Preventing Suicide with Mental Health Service Policies and Practices

A study in England and Wales revealed that mental health service providers who implemented at least seven of nine recommendations for improving mental health services achieved reductions in the suicide rates among their clients. Interventions that were associated with reductions in suicide rates included a crisis team that was available 24 hours/day, a written policy on the management of patients diagnosed with both a psychiatric illness and a drug or alcohol problem, and a written policy on multidisciplinary review after a suicide.

Several of the recommendations were relevant to specific groups of patients. Removing ligature points from inpatient wards significantly reduced the suicide rate among psychiatric inpatients. An assertive outreach policy resulted in a reduction in the suicide rate for patients who were not taking their medications as prescribed or who had failed to appear for their last appointment. A written policy on following up on patients within seven days of discharge did not seem to reduce risk during that period, but was associated with a decrease in the suicide rate for the three-month period after discharge. The other key service recommendations contributing to declines in the suicide rate (if implemented with at least six other recommendations) were: (1) a written policy on sharing information about risk with criminal justice agencies, (2) training clinical staff in managing suicide risk at least once every three years, and (3) a written policy on responding to patients who are not adhering to their treatment program.

Mental health services in catchment areas characterized by socio-economic deprivation and a large clinical population saw the largest decreases in suicide rates.

The key service recommendations were made by the National Confidential Inquiry (NCI) into Suicide and Homicide by People with Mental Illness, which seeks to improve the quality of mental health care in the United Kingdom. This research included a survey of mental health services in England and Wales and data on people who died by suicide (1997-2006) within 12 months of being in contact with mental health agencies affiliated with the National Health Service.

SPRC Commentary:

These research findings are very much in keeping with implementation research that suggests that staff training alone, even of the highest quality, will not produce practice changes with resultant patient or client outcomes.  Health delivery systems seeking to make measureable progress in reducing suicidal behaviors should implement multiple interventions across the system, including those identified by this study as being more potent.

If this research article has caught your interest, check out the Suicide Care in Systems Framework report produced by the Clinical Care and Intervention Task Force of the National Action Alliance for Suicide Prevention. This report lays out a conceptual framework to transform health systems with the goal of making patient suicide a “never event.”
 

While, D., Bickley, H., Roscoe, A., Windfuhr, K., Rahman, S., Shaw, J., Appleby, L., & Kapur, N. (2012). Implementation of mental health service recommendations in England and Wales and suicide rates, 1997-2006: A cross-sectional and before-and-after observational study. Lancet, 379(9820), 1005-1012.