Abstract:The objective of this study was to acquire process information, clinician and client feedback during implementation of a routine suicide risk screening program for outpatients with serious mental disorders. We studied implementation of a suicide-screening tool in a large public mental health outpatient facility in New York City. Most clinical staff who provided an opinion indicated screening was useful, feasible and helpful; most clients did not mind screening. Facilitators to program implementation included a… Show more
“…In response to the first question, benefits of participation, one clinician wrote, “participation in the meetings decreases isolation, decreases shame, develops support networks, breaks through denial, [helps them] accept their illness, and gives them the support to hold onto a job.” Not all clinicians were sanguine about 12-step benefits. In response to the question about potential problems and risks with participation, several indicated that they had “issues with religious orientation,” and that they had concerns about “wrong advice offered by non-professionals;” another opined that “low cognitive ability would hamper clients’ abilities to understand concepts.” Of particular interest was the leitmotif (cited by 10 clinicians) that 12-step participation acts as a trigger: “Hearing war stories can trigger them; one person monopolizes the group… meeting active users, then going astray.” Beliefs that 12-step might reawaken and trigger substance use behaviors in vulnerable clients is consonant with similar findings in which clinicians expressed concern that suicide screenings could induce suicidal ideation in clients not previously disposed to such thoughts 31 . The question about what the clinic could do to increase participation elicited a call for guaranteeing that the meetings take place “no matter what.” One clinician lamented that meetings were inconsistently held around holiday times when they are needed most.…”
As substance use and mental illness services are increasingly integrated, mental health professionals are presented with opportunities to refer greater numbers of dually-diagnosed clients to 12-step groups. This study examined the relationships among clinicians’ 12-step experiences, attitudes and referral practices in 6 NYC mental health clinics. A path analysis model showed that greater interest in learning about 12-step (12-step interest) directly predicted 12-step referral practices and that 12-step interest was predicted both by clinicians’ perception of the helpfulness of 12-Step groups and the severity of their patients’ problems with substance abuse. Clinicians’ responses to open-ended questions supported this model. Didactic and experiential education for clinicians in substance abuse and mutual aid would likely increase patient referrals to 12-step groups.
“…In response to the first question, benefits of participation, one clinician wrote, “participation in the meetings decreases isolation, decreases shame, develops support networks, breaks through denial, [helps them] accept their illness, and gives them the support to hold onto a job.” Not all clinicians were sanguine about 12-step benefits. In response to the question about potential problems and risks with participation, several indicated that they had “issues with religious orientation,” and that they had concerns about “wrong advice offered by non-professionals;” another opined that “low cognitive ability would hamper clients’ abilities to understand concepts.” Of particular interest was the leitmotif (cited by 10 clinicians) that 12-step participation acts as a trigger: “Hearing war stories can trigger them; one person monopolizes the group… meeting active users, then going astray.” Beliefs that 12-step might reawaken and trigger substance use behaviors in vulnerable clients is consonant with similar findings in which clinicians expressed concern that suicide screenings could induce suicidal ideation in clients not previously disposed to such thoughts 31 . The question about what the clinic could do to increase participation elicited a call for guaranteeing that the meetings take place “no matter what.” One clinician lamented that meetings were inconsistently held around holiday times when they are needed most.…”
As substance use and mental illness services are increasingly integrated, mental health professionals are presented with opportunities to refer greater numbers of dually-diagnosed clients to 12-step groups. This study examined the relationships among clinicians’ 12-step experiences, attitudes and referral practices in 6 NYC mental health clinics. A path analysis model showed that greater interest in learning about 12-step (12-step interest) directly predicted 12-step referral practices and that 12-step interest was predicted both by clinicians’ perception of the helpfulness of 12-Step groups and the severity of their patients’ problems with substance abuse. Clinicians’ responses to open-ended questions supported this model. Didactic and experiential education for clinicians in substance abuse and mutual aid would likely increase patient referrals to 12-step groups.
“…Beneficial risk management from the patient perspective was associated with the gradual cultivation of trust. This was to nurture an openness with relationships, so patients felt able to discuss risks, while staff respectfulness made troublesome topics (i.e., those delicate to the patient) easier to discuss (Lang, Uttaro, Caine, Carpinello, & Felton, ; Long et al, ). Patient desire for sincerity and collaboration was also met when they felt listened to, even though there were disagreements (Long et al, ).…”
Section: Resultsmentioning
confidence: 99%
“…Nevertheless, some patients voiced enthusiasm for assessment, significantly when relating to the prevention of suicide. They observed that assessment led to productive conversations, or further exploration that otherwise would not have been disclosed (Comtois et al, ; Lang et al, ). Moreover, alternative ways of coping that emerged from conversations aided agency, for patients developed choices in how to manage risks (Schembari et al, );“It is good to screen”, “this can save lives”, and “I felt better afterward by letting my therapist know”.…”
Section: Resultsmentioning
confidence: 99%
“…Moreover, alternative ways of coping that emerged from conversations aided agency, for patients developed choices in how to manage risks (Schembari et al, );“It is good to screen”, “this can save lives”, and “I felt better afterward by letting my therapist know”. (Lang et al, :163)The feeling of being heard, taken seriously… and “I now know where to go, which I did not before”. (Schembari et al, :221)…”
Section: Resultsmentioning
confidence: 99%
“…“It is good to screen”, “this can save lives”, and “I felt better afterward by letting my therapist know”. (Lang et al, :163)…”
Accessible Summary
What is known about the subject?
Risk in psychiatry involves harm to self or others owing to mental health difficulties, for example iatrogenic effects of treatment, self‐harm, suicide and violence.
Risk management is a framework to minimize risks, comprising of risk assessment, generation of risk management plans and evaluation of interventions.
Literature has extensively explored risk management and presented a critique that its practices can lead to patient harm. However, there is a paucity of literature about what patients identify as helpful risk management practices, despite the potential for such patient views to ameliorate harm and improve mental health care.
What this paper adds to existing knowledge
Interpersonal relationships with clinicians, and communication that keeps patients involved and informed of management processes, were found to be central to beneficial risk management practices, while patients having agency and autonomy to influence their participation was also important.
Beneficial interpersonal relationships and connectivity in the form of patients’ wider community of support were found to be influential in aiding risk management. Meaningful relationships, and particularly peer support, that maintained personal and collective identities were prevalent in the literature.
What are the implications for practice?
Rendering risk management more visible and accessible in practice might cultivate an openness that promotes patient participation. This includes drawing on a wider network of support, for example the patient’s friends and family, as well as having advocacy utilizing peer support.
AbstractIntroductionMinimizing the harm that patients pose to themselves and others, due to mental health difficulties, is a central component of risk management in psychiatry. However, risk management itself can cause patient harm, but despite this and the potentially informative value of lived experience, little is known about what patients want or expect from risk management.AimTo review research and explore what patients consider beneficial in risk management practice.MethodA mixed studies systematic review utilizing PRISMA guidelines, alongside a convergent qualitative design to categorize findings.ResultsTwelve papers were identified, generating two categories of beneficial practices: interpersonal relationships and communication with clinicians; coupled with patient agency in their own risk management.DiscussionConnectivity appears important. Particularly patients feeling involved, and their voices being heard in both the identification of risks and then shaping risk management practice. Moreover, this included involvement of friends, family and peers to widen input and supportive networks beyond clinical relationships.Implications for PracticeRisk management needs to be an accessible part of care, which is more inclusive of patient views and needs. The latter might also be aided by drawing on the patient's wider community in order to provide more effective support and r...
Aims and objectivesTo describe psychiatric nursing staff´s experiences of working with suicide risk assessment instruments.BackgroundAround the world, approximately 720,000 people die by suicide each year, of which almost 20% have an ongoing contact with specialist psychiatry during their last month alive. To identify which patients have an increased risk of suicide is a highly important task for nursing staff. Suicidal behaviour is complex and unpredictable. Nursing staff work closely with patients in everyday psychiatric care and often possess unique patient knowledge. These professionals must therefore be able to know when a patient's eventual suicidality requires further attention and efforts.DesignA descriptive qualitative study.MethodsConvenience sampling including nursing staff with more than 2 years of experience in specialist psychiatry. The data collection took place through semi‐structured interviews and was then analysed according to conventional content analysis.ResultsThe nursing staff felt that a natural conversation is superior suicide risk assessment instruments and that experience and patient knowledge are the primary factors for facilitating a suicide risk assessment. This meant that some nursing staff rarely used suicide risk assessment instruments, although they sometimes could be a useful support in the conversation and provided a sense of personal security when documenting results.ConclusionSuicide risk assessment instrument can be significant and helpful in certain cases, but the essential components of a suicide risk assessment consist of a conversation to understand the meaning of suicide from the patient's perspective.Patient or Public ContributionPsychiatric nursing staff contributed to this study by sharing their experiences through interviews.
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