variable. Negative binomial models were fitted to investigate the relationship between spatially estimated recorded quality of care and suicide risk at the LSOA level. Incidence rate ratios (IRRs) were adjusted for deprivation, social fragmentation, prevalence of depression and SMI as well as other 2011 Census variables. RESULTS No association was found between practice performance on the mental health indicators and suicide incidence in practice localities (IRR=1.000, 95% CI 0.998-1.002). IRRs indicated elevated suicide risks linked with area-level social fragmentation (1.030; 95% CI 1.027-1.034), deprivation (1.013, 95% CI 1.012-1.014) and rurality (1.059, 95% CI 1.027-1.092). CONCLUSIONS Primary care has an important role to play in suicide prevention, but we did not observe a link between practices' higher reported quality of care on incentivised mental health activities and lower suicide rates in the local population. It is likely that effective suicide prevention needs a more concerted, multiagency approach. Better training in suicide prevention for general practitioners is also essential. These findings pertain to the UK but have relevance to other countries considering similar programmes.Declaration of interestNone.
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Affiliation(s)
- Christos Grigoroglou
- NIHR School for Primary Care Research,Centre for Primary Care,Division of Population Health, Health Services Research and Primary Care,University of Manchester, Manchester Academic Health Sciences Centre (MAHSC),UK
| | - Luke Munford
- Research Fellow in Health Economics,Centre for Health Economics,Division of Population Health, Health Services Research and Primary Care,University of Manchester, Manchester Academic Health Sciences Centre (MAHSC),UK
| | - Roger T Webb
- Professor in Mental Health Epidemiology,Centre for Mental Health and Safety,University of Manchester, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC),UK
| | - Nav Kapur
- Professor of Psychiatry and Population Health,Centre for Suicide Prevention,University of Manchester, Greater Manchester Mental Health Trust and NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC),UK
| | - Tim Doran
- Professor of Health Policy,Department of Health Sciences,University of York,UK
| | - Darren M Ashcroft
- Professor of Pharmacoepidemiology,Centre for Pharmacoepidemiology and Drug Safety,School of Health Sciences,Faculty of Biology, Medicine and Health,University of Manchester, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC),UK
| | - Evangelos Kontopantelis
- Professor of Data Science and Health Services Research,Faculty of Biology, Medicine and Health,University of Manchester, Manchester Academic Health Sciences Centre (MAHSC),UK
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20
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General practitioners’ clinical expertise in managing suicidal young people: implications for continued education. Prim Health Care Res Dev 2017; 18:419-428. [DOI: 10.1017/s1463423617000299] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aim
To examine general practitioners’ (GPs) clinical expertise in assessing, communicating with, and managing suicidal young people aged 14–25 to inform the development of an educational intervention for GPs on youth suicide prevention.
Background
Suicide is the second leading cause of death for young people worldwide. GPs are ideally suited to facilitate early identification and assessment of suicide risk. However, GPs’ levels of competence, knowledge, and attitudes towards suicidal young people have not yet been explored.
Methods
A cross-sectional survey on GPs’ levels of confidence in assessing and managing young people at risk of suicide; knowledge of risk factors and warning signs of suicide in young people; attitudes towards young suicidal people; and training preferences on managing suicide risk.
Findings
Seventy GPs completed the survey (30 males). The majority of GPs reported high levels of confidence in assessing and managing suicidality in young people. Experienced GPs demonstrated high levels of knowledge of suicide risk factors in young people but low levels of knowledge of warning signs that might indicate heightened risk. Although 48% of GPs disagreed that maintaining compassionate care is difficult with those who deliberately self-harm, GPs perceived communication with young people to be difficult, with one-third reporting frustration in managing those at risk of suicide. A total of 75% of GPs said they would be interested in receiving further training on assessing and managing young people at risk of suicide.
The study has important implications for providing specialist training to support GPs in assessing and managing youth suicide risk and facilitating attitudinal change. GP education on youth suicide risk assessment and management should promote a holistic understanding and assessment of risk and its individual, social and contextual influences in line with clinical recommendations to facilitate therapeutic engagement and communication with young people.
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21
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Weber AN, Michail M, Thompson A, Fiedorowicz JG. Psychiatric Emergencies: Assessing and Managing Suicidal Ideation. Med Clin North Am 2017; 101:553-571. [PMID: 28372713 PMCID: PMC5777328 DOI: 10.1016/j.mcna.2016.12.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The assessment of suicide risk is a daunting, but increasingly frequent task for outpatient practitioners. Guidelines for depression screening identify more individuals at risk for treatment and mental health resources are not always easily accessible. For those patients identified as in need of a formal suicide risk assessment, this article reviews established risk and protective factors for suicide and provides a framework for the assessment and management of individuals at risk of suicide. The assessment should be explicitly documented with a summary of the most relevant risk/protective factors for that individual with a focus on interventions that may mitigate risk.
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Affiliation(s)
- Andrea N Weber
- Department of Internal Medicine, The University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA; Department of Psychiatry, Carver College of Medicine, The University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Maria Michail
- School of Health Sciences, University of Nottingham, D17 Institute of Mental Health, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | - Alex Thompson
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Jess G Fiedorowicz
- Department of Internal Medicine, The University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA; Department of Psychiatry, Carver College of Medicine, The University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA; Department of Epidemiology, College of Public Health, The University of Iowa, 145 North Riverside Drive, 100 CPH, Iowa City, IA 52242, USA; Abboud Cardiovascular Research Center, Carver College of Medicine, The University of Iowa, 2269 Carver Biomedical Research Building, Iowa City, IA 52242, USA.
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22
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McCabe R, Sterno I, Priebe S, Barnes R, Byng R. How do healthcare professionals interview patients to assess suicide risk? BMC Psychiatry 2017; 17:122. [PMID: 28372553 PMCID: PMC5379679 DOI: 10.1186/s12888-017-1212-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 01/19/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND There is little evidence on how professionals communicate to assess suicide risk. This study analysed how professionals interview patients about suicidal ideation in clinical practice. METHODS Three hundred nineteen video-recorded outpatient visits in U.K. secondary mental health care were screened. 83 exchanges about suicidal ideation were identified in 77 visits. A convenience sample of 6 cases in 46 primary care visits was also analysed. Depressive symptoms were assessed. Questions and responses were qualitatively analysed using conversation analysis. χ 2 tested whether questions were influenced by severity of depression or influenced patients' responses. RESULTS A gateway closed question was always asked inviting a yes/no response. 75% of questions were negatively phrased, communicating an expectation of no suicidal ideation, e.g., "No thoughts of harming yourself?". 25% were positively phrased, communicating an expectation of suicidal ideation, e.g., "Do you feel life is not worth living?". Comparing these two question types, patients were significantly more likely to say they were not suicidal when the question was negatively phrased but were not more likely to say they were suicidal when positively phrased (χ 2 = 7.2, df = 1, p = 0.016). 25% patients responded with a narrative rather than a yes/no, conveying ambivalence. Here, psychiatrists tended to pursue a yes/no response. When the patient responded no to the gateway question, the psychiatrist moved on to the next topic. A similar pattern was identified in primary care. CONCLUSIONS Psychiatrists tend to ask patients to confirm they are not suicidal using negative questions. Negatively phrased questions bias patients' responses towards reporting no suicidal ideation.
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Affiliation(s)
- Rose McCabe
- University of Exeter Medical School, Room 1.05, College House, Exeter, EX1 2 LU, UK.
| | - Imren Sterno
- Live Well Suffolk, 8 Turret Lane, Ipswich, IP4 1DL UK
| | - Stefan Priebe
- grid.4868.2Unit for Social and Community Psychiatry, Queen Mary University of London, Newham Centre for Mental Health, London, E13 8SP UK
| | - Rebecca Barnes
- grid.5337.2University of Bristol, Office Room 1.05 Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Richard Byng
- grid.467855.dPlymouth University Peninsula Schools of Medicine and Dentistry, N32, Tamar Science Park, Drake Circus, Plymouth, Devon PL4 8AA UK
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Saini P, Chantler K, Kapur N. GPs' views and perspectives on patient non-adherence to treatment in primary care prior to suicide. J Ment Health 2017. [PMID: 28635435 DOI: 10.1080/09638237.2017.1294736] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Individuals who do not adhere to their treatment regimens may be at greater risk of suicide but these issues are relatively unexplored in primary care services. AIM To explore GPs' views and perspectives on the reasons why patients who were in contact with mental health services in the year prior to suicide was non-adherent to treatment prior to their death. METHOD In total, 198 semi-structured face-to-face interviews with GPs of people who had died by suicide. Interviews were transcribed verbatim and analyzed using a thematic approach. RESULTS The following themes were conceptualized from GP interviews: (i) "Lack of insight or denial?" relates to what GPs perceived as their patients lack of insight into their psychiatric illness; (ii) "Lack of treatment choices" discusses GPs' understanding of patient treatment choices; (iii) "Services for comorbidity and dual diagnosis" refers to treatment availability for suicidal patients with two or more mental health diagnoses. CONCLUSIONS For suicide prevention, it is crucial for health professionals to assess patients and manage the possible causes of non-adherence. Policies for increasing treatment adherence, improving services for dual diagnosis, or providing alternative treatments to meet individual patient needs may help to achieve the best health outcomes and could potentially prevent suicide.
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Affiliation(s)
- Pooja Saini
- a Department of Health Services Research , NIHR CLAHRC NWC, University of Liverpool , Liverpool , UK
| | - Khatidja Chantler
- b School of Social Work, University of Central Lancashire , Preston , UK , and
| | - Navneet Kapur
- c Centre for Mental Health and Risk, University of Manchester , Manchester , UK
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Saini P, Chantler K, While D, Kapur N. Do GPs want or need formal support following a patient suicide?: a mixed methods study. Fam Pract 2016; 33:414-20. [PMID: 27221733 DOI: 10.1093/fampra/cmw040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patient suicide can be a devastating event for some general practitioners (GPs). Few guidelines exist to aid or support GPs in the aftermath of patient suicide. AIM To explore GPs views on how they are affected by a patient suicide and the formal support available to them following a patient suicide. DESIGN Questionnaires and semi-structured interviews. SETTING General practices in the northwest of England. METHODS About 198 semi-structured interviews were conducted as part of a retrospective study. Interviews were transcribed verbatim and analysed using descriptive statistics and a framework thematic approach. RESULTS GPs were aged between 31 and 67 years, 144 (73%) were male and the number of years in practice varied between 8 and 40 years (median = 24 years). GPs were based at 133 (67%) urban and 65 (33%) rural practices, 30 (15%) were single-handed GP practices and 168 (85%) practices had two or more GPs. About 131 (66%) GPs reported being affected by patient suicide through feelings of grief, guilt and self-scrutiny. A greater number of years in practice may have been protective against these effects. About 54 (27%) GPs reported having mostly 'informal' support from peers or colleagues and support was less available to younger and single handed GPs. CONCLUSIONS Our findings suggest that the majority of GPs are affected by patient suicide and most seek informal support from their peers and colleagues. Although many indicated that informal support systems were adequate and provided a protective environment, procedures should be developed to ensure the availability of guidelines for those who may require formal support.
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Affiliation(s)
- Pooja Saini
- Department of Health Services Research, University of Liverpool, Liverpool, UK,
| | - Khatidja Chantler
- School of Social Work, University of Central Lancashire, Preston, UK and
| | - David While
- Centre for Mental Health and Safety, University of Manchester and Manchester Mental Health and Social Care Trust, Lancashire, UK
| | - Navneet Kapur
- Centre for Mental Health and Safety, University of Manchester and Manchester Mental Health and Social Care Trust, Lancashire, UK
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Saini P, Chantler K, Kapur N. General practitioners' perspectives on primary care consultations for suicidal patients. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:260-269. [PMID: 25661202 DOI: 10.1111/hsc.12198] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/26/2014] [Indexed: 06/04/2023]
Abstract
Little is known about general practitioners' (GPs') perspectives, management of and interactions with suicidal patients prior to the patient's suicide. The aims of the study were to explore GPs' interpretations of patient communication and treatment in primary care leading up to suicide and to investigate the relationship between GPs and mental health services prior to a patient's suicide. Thirty-nine semi-structured interviews with GPs of people who had died by suicide were conducted as part of a retrospective study. Interviews were transcribed verbatim and analysed using a thematic approach. The following themes emerged from GP interviews: (i) GP interpretations of suicide attempts or self-harm; (ii) professional isolation; and (iii) GP responsibilities versus patient autonomy. GPs recruited for the study may have different views from GPs who have never experienced a patient suicide or who have experienced the death of a patient by suicide who was not under the care of specialist services. Our findings may not be representative of the rest of the United Kingdom, although many of the issues identified are likely to apply across services. This study highlighted the following recommendations for future suicide prevention in general practice: increasing GP awareness of suicide-related issues and improving training and risk assessment skills; removing barriers to accessing therapies and treatments needed in primary care; improving liaison and collaboration between services to provide better patient outcomes; and increasing awareness in primary care about why patients may not want treatments offered by focusing on each individual's situational context.
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Affiliation(s)
- Pooja Saini
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Khatidja Chantler
- School of Social Work, University of Central Lancashire, Preston, UK
| | - Navneet Kapur
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK
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Michail M, Tait L. Exploring general practitioners' views and experiences on suicide risk assessment and management of young people in primary care: a qualitative study in the UK. BMJ Open 2016; 6:e009654. [PMID: 26758263 PMCID: PMC4716217 DOI: 10.1136/bmjopen-2015-009654] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore general practitioner (GP) views and experiences of assessing, communicating with and managing suicidal young people with the aim of co-producing an educational intervention on youth suicide prevention tailored to GPs' perceived needs. DESIGN Qualitative focus group study using framework analysis. SETTING 5 inner city general practices in Nottingham. PARTICIPANTS 28 GPs took part (9 males) with mean age of 37 years. The median number of years of professional experience was 13. Participants were recruited through convenience sampling based on accessibility, interest in the study and willingness to participate. RESULTS 3 themes emerged from the data in relation to GP's attitudes and beliefs towards suicide; the challenges GPs experience when it comes to the assessment and management of suicide risk in young people; and optimal ways of addressing some of these challenges through the provision of specialist education and training targeting GPs' knowledge and clinical skills in this field. CONCLUSIONS The findings revealed wide variations in the understanding and operationalisation of risk among GPs, which has subsequent implications to how GPs perceive risk should be assessed. GP education on suicide risk assessment and management in youth should promote a holistic understanding and assessment of risk and its individual, social and contextual influences.
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Affiliation(s)
- Maria Michail
- School of Health Sciences, Jubilee Campus, University of Nottingham, Nottingham, UK
| | - Lynda Tait
- School of Health Sciences, Jubilee Campus, University of Nottingham, Nottingham, UK
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Chandler A, King C, Burton C, Platt S. General Practitioners' Accounts of Patients Who Have Self-Harmed: A Qualitative, Observational Study. CRISIS 2015; 37:42-50. [PMID: 26572907 PMCID: PMC4904492 DOI: 10.1027/0227-5910/a000325] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Abstract.Background: The relationship between self-harm and suicide is
contested. Self-harm is simultaneously understood to be largely nonsuicidal but
to increase risk of future suicide. Little is known about how self-harm is
conceptualized by general practitioners (GPs) and particularly how they assess
the suicide risk of patients who have self-harmed. Aims: The
study aimed to explore how GPs respond to patients who had self-harmed. In this
paper we analyze GPs’ accounts of the relationship between self-harm, suicide,
and suicide risk assessment. Method: Thirty semi-structured
interviews were held with GPs working in different areas of Scotland. Verbatim
transcripts were analyzed thematically. Results: GPs provided
diverse accounts of the relationship between self-harm and suicide. Some
maintained that self-harm and suicide were distinct and that risk assessment was
a matter of asking the right questions. Others suggested a complex
inter-relationship between self-harm and suicide; for these GPs, assessment was
seen as more subjective. In part, these differences appeared to reflect the
socioeconomic contexts in which the GPs worked. Conclusion:
There are different conceptualizations of the relationship between self-harm,
suicide, and the assessment of suicide risk among GPs. These need to be taken
into account when planning training and service development.
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Affiliation(s)
- Amy Chandler
- 1 Centre for Research on Families and Relationships, University of Edinburgh, Edinburgh, UK
| | - Caroline King
- 2 Institute for Applied Health Research, Glasgow Caledonian University, Glasgow, UK
| | | | - Stephen Platt
- 4 Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
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Tait L, Michail M. Educational interventions for general practitioners to identify and manage depression as a suicide risk factor in young people: a systematic review and meta-analysis protocol. Syst Rev 2014; 3:145. [PMID: 25510820 PMCID: PMC4276044 DOI: 10.1186/2046-4053-3-145] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 12/08/2014] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Suicide is a major public health problem and globally is the second leading cause of death in young adults. Globally, there are 164,000 suicides per year in young people under 25 years. Depression is a strong risk factor for suicide. Evidence shows that 45% of those completing suicide, including young adults, contact their general practitioner rather than a mental health professional in the month before their death. Further evidence indicates that risk factors or early warning signs of suicide in young people go undetected and untreated by general practitioners. Healthcare-based suicide prevention interventions targeted at general practitioners are designed to increase identification of at-risk young people. The rationale of this type of intervention is that early identification and improved clinical management of at-risk individuals will reduce morbidity and mortality. This systematic review will synthesise evidence on the effectiveness of education interventions for general practitioners in identifying and managing depression as a suicide risk factor in young people. METHODS/DESIGN We shall conduct a systematic review and meta-analysis following the Cochrane Handbook for Systematic Reviews of Interventions guidelines and conform to the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. Electronic databases will be systematically searched for randomised controlled trials and quasi-experimental studies investigating the effectiveness of interventions for general practitioners in identifying and managing depression as a suicide risk factor in young people in comparison to any other intervention, no intervention, usual care or waiting list. Grey literature will be searched by screening trial registers. Only studies published in English will be included. No date restrictions will be applied. Two authors will independently screen titles and abstracts of potential studies. The primary outcome is identification and management of depression. Secondary outcomes are suicidal ideation, suicide attempts, deliberate self-harm, knowledge of suicide risk factors and suicide-related behaviours, attitudes towards suicide risk and suicide-related behaviours, confidence in dealing with suicide risk factors and suicide-related behaviour. DISCUSSION Our study will inform the development of future education interventions and provide feasibility and acceptability evidence, to help general practitioners identify and manage suicidal behaviour in young people. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42014009110.
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Affiliation(s)
- Lynda Tait
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK.
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Windfuhr K, Kapur N. Suicide and mental illness: a clinical review of 15 years findings from the UK National Confidential Inquiry into Suicide. Br Med Bull 2011; 100:101-21. [PMID: 21948337 DOI: 10.1093/bmb/ldr042] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Suicide risk is most commonly associated with mental illness. In particular, suicide in people under mental health care presents distinct patterns of risk and opportunities for prevention due to their close proximity to specialist care. SOURCES OF DATA The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (Inquiry) is a unique UK-wide national database of all suicide cases in contact with mental health services in the 12 months preceding suicide. This review presents Inquiry findings from the beginning of the Inquiry in 1996 up to the present (2011) (15 years). AREAS OF AGREEMENT Suicide varies substantially by socio-demographic (age, gender) and clinical features (e.g. diagnosis; care variables). Effective suicide prevention initiatives should incorporate research findings to inform clinical practice and policy. AREAS OF CONTROVERSY Risk assessment remains one of the most difficult areas of clinical practice and management although all areas of clinical practice, research and policy development would benefit from continued high-quality studies. GROWING POINTS The Inquiry work has positively influenced mental health practice and policy in the UK. These changes include: falling suicide rates in mental health patients, informing suicide prevention strategies and developing safety checklists for mental health services. AREAS TIMELY FOR DEVELOPING RESEARCH Investigating suicide in non-mental health settings, investigating suicide following different treatment services and investigating models of service delivery could usefully inform future directions for improving patient safety.
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Affiliation(s)
- Kirsten Windfuhr
- Centre for Mental Health and Risk, 2nd Floor, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK.
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