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Che SE, Geun GY, Lee JY, Lee H, Yun K, Sim B, Kim KH. Trends in patient suicide rate after psychiatric discharge in Korea from 2010 to 2018: A nationwide population-based study. J Affect Disord 2023; 323:860-865. [PMID: 36526113 DOI: 10.1016/j.jad.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 12/01/2022] [Accepted: 12/03/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is limited quantitative evidence to investigate short-term suicide rates although the risk of suicide in psychiatric patients is exceptionally high in the early post-discharge period. This study aimed to explore the trends of the 30 days suicide rate after discharge using population-based data from Korea. METHODS This study was conducted on psychiatric patients aged 15 years or older discharged between 2010 and 2018. Patients were extracted from the National Health Insurance Claim Database (NHICD) and information on suicide was obtained from the National Statistical Office. Age-standardized suicide rate (ASR) and Standardized Mortality Ratio (SMR) within 30 days after discharge was estimated and tested using joinpoint regression. RESULTS Of the 1,576,028 patients discharged from hospitals from 2010 to 2018, 53.9 % were male and 47.9 % were aged between 40 and 59 years. The 30 days ASRs for psychiatric patients after discharge varied from 174.9 to 218.0 per 100,000 patients with no clear trend excluding patients with schizophrenia and anxiety disorder. The SMR for suicide within 30 days after discharge was 66.8 in 2016-2018, and patients aged 20 to 39, female, and patients with depression had high SMRs compared to other groups. LIMITATIONS Factors that may impact the suicide were not considered in this study. Since the NHICD data is collected for payment of medical expenses, there may be scope for inaccuracies. CONCLUSIONS The 30 days suicide rate after psychiatric discharge has failed to decrease between 2010 and 2018. This study recommends early interventions after discharge and intensive interventions for patient groups who may be vulnerable to suicide.
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Affiliation(s)
- Song Ee Che
- HIRA Research Institute, Health Insurance Review & Assessment Service, Wonju, South Korea
| | - Gwon Yeong Geun
- HIRA Research Institute, Health Insurance Review & Assessment Service, Wonju, South Korea
| | - Jin Yong Lee
- HIRA Research Institute, Health Insurance Review & Assessment Service, Wonju, South Korea; Public Healthcare Center, Seoul National University Hospital, Seoul, South Korea; Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyejin Lee
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kookhoe Yun
- HIRA Research Institute, Health Insurance Review & Assessment Service, Wonju, South Korea
| | - Boram Sim
- HIRA Research Institute, Health Insurance Review & Assessment Service, Wonju, South Korea
| | - Kyoung-Hoon Kim
- HIRA Research Institute, Health Insurance Review & Assessment Service, Wonju, South Korea.
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2
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Loving RT. Admission to a psychiatric hospital independently increases suicide risk. Arch Psychiatr Nurs 2022; 41:103-104. [PMID: 36428036 DOI: 10.1016/j.apnu.2022.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 05/14/2022] [Accepted: 07/15/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Richard T Loving
- Sharp Mesa Vista Hospital, San Diego, CA, United States of America.
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3
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Chowdhury NZ, Wand H, Albalawi O, Adily A, Kariminia A, Allnutt S, Sara G, Dean K, Ellis A, Greenberg D, Schofield PW, Butler T. Mental health service contact following release from prison or hospital discharge in those with psychosis. Front Psychiatry 2022; 13:1034917. [PMID: 36590622 PMCID: PMC9798427 DOI: 10.3389/fpsyt.2022.1034917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/02/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND An association exists between psychosis and criminal offending, which evidence suggests can be reduced by effective mental health care for this vulnerable population. However mental health services often lose contact with people after diagnosis. The association between the first episode of psychosis and criminal offending highlights the need for effective mental health care for this vulnerable population. AIMS To investigate the association between the first diagnosis of psychosis (FDP) in prison or hospital and subsequent mental health service contact following release from prison or discharge from hospital. MATERIALS AND METHODS Individuals with a FDP either in prison (n = 492) or hospital setting (n = 24,910) between July 2006 and December 2011 in NSW (Australia), were followed post-release or discharge until their first mental health service contact in the community, the occurrence of an offence, death, or completion of the study period at the end of December 2012. Cox regression models were used to examine the predictors for the mental health service contacts following release or discharge. RESULTS Over 70% of those with a FDP in prison or hospital had a psychosis-related or any community-based mental health service contact following release or discharge between July 2006 and December 2012. Those with a FDP in prison were more likely to have no contact with mental health services than those in hospital with no prior offence record (hazard ratio, HR = 3.14, 95% CI: 2.66-3.72 and adjusted hazard ratio, aHR = 3.05, 95% CI: 2.56-3.63) within a median follow-up time of 25 days for the prison group and 26 days for hospital group. Males, individuals of Aboriginal heritage and individuals diagnosed with substance-related psychoses compared to those with schizophrenia and related psychoses were less likely to have a mental health service contact following release or discharge in both the univariable and multivariable analysis. CONCLUSION This study suggests that prior offending or a previous prison episode represents a barrier to mental health service contact in the community for those with a FDP. Effective rehabilitation planning while exiting prison and discharge planning from hospital are essential to the successful reintegration of these individuals with a FDP.
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Affiliation(s)
- Nabila Z Chowdhury
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Handan Wand
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Olayan Albalawi
- Department of Statistics, Faculty of Science, University of Tabuk, Tabuk, Saudi Arabia
| | - Armita Adily
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Azar Kariminia
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Stephen Allnutt
- Forensic Mental Health Program, University of New South Wales, Sydney, NSW, Australia
| | - Grant Sara
- Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Kimberlie Dean
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales and Justice Health and Forensic Mental Health Network, Sydney, NSW, Australia
| | - Andrew Ellis
- NSW Justice Health & Forensic Mental Health Network, Newcastle, NSW, Australia
| | - David Greenberg
- NSW Justice Health & Forensic Mental Health Network, Newcastle, NSW, Australia
| | | | - Tony Butler
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
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Schuster H, Jones N, Qadri SF. Safety Planning: Why It Is Essential on the Day of Discharge From In-patient Psychiatric Hospitalization in Reducing Future Risks of Suicide. Cureus 2021; 13:e20648. [PMID: 35106206 PMCID: PMC8786576 DOI: 10.7759/cureus.20648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 12/05/2022] Open
Abstract
Individuals who suffer from mental illness are at an increased risk for suicide. That risk is substantially higher in the post-discharge period from psychiatric hospitalization. Safety planning intervention (SPI) is a common intervention tool that is utilized to mitigate the risk of suicide. Current research notes promising results of SPI use in the emergency department (ED); however, there is limited research regarding SPI use during psychiatric hospitalization on the day of discharge. This paper aims to evaluate current research on the topic and establish a need for more widespread use of SPI during psychiatric hospitalization.
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Affiliation(s)
- Haley Schuster
- Psychiatry, Creighton University School of Medicine, Omaha, USA
| | - Nathan Jones
- College of Allied Health Professionals, University of Nebraska Medical Center, Omaha, USA
| | - Syed F Qadri
- Psychiatry, Creighton University School of Medicine, Omaha, USA
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5
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Probert J. Moving Toward a Human Rights Approach to Mental Health. Community Ment Health J 2021; 57:1414-1426. [PMID: 33934236 PMCID: PMC8088315 DOI: 10.1007/s10597-021-00830-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 04/24/2021] [Indexed: 11/29/2022]
Abstract
The University of Florida Counseling and Wellness Center (UFCWC) has implemented peer support and professional training programs to address human rights identified within advocacy groups comprised of individuals who have, themselves, been diagnosed with mental illness. These programs are moving the UFCWC toward fulfilling a 2017 United Nations report emphasizing rights-based professional training, provision of genuine informed consent, and availability of non-compromised peer support alternatives. Collaborating with student peers, four UFCWC faculty members have facilitated forms of peer support developed within service-user movements, while openly identifying experiences of reclaiming their own lives from the impacts of adversity, intense mental distress, and traumatizing responses of others to their distress. In the wake of the current pervasive health, economic, and social justice crises, professionals have a collective opportunity to recognize the human experience and rights of those suffering mental distress. These UFCWC programs offer one example of steps taken toward that goal.
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Affiliation(s)
- Jim Probert
- Division of Student Affairs/Department of Psychology, University of Florida Counseling and Wellness Center, 3190 Radio Road, P.O. Box 112662, Gainesville, FL, 32611-2662, USA.
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Boafo A, Greenham S, Cloutier P, Abraham S, Dumel M, Gendron V, Rowsell D. Development of a Clinical Pathway for the Assessment and Management of Suicidality on a Pediatric Psychiatric Inpatient Unit. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2020; 11:123-133. [PMID: 33061732 PMCID: PMC7522520 DOI: 10.2147/ahmt.s240060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/18/2020] [Indexed: 11/23/2022]
Abstract
Purpose This article describes steps taken by a mental health inpatient multidisciplinary team to develop a clinical pathway for the assessment and management of suicidality in a pediatric psychiatric inpatient unit. Patients and Methods The setting for this project is a 19-bed inpatient psychiatry unit providing care for children and adolescents (6-17 years of age) in a tertiary care pediatric hospital in Ontario, Canada. Three Lean methodologies were used: 1) The A3 process was used to articulate a problem statement and help clarify expectations, determine goals, and uncover, address and encourage discussion of potential issues; 2) Process mapping was used to show how work process activities are sequenced from the time of the patient's admission to discharge; and 3) Standard work, where consideration was given to the breakdown of the work into categories which are sequenced, organized and repeatedly followed. Generally accepted methodologies for developing clinical pathways were used to create a framework and algorithm for the assessment and management of suicidality in psychiatrically hospitalized children and adolescents. Results The clinical pathway development resulted in six steps from admission to discharge: intake process, inclusion/exclusion criteria, data integration and treatment formulation, interventions, determination of readiness for discharge, and the discharge process. Conclusion This framework, developed with the aim to standardize care for psychiatrically admitted suicidal children and adolescents, may serve as a flexible template for use in similar settings and could be adapted according to local realities and resources.
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Affiliation(s)
- Addo Boafo
- Mental Health Program, CHEO, Ottawa, ON, Canada.,CHEO Research Institute, CHEO, Ottawa, ON, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Stephanie Greenham
- Mental Health Program, CHEO, Ottawa, ON, Canada.,CHEO Research Institute, CHEO, Ottawa, ON, Canada.,School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Paula Cloutier
- Mental Health Program, CHEO, Ottawa, ON, Canada.,CHEO Research Institute, CHEO, Ottawa, ON, Canada
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Bojanić L, Hunt IM, Baird A, Kapur N, Appleby L, Turnbull P. Early Post-Discharge Suicide in Mental Health Patients: Findings From a National Clinical Survey. Front Psychiatry 2020; 11:502. [PMID: 32581877 PMCID: PMC7296132 DOI: 10.3389/fpsyt.2020.00502] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 05/18/2020] [Indexed: 12/13/2022] Open
Abstract
Studies on suicide by recently discharged mental health patients have reported a high number of deaths in the early post-discharge period, which has led to recommendations of follow-up within 7 days (d). More recently, the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) proposed a more "stringent" follow-up period of 2-3 days (d) after discharge. Patients who died within this early time-frame post-discharge were more likely to die before the follow-up appointment occurred. They more often had a primary diagnosis of a personality disorder, self-discharged, and had a higher frequency of death by jumping from a height or in front of the vehicle compared to later deaths. This study provides practical implications for post-discharge management and safety planning. Clinicians should be aware of (1) the increased risk of immediate suicide in the post-discharge period by people with a diagnosis of personality disorder, (2) immediate suicide risk in patients who initiate their own discharge, and (3) the increased risk of death by jumping from a height or in front of the vehicle in the immediate post-discharge period. Our findings support the recent recommendation from NCISH that follow-up should occur within 3 d of discharge from in-patient care.
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Affiliation(s)
- Lana Bojanić
- National Confidential Inquiry into Suicide and Safety in Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Isabelle M. Hunt
- National Confidential Inquiry into Suicide and Safety in Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Alison Baird
- National Confidential Inquiry into Suicide and Safety in Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Navneet Kapur
- National Confidential Inquiry into Suicide and Safety in Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Pauline Turnbull
- National Confidential Inquiry into Suicide and Safety in Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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Abstract
The risk of suicide is significant during the transition of care; the highest in the first few weeks after discharge from a healthcare facility. This systematic review summarizes the evidence for interventions providing care during this high-risk period. In January 2019, PubMed and Scopus were systematically searched using the search terms: Suicide AND (Hospital OR Emergency department) AND Discharge. Articles relevant to interventions targeting suicidal behaviors during the transition of care were selected after the title and abstract screening followed by full-text screening. This review article included 40 articles; with a total patient population of 24,568. The interventions included telephone contacts, letters, green cards, postcards, structured visits, and community outreach programs. An improvement in the engagement of patients in outpatient services was observed but the evidence for suicidal behaviors was conflicting. The reviewed interventions were efficacious in linking patients to outpatient services, reducing feelings of social isolation and helping patients in navigating the available community resources. For patients with repetitive suicidal behaviors, psychosocial interventions such as dialectical behavioral therapy can be helpful. Patients should be followed by targeted interventions based on risk categorization of the patients by using evidence-based tools.
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9
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Dimeff LA, Jobes DA, Chalker SA, Piehl BM, Duvivier LL, Lok BC, Zalake MS, Chung J, Koerner K. A novel engagement of suicidality in the emergency department: Virtual Collaborative Assessment and Management of Suicidality. Gen Hosp Psychiatry 2020; 63:119-126. [PMID: 29934033 DOI: 10.1016/j.genhosppsych.2018.05.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/17/2018] [Accepted: 05/17/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE A novel avatar system (Virtual Collaborative Assessment and Management of Suicidality System; V-CAMS) for suicidal patients and medical personnel in emergency departments (EDs) was developed and evaluated. V-CAMS facilitates the delivery of CAMS and other evidence-based interventions to reduce unnecessary hospitalization, readmissions, and suicide following an ED visit. METHOD Using iterative user-centered design with 24 suicidal patients, an avatar prototype, "Dr. Dave" (based on Dr. Jobes) was created, along with other patient-facing tools; provider-facing tools, including a clinical decision support tool were also designed and tested to aid discharge disposition. RESULTS Feasibility tests supported proof of concept. Suicidal patients affirmed the system's overall merit, positive Perception of Care, and acceptability; medical providers (n = 21) viewed the system as an efficient, effective, and safe method of improving care for suicidal ED patients and reducing unnecessary hospitalization. CONCLUSIONS Technology tools including a patient-facing avatar and e-caring contacts, along with provider-facing tools may offer a powerful method of facilitating best-practice suicide prevention interventions and point-of-care tools for suicidal patients seeking ED services and their medical providers. Future directions include full development of V-CAMS and integration into a health electronic medical record and a rigorous randomized controlled trial to study its effectiveness.
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Affiliation(s)
- Linda A Dimeff
- Evidence-Based Practice Institute, LLC, 3303 South Irving Street, Seattle, WA 98144, USA.
| | - David A Jobes
- The Catholic University of America, O'Boyle Hall, Room 314, 620 Michigan Ave NE, Washington, DC 20064, USA.
| | - Samantha A Chalker
- The Catholic University of America, O'Boyle Hall, Room 314, 620 Michigan Ave NE, Washington, DC 20064, USA.
| | - Brian M Piehl
- The Catholic University of America, O'Boyle Hall, Room 314, 620 Michigan Ave NE, Washington, DC 20064, USA.
| | - Leticia Lobo Duvivier
- Central Arkansas Veterans Healthcare System, 5665 Ponce de Leon Boulevard, Coral Gables, FL 33146, USA
| | - Benjamin C Lok
- University of Florida, Department of Computer and Information Sciences and Engineering, CSE Room E544, P.O. Box 116120, Gainesville, FL 32611-6120, USA.
| | - Mohan S Zalake
- Evidence-Based Practice Institute, LLC, 3303 South Irving Street, Seattle, WA 98144, USA
| | - Julie Chung
- Evidence-Based Practice Institute, LLC, 3303 South Irving Street, Seattle, WA 98144, USA.
| | - Kelly Koerner
- Evidence-Based Practice Institute, LLC, 3303 South Irving Street, Seattle, WA 98144, USA.
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Abstract
SUMMARYRates of suicide and self-harm are rising in many countries, and it is therapeutically important to explore the personal stories and relationships that underlie this behaviour. In this article psychoanalytic and psychodynamic principles and concepts in relation to violence towards the self are introduced and the various unconscious meanings of suicide and self-harm are explored within a relational context and attachment framework. We describe how a psychodynamic approach may enhance the risk assessment and treatment of patients presenting with self-harm and suicidality, particularly examining the role of transference and countertransference within the therapeutic relationship.LEARNING OBJECTIVES•Understand historical and contemporary psychoanalytic theories and concepts regarding the aetiology of suicide and self-harm•Understand the different meanings and expressions of acts of suicide and self-harm•Understand the use of countertransference in the risk assessment and management of self-harm and suicide attemptsDECLARATION OF INTERESTNone.
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11
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Toynbee L, Allen D. Non-engagement and the assertive outreach team. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.32.12.474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Schechter M, Goldblatt MJ, Ronningstam E, Herbstman B, Maltsberger JT. Postdischarge suicide: A psychodynamic understanding of subjective experience and its importance in suicide prevention. Bull Menninger Clin 2016; 80:80-96. [DOI: 10.1521/bumc.2016.80.1.80] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Sands N, Elsom S, Keppich-Arnold S, Henderson K, King P, Bourke-Finn K, Brunning D. Investigating the validity and usability of an interactive computer programme for assessing competence in telephone-based mental health triage. Int J Ment Health Nurs 2016; 25:80-6. [PMID: 26365233 DOI: 10.1111/inm.12165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Telephone-based mental health triage services are frontline health-care providers that operate 24/7 to facilitate access to psychiatric assessment and intervention for people requiring assistance with a mental health problem. The mental health triage clinical role is complex, and the populations triage serves are typically high risk; yet to date, no evidence-based methods have been available to assess clinician competence to practice telephone-based mental health triage. The present study reports the findings of a study that investigated the validity and usability of the Mental Health Triage Competency Assessment Tool, an evidence-based, interactive computer programme designed to assist clinicians in developing and assessing competence to practice telephone-based mental health triage.
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Affiliation(s)
- Natisha Sands
- School of Nursing and Midwifery, Deakin University, Geelong
| | - Stephen Elsom
- Centre for Psychiatric Nursing, The University of Melbourne, Melbourne
| | | | | | - Peter King
- Crisis Assessment and Treatment Team, Alfred Health, Melbourne
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Bucci S, Roberts NH, Danquah AN, Berry K. Using attachment theory to inform the design and delivery of mental health services: a systematic review of the literature. Psychol Psychother 2015; 88:1-20. [PMID: 24729543 DOI: 10.1111/papt.12029] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 12/23/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this review was to propose and describe the design and delivery of an attachment-informed general mental health service. METHOD We systematically searched the PsycINFO, MEDLINE, Web of Knowledge, COPAC, CINAHL, and Science Direct databases from 1960 to 2013. We also searched reference lists of relevant papers and directly contacted authors in the field. Literature describing attachment theory and its applicability in designing and delivering general mental health services was synthesized using thematic analysis. Papers published in English, books or chapters in edited books that described applying attachment theory in designing and delivering mental health services for adults and adolescents were included in the review. Of the 1,105 articles identified, 14 met inclusion criteria for the review. Eight key themes, and four subthemes, were extracted and organized to reflect the experience of a service user moving through the mental health system. RESULTS Key themes extracted were as follows: service policy and evaluation; referrals; assessment and formulation; intervention; support for staff; support for carers; moving on; and potential service benefits. Papers reviewed suggested that service users with severe mental health problems have attachment needs that should be met in general mental health services. CONCLUSIONS Attachment theory provides a useful framework to inform the design and delivery of general mental health services. The resource implications for services are discussed, as are limitations of the review and recommendations for future research. PRACTITIONER POINTS Attachment theory should be used to inform the design and delivery of general mental health services. Mental health services should evaluate the extent to which they meet service users' attachment needs. Attachment-informed mental health services should assess outcomes, including cost-effectiveness over time. Papers included in this review focus on long-stay residential care or secure services and there is a limited experimental evidence base to show that providing an attachment-informed service improves patient outcomes.
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Affiliation(s)
- Sandra Bucci
- School of Psychological Sciences, University of Manchester, UK
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15
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Bagge CL, Littlefield AK, Conner KR, Schumacher JA, Lee HJ. Near-term predictors of the intensity of suicidal ideation: an examination of the 24 h prior to a recent suicide attempt. J Affect Disord 2014; 165:53-8. [PMID: 24882177 DOI: 10.1016/j.jad.2014.04.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 04/11/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND The extent to which acute exposures such as alcohol use (AU) and negative life events (NLE) are uniquely associated with intensity of suicidal ideation during the hours leading up to a suicide attempt is unknown. The main aim of the current study was to quantify the unique effect of acute exposures on next-hour suicidal ideation when adjusting for previous hour acute exposures and suicidal ideation. An exploratory aim of the current study was to examine the effect of non-alcohol drug use (DU) on suicidal ideation. METHODS Participants included 166 (61.0% female) recent suicide attempters presenting to a Level 1 trauma hospital. A timeline follow-back methodology was used to assess acute exposures and intensity of suicidal ideation within the 24h prior to the suicide attempt. RESULTS Findings indicated that acute AU (b=.20, p<.01) and NLE (b=.58, p<.01) uniquely predicted increases in next-hour suicidal ideation, over and above previous hour suicidal ideation, whereas acute DU did not. LIMITATIONS The current study׳s methodology provides continuous hourly snapshots prior to the suicide attempt, quite close to when it happened, but is retrospective and causality cannot be inferred. CONCLUSIONS Understanding that, within a patient, AU and NLE predict near-term increases in suicidal ideation has practical utility impacting providers׳ clinical decision-making, safety concerns, and ultimate determination of level of risk for suicide.
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Affiliation(s)
- Courtney L Bagge
- University of Mississippi Medical Center, Department of Psychiatry and Human Behavior, 2500 North State Street, Jackson, MS 39216, United States.
| | - Andrew K Littlefield
- Texas Tech University, Department of Psychology, Lubbock, TX 79409, United States.
| | - Kenneth R Conner
- VISN 2 Center of Excellence for Suicide Prevention, 400 Fort Hill Avenue, Canandaigua, NY 14424, United States.
| | - Julie A Schumacher
- University of Mississippi Medical Center, Department of Psychiatry and Human Behavior, 2500 North State Street, Jackson, MS 39216, United States.
| | - Han-Joo Lee
- University of Wisconsin-Milwaukee, Department of Psychology, 2441 E. Hartford Avenue, Garland 211, Milwaukee, WI 53211, United States.
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17
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Patient Safety in Behavioral Health. PATIENT SAFETY 2014. [DOI: 10.1007/978-1-4614-7419-7_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Zhinchin G, Shah A. The relationship between NHS performance indicators and suicide rates. MEDICINE, SCIENCE, AND THE LAW 2013; 53:223-226. [PMID: 23945260 DOI: 10.1177/0025802413487903] [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: 06/02/2023]
Abstract
AIMS AND METHOD As mental health services have an important role in prevention of suicides, the relationship between Care Quality Commission performance ratings of mental health trusts and the local suicide rates were examined with the null hypothesis that there will be no relationship between them. Data on suicide rates for men and women aged 16-65 for each district covered by a mental health trust were ascertained from the Office of National Statistics for the year 2009. Data on performance ratings of mental health trusts for the same year were obtained from the Care Quality Commission Report. RESULTS There was no significant relationship between suicide rates in the districts covered by 60 mental health trusts in England and Wales and their performance ratings. CLINICAL IMPLICATIONS The negative findings suggest that the performance rating of mental health trusts do not influence local suicide rates.
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Abstract
AbstractGiven the uncontested role of psychiatric illnesses in both fatal and non-fatal suicidal behaviours, efforts are continuously made in improving mental health care provision. In cases of severe mental disorder, when intensified treatment protocols and continuous supervision are required due to individual's impaired emotional, cognitive and social functioning (including danger to self and others), psychiatric hospitalisation is warranted. However, to date there is no convincing evidence that in-patient care prevents suicide. In fact, quite paradoxically, both admissions to a psychiatric ward and recent discharge from it have been found to increase risk for suicidal behaviours. What elements in the chain of well-intentioned approaches to treating psychiatric illness and suicidality fail to protect this vulnerable population is still unclear. The same holds true for the identifications of factors that may increase the risk for suicide. This editorial discusses current knowledge on this subject, proposing strategies that might improve prevention.
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Gillespie M. Relapse in long-term conditions: learning from mental health methods. ACTA ACUST UNITED AC 2011; 19:1236-42. [PMID: 21042252 DOI: 10.12968/bjon.2010.19.19.79298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Within the UK, health-related policy and legislation have supported a shift towards a more pluralistic provision of health care in order to meet the challenges associated with the shifting demographics in society (Scottish Executive Health Department, 2009). The management of long-term conditions such as diabetes, heart disease and asthma, is recognized as a priority (Department of Health, 2009), with recognition that these long-term disorders share many similarities with serious mental health problems (Loggernberg, 2008), and suggestions that interventions already applied within the mental health setting are transferable across heathcare settings (Fleming et al, 2010). The application of one such intervention is discussed in this article.
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Johannessen HA, Dieserud G, Jakhelln F, Zahl PH, De Leo D. Changes in institutional psychiatric care and suicidal behaviour: a follow-up study of inpatient suicide attempters in Baerum, Norway. Soc Psychiatry Psychiatr Epidemiol 2009; 44:845-51. [PMID: 19247559 DOI: 10.1007/s00127-009-0006-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Accepted: 01/30/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND During the past decades, extensive reformatory changes in institutional psychiatric care have been implemented in Norway. AIMS The objective of the present study was to investigate whether these changes have resulted in shortened length of psychiatric hospital stays for suicide attempters. Further, to examine if length of hospital stay and time period in which the patients received treatment were related to the risk of a repeated suicide attempt and/or committing suicide. METHODS All cases of suicide attempters hospitalised between 1984 and 2006 in the municipality of Baerum, a suburb outside Oslo, were examined. The period of observation was further subdivided in two time intervals on the basis of the de-institutionalisation of psychiatric care, which started to plateau in 1996. RESULTS Among 1,574 patients consecutively admitted to the local general hospital after a suicide attempt, 330 were admitted to inpatient psychiatric care. Patients admitted in the period 1996-2006 had significantly shorter hospital stays than patients in the preceding period 1984-1995 (Log Rank P < 0.001). Neither the time period of treatment variable nor the length of hospital stay variable was significantly associated with the risk of a repeated suicide attempt or suicide. CONCLUSIONS Psychiatric de-institutionalisation appears as not having affected suicide attempt repetition. It is possible that reduced length of hospital stay has been compensated by improved mental health care in general and extended outpatient services in particular.
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Affiliation(s)
- Håkon A Johannessen
- Division of Mental Health, Department of Suicide Research and Prevention, Norwegian Institute of Public Health, 0403, Oslo, Norway.
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Conlon L, Garland M, Prescott P, Mannion L, Leonard M, Fahy TJ. Psychiatric aftercare and suicide risk: a case-control study using blind rating. Arch Suicide Res 2007; 11:291-5. [PMID: 17558614 DOI: 10.1080/13811110701404021] [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: 10/23/2022]
Abstract
Blindly abstracted records of last episode of care together with aftercare records of 39 psychiatric patient suicides and their matched controls were rated blind for suicidal talk during aftercare, reduction of aftercare at last appointment and high-low suicide risk. Neither suicidal talk nor reduction of aftercare was confirmed as a predictor of suicide, although trends in the predicted directions were observed. Blind estimates of high-low risk correctly identified a significant minority (40%) of suicides but at the cost of misclassifying 60% as controls. Evidence is still lacking that clinicians blind to case identity may, from records, reliably distinguish a majority of suicides from their matched controls. Some implications for practice and research are discussed.
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Affiliation(s)
- Louise Conlon
- Department of Psychiatry, University College Hospital, Galway, Ireland
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Turner T. Suicide now and then ... an elusive comparison: invited commentary on: Lifetime suicide rates in treated schizophrenia: 1875-1924 and 1994-1998 cohorts compared. Br J Psychiatry 2006; 188:229-30. [PMID: 16507963 DOI: 10.1192/bjp.bp.104.007526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Comparing suicide rates between Victorian and modern times, and the impact of the asylum, should enable a useful historical perspective on how effective our treatment approaches really are. Difficulties include clarifying the 'social geography', the underlying diagnoses, the reasons for admission and the reliability of case book data and follow-up arrangements.
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Affiliation(s)
- Trevor Turner
- Department of Psychiatry, East Wing, Homerton University Hospital, Homerton Row, London E9 6QR, UK.
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