Suicide prevention in mental health services: A qualitative analysis of coroners’ reports

Abstract

Suicide is a major concern for mental health nurses because of its clear correlation with mental illness. In New Zealand, coroners investigate all deaths that appear to be a result of suicide, and provide reports to mental health services (MHS). The aim of the present study was to investigate coronial recommendations to MHS in relation to suicide prevention and to examine clinical and family responses to these. The present study was a three-phase design: (i) analysis of coroners' recommendations related to suicide in MHS; (ii) interviews with clinicians for their response to the recommendations; and (iii) interviews with individuals working with families of consumers of MHS for their responses in relation to family-related recommendations. A qualitative content analysis was conducted on the recommendations from coroners, the interviews with clinical leaders, and the focus group for family workers. Coroners recommended that MHS should implement suicide-prevention strategies that would facilitate improved communication, risk containment, service delivery, and family involvement. Clinicians agreed with most recommendations, apart from those related to risk containment. Family workers endorsed the coronial perspective that family inclusion in MHS was suboptimal. Coroners, MHS, and mental health nurses need to consider the latest clinical evidence for suicide prevention. However, given the complexity of factors that influence suicide, it is important to be realistic about MHS role in preventing suicide, but ensure that MHS provide interventions for which there is evidence, including facilitating family participation and providing access to psychotherapies.

Contact and communication with patients experiencing suicidal ideation: A qualitative study of nurses’ perspectives

“…These nurses seem to be more concerned with fulfilling observing and reporting functions than with involving in compassionate and considerate contact and communication with patients (Cutcliffe & Barker, ; Hagen, Hjelmeland, et al, ; Horsfall & Cleary, ). Nurses’ involvement in a checking and controlling approach is likely to be inspired and reinforced by suicide prevention guidelines, suggesting that nurses must be involved in observation policies and patient checks and must use protocols that enable direct and specific questioning about SI (Bowers, Gournay, & Duffy, ; Manuel et al, ). At the same time, the findings show that some nurses on open and closed wards seem to have the interpersonal qualities and skills to move beyond checking and controlling suicide risk and instead make efforts to acknowledge and connect (with) the patient as a person, even during standardized assessments and observations.…”

“…In addition, it is argued that nurses are increasingly involved in protocol‐based practices for suicide prevention. These practices are often defensive and do not value or obstruct nurses’ efforts to provide relational–emotional care for patients experiencing SI (Hagen, Hjelmeland, & Knizek, ; Horsfall & Cleary, ; Manuel, Crowe, Inder, & Henaghan, ).…”

Systematic review of interventions to improve constant observation on adult inpatient psychiatric wards

“…Nursing staff view constant observation as a necessary tool to keep patients safe from harm (Holyoake, ), as it provides nurses with an opportunity for quick intervention, allows them to assess and monitor the risk of patients and identify deviations in patient behaviours (Cleary et al ., ; Holyoake, ; Mackay, Paterson & Cassells, ). On the other hand, staff also report feeling regret at having to use such a custodial practice and felt it could undermine their therapeutic relationship with the patient (Duffy, ; Holyoake, ; Manuel et al ., ). Nurses also report feeling overwhelmed, isolated and bored when constantly monitoring patients (Cleary et al ., ; Mackay, Paterson & Cassells, ), which can likely trigger burnout in staff on inpatient wards (O'Connor, Muller Neff & Pitman, ).…”

‘Promoting and preserving safety and a life‐oriented perspective’: A qualitative study of nurses’ interactions with patients experiencing suicidal ideation

“…Their position proximate to patients has made nurses a particular target of suicide prevention policies encompassing the use of risk assessment tools, involvement in formal observations, removal of harmful items, and restraint and seclusion of patients (Bowers et al ; Kontio et al ; Manuel et al ). In addition, their proximity to patients makes nurses ideally placed to develop a therapeutic engagement with patients experiencing SI that is underpinned by an interpersonal relationship, trust, acceptance and tolerance, and listening and understanding (Cutcliffe & Barker ; Lees et al ).…”