Hi there,
For this insight – we have a guest! Steve often sends me posts on linked in that I might find interesting (and mostly I do!), this time I persuaded him to write a bit more about it, to share with you… hope you enjoy!
I have been thinking a lot about the incidents we investigate in mental health settings. This was sparked by a fantastic paper I read: Rethinking suicide: from prediction to understanding, by Rachel Gibbons and it really made me reflect.
When I think about the learning responses, we complete to understand what happened, why it happened and what do we need to do to prevent something like this happening again; there is a lot to think about that is really specific to mental health incidents. Let’s think about suicide and self-harm as the overwhelming majority of incidents we investigate in MH services.
Rachel’s work identifies that MH professionals believe that predicting and preventing suicide is a core part of their role – despite strong evidence that prediction is not achievable.
This is in line with my own reflections on my career as a mental health nurse. There is a widespread assumption that NHS services can keep people at risk safe. I know first hand the impact on a professional when someone they are working with completes suicide; the whole range of grief emotions, like any bereavement, coupled with the worry and fear of blame.
Our investigation and learning work take place right in the middle of these emotions for people and so it takes skill, and above all, compassion to help us think through, what happened why it happened and what we can do to prevent something similar happening again.
How compassionate are your investigations to the clinicians involved?
Suicide is clearly devastating and the pain felt when loved ones end their lives runs deep. The desire for someone to be accountable is understandable, but suicide like everything else is complex.
It would be understandable to think that suicide is a mental health problem, however over half of the people who complete suicide do not have a diagnosed mental illness. Less than 27% of people who died by suicide had contact with mental health services. Any retrospective diagnosis of mental health problems is clearly prone to bias.
When mental health services are providing care to someone, there is a constant push to identify, define and mitigate risk and when people do complete suicide, there is often an undercurrent that something must have been missed which resulted in the person completing suicide.
Clinical notes commonly refer to the presence or lack of suicidal thoughts; suicide ideation has a poor predictive value. 60% of people who complete suicide don’t speak about suicide and most people who speak about suicidal ideation don’t die by suicide.
How do we hold the hope and not go down in a spiral of negativity that this is all pointless?
I strongly believe that the more we understand about our system, in its messy glory, the more we can learn about where it is going well. In society suicide is comparatively rare and most people in mental health services don’t die by suicide.
If you are sat wondering how can we compassionately understand more about our system, get in touch for a chat about how we can help.
Thanks, Steve Dawson
