Prioritizing suicide prevention guideline recommendations in specialist mental healthcare: a Delphi study

Abstract

Background: The Delphi technique is a proven and reliable method to create common definitions and to achieve convergence of opinion. This study aimed to prioritize suicide prevention guideline recommendations and to develop a set of quality indicators (QIs) for suicide prevention in specialist mental healthcare. Methods: This study selected 12 key recommendations from the guideline to modify them into QIs. After feedback from two face-to-face workgroup sessions, 11 recommendations were rephrased and selected to serve as QIs. Next, a Delphi study with the 11 QIs was performed to achieve convergence of opinion among a panel of 90 participants (23 suicide experts, 23 members of patients' advisory boards or experts with experiences in suicidal behavior and 44 mental healthcare professionals). The participants scored the 11 QIs on two selection criteria: relevance (it affects the number of suicides in the institution) and action orientation (institutions or professionals themselves can influence it) using a 5-point Likert scale. Also, data analysts working in mental healthcare institutions (MHIs) rated each QI on feasibility (is it feasible to monitor and extract from existing systems). Consensus was defined as 70% agreement with priority scores of four or five. Results: Out of the 11 recommendations, participants prioritized five recommendations as relevant and actionoriented in optimizing the quality of care for suicide prevention: 1) screening for suicidal thoughts and behavior, 2) safety plan, 3) early follow-up on discharge, 4) continuity of care and 5) involving family or significant others. Only one of the 11 recommendations early follow-up on discharge reached consensus on all three selection criteria (relevance, action orientation, and feasibility). Conclusions: The prioritization of relevant and action-oriented suicide prevention guideline recommendations is an important step towards the improvement of quality of care in specialist mental healthcare.

Cultural adaptation of the mental health first aid guidelines for assisting a person at risk of suicide to China: a Delphi expert consensus study

“…Considerations for future use of the MHFA guidelines for China Repeated suicidal attempts Evidence suggests that the repetition of suicide attempts is an important societal and health issue among Chinese people, particularly for rural residents and the elderly [7][8][9]13]. With a national suicide prevention system yet to be established in China, there are relatively few follow-up health services for people who have attempted suicide [28], though literature show that such services are essential for preventing repeated suicidal attempts [16]. Also, it is not uncommon to believe that suicide is due to weak personality (or not being "tough" enough) and that people should pay for their weakness, without adequate consideration of the multiple risk factors for suicide as well as the need for treatment [1].…”

“…However, as in many other LMICs, suicide prevention efforts are relatively limited in China, mostly depending on health professionals for recognition and clinical management. Some strategies targeting practice changes in mental health services (e.g., improved ward safety, community services, and staff training) have had beneficial impacts on suicide in high-income countries [15,16], but evidence suggests that most Chinese people at risk of suicide have limited access to appropriate health services [17,18]. Community education programs, including gatekeeper training, which involves educating community members to recognise and identify people at risk of suicide and to assist them in receiving appropriate care are also commonly implemented in high-income countries [19].…”

An integer programming model to assign patients based on mental health impact for tele-psychotherapy intervention during the Covid–19 emergency

“…Thakur and Jain [77] explained how suicide stigma, basic psychology, the failure of individ-An IP model for assignment in tele-psychoterapy during Covid-19 3 uals to act, and the lack of government involvement are linked to the incidence of suicide during the Covid-19 pandemic. Consequently, addressing suicide risk is one of the critical preventive strategies [68,75]. Throughout this period of isolation, diverse contextual factors can influence and anticipate suicide rates in Ecuador.…”

An integer programming model to assign patients based on mental health impact for tele-psychotherapy intervention during the Covid–19 emergency

“…Thakur et al [ 77 ] explained how suicide stigma, basic psychology, the failure of individuals to act, and the lack of government involvement are linked to the incidence of suicide during the Covid–19 pandemic. Consequently, addressing suicide risk is one of the critical preventive strategies [ 68 , 75 ]. Throughout this period of isolation, diverse contextual factors can influence and anticipate suicide rates in Ecuador.…”