Managing suicidality in inpatient care: a rapid review

Evans, Nicola; Edwards, Deborah; Chick, Phill

doi:10.1108/jmhtep-05-2020-0023

Cited by 2 publications

(2 citation statements)

References 47 publications

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“…Many die from low-lying ligature points (NCISH, 2023) and vigilance is needed where removal of low anchor points is not possible or self-strangulation (without a ligature point) may occur. Environmental risk audits are central to national and local ward safety guidance but effective engagement and high quality therapeutic relationships are also likely to improve the in-patient experience and promote recovery (Evans, Edwards, & Chick, 2022;Staniszewska et al, 2019).…”

Section: Interpretation Of Findings and Implicationsmentioning

confidence: 99%

Psychiatric in-patient care in England: as safe as it can be? An examination of in-patient suicide between 2009 and 2020

Hunt,

Baird,

Turnbull

et al. 2024

Psychol. Med.

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Background Psychiatric in-patients have a greatly elevated risk of suicide. We aimed to examine trends in in-patient suicide rates and determine if characteristics of in-patients who died by suicide have changed over time. Methods We identified all in-patients in England who died by suicide between 2009 and 2020 from the National Confidential Inquiry into Suicide and Safety in Mental Health. Suicide rates were calculated using data from Hospital Episodes Statistics. Results The rate of in-patient suicide per 100 000 bed days fell by 41.9% between 2009–2011 and 2018–2020. However, since 2016 the rate has remained static with no significant fall. Rates fell in men, those aged 30–59, and those with schizophrenia and other delusional disorders or personality disorder. Rates also fell for suicide by hanging (including hanging on the ward) and jumping. No falls were seen in suicide rates among women, younger and older age groups, and those with affective disorder. There was no indication of a transfer of risk to the post-discharge period or to home treatment/crisis care. More in-patients in the latter part of the study were aged under 25, were on authorised leave, and had psychiatric comorbidity. Conclusions In-patient suicide has significantly fallen since 2009, suggesting patient safety may have improved. The recent slowdown in the fall in rates, however, highlights that renewed preventative efforts are needed. These should include a greater focus on women, younger and older patients, and those with affective disorder. Careful reviews prior to granting leave are important to ensure a safe transition into the community.

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Section: Interpretation Of Findings and Implicationsmentioning

confidence: 99%

Psychiatric in-patient care in England: as safe as it can be? An examination of in-patient suicide between 2009 and 2020

Hunt,

Baird,

Turnbull

et al. 2024

Psychol. Med.

View full text Add to dashboard Cite

show abstract

“…Prevention of self‐harm by ligature is largely reliant on removal of ligature points and potential ligatures. However, it is widely acknowledged it is not possible to remove all possible ligatures or ligature points within a ward environment (Evans et al., 2022). Therefore, staff observation is frequently used to facilitate a fast response to incidents.…”

Section: Introductionmentioning

confidence: 99%

Experiences of clinical staff who work with patients who self‐harm by ligature: An exploratory survey of inpatient mental health service staff

Groves,

Lascelles,

Hawton

2023

Psychiatric Ment Health Nurs

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Accessible SummaryWhat is known on the subject Self‐harm by ligature is common within inpatient mental healthcare settings and is a dangerous method of self‐harm. Most fatal and non‐fatal suicidal behaviours in inpatient settings are a result of ligature use. There is a lack of research which has explored the experiences of staff members who work within inpatient settings where patients may self‐harm by ligature. What the paper adds to existing knowledge Key issues related to self‐harm by ligature reported by staff included (1) understaffing increasing risk of ligature incidents, (2) spreading of self‐harm by ligature within inpatient settings and (3) negative attitudes of staff related to patients who self‐harm by ligature. Working with self‐harm by ligature can have negative impacts on staff's personal (e.g. fear of blame) and professional lives (e.g. increased cautiousness). Many staff members currently feel underprepared by training related to working with self‐harm by ligature, and unsupported after responding to a ligature incident. What are the implications for practice Training about self‐harm by ligature needs to be improved and be accessible for all inpatient mental healthcare staff. Training should be coproduced, and could include practical components, education on potential reasons for self‐harm, and acknowledgement of the emotional impact on staff. Support for staff members who respond to ligature incidents should be available for all staff members who respond to self‐harm by ligature incidents. Stigma associated with accessing support should be challenged, alongside blame cultures within the workplace. AbstractIntroductionSelf‐harm by ligature is a common form of self‐harm within inpatient mental health services in England, where most suicides within inpatient settings involve hanging or suffocation. However, little research has examined the experiences of staff members working with this method of self‐harm.AimWe explored the experiences of clinical staff who work with patients who self‐harm by ligature.MethodA staff survey was developed and disseminated to clinical staff working in inpatient settings in England. Quantitative data were analysed using descriptive statistics, and qualitative data using the framework approach. The study was STROBE checklist compliant.Results275 staff members participated. Challenges most frequently reported about working with self‐harm by ligature included understaffing (210, 76.6%), spreading of ligature incidents (198, 72.8%) and negative attitudes held by clinical staff towards such patients (185, 68.5%). Participants' responses indicated that this work could have significant impacts on their professional and personal lives. Staff often reported inadequate training and lack of preparedness, alongside insufficient support opportunities following ligature incidents.DiscussionStaff had a diverse range of professional and personal experiences and identified multiple challenges associated with working with patients who have self‐harmed by ligature.Implications for PracticeThere is a need to improve accessibility, format and content of training and support for staff working within inpatient settings where patients may self‐harm by ligature.

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Managing suicidality in inpatient care: a rapid review

Cited by 2 publications

References 47 publications

Psychiatric in-patient care in England: as safe as it can be? An examination of in-patient suicide between 2009 and 2020

Psychiatric in-patient care in England: as safe as it can be? An examination of in-patient suicide between 2009 and 2020

Experiences of clinical staff who work with patients who self‐harm by ligature: An exploratory survey of inpatient mental health service staff

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