Foundation series

Combating the risk of suicide in people with mental disorders

Clinical researchers from the Department of Psychiatry at the University of Oxford and the Oxford Health NHS Foundation Trust, including nurse consultant Karen Lascelles, along with colleagues elsewhere, have developed guidance to help clinicians identify and treat patients at risk of suicide.

The alternative approach to clinical practice, published in The Lancet Psychiatry, was developed by health practitioners and suicide prevention experts, in collaboration with a service user.

The new guidelines aim to reduce risk through a person-centered strategy in which assessment is viewed as a therapeutic process to identify interventions to improve well-being, as well as an individualized safety plan developed in cooperation with the patient.

Professor Keith Hawton CBE, Professor of Psychiatry and Director of the Center for Suicide Research at the University of Oxford, and lead author of the paper, said:

“A significant proportion of people who die by suicide each year suffer from mental illness. Therefore, suicide prevention is a key task of mental health practitioners, but traditionally this has been dominated by attempts to predict suicide risk. Our approach, which is more focused on a therapeutic approach to risk management, should greatly improve patient management, with probable benefits for suicide prevention.

Karen Lascelles, nurse consultant at Oxford Health NHS Foundation Trust and co-lead author of the paper, said:

“This therapeutic and collaborative approach to patient safety can help clinicians, patients and patient families better understand when and why a patient may become vulnerable, and what the patient and those involved in their care can do to help. help them stay safe. It should be taught to clinicians in training and in practice, and supported by organizations and regulators.

Steve Gilbert, OBE, another author of the article, said:

“As a survivor of a multi-episode suicide attempt, I know all too well the heartbreaking agony of learning that you are at ‘low risk of suicide’ based on risk prediction methodology. L he importance of a clinician meeting me where I am, acknowledging my situation, and working with me to understand ways in which we can collectively ensure my safety cannot be understated. I believe that a therapeutic assessment and empathy can be the starting point for a life-saving relationship.

The authors point out that there is ample evidence from multiple countries that predicting risk largely does not work. They also point out that preoccupation with predicting risk can undermine efforts to help patients solve their problems, which has been pointed out by both family members and patients themselves.

The full article, “Assessing Suicide Risk in Mental Health Practice: Moving From Prediction to Therapeutic Assessment, Formulation, and Risk Management,” can be read here in Lancet Psychiatry.

Karen’s pioneering work

Nurse Consultant Karen Lascelles is Suicide Prevention Lead at Oxford Health and has done extensive work on suicide awareness training for staff and partner organisations. In 2021, Karen hosted two series of suicide prevention webinars, featuring leading professionals across the country as well as experts by experience. The fall series alone brought together more than 900 people.

Recordings of the webinars are posted on the Trust’s YouTube channel on the Suicide Awareness playlist and have been viewed over 4,500 times.

Another series of webinars will be organized in September-October 2022, with one of the webinars dedicated to the Lancet article mentioned here, with the authors forming the panel.