Analysis

Nurse suicide: why NHS employers need to learn from past tragedies

Employers could be missing opportunities to improve psychological support for staff

Employers could be missing opportunities to improve psychological support for staff


Female nurses have an elevated risk of suicide. Picture: iStock

If a nurse dies by suicide it is unlikely their employer will have a record of the fact – but with most nurses at above-average risk it seems all the more important that opportunities to improve workplace psychological support are not missed. 

1,326

nurses have died in service at 148 NHS organisations in the UK since 2012

237 

nurses reported feeling suicidal to the RCN's counselling service in 2018 

A Nursing Standard survey found eight (5.4%) of 148 NHS participating employers said they were aware of suicide having been a cause of death among nurses they employed. 

Among the organisations with no knowledge of suicides in their nursing staff are six NHS trusts where such cases were known to Nursing Standard because they had been reported in the media. 

How do employers respond to suicide?

Only a handful of trusts and health boards we surveyed outlined specific changes in practice resulting from staff suicide, although many draw attention to standard health and well-being programmes and access to occupational health support.

The RCN says the health service is losing an opportunity to learn wider lessons about suicide in the workforce and NHS Employers urges organisations to offer better support.

Our investigation using the Freedom of Information law follows a number of highly-publicised nurse and nursing student suicides, which have led to calls for improved monitoring and support.

‘Individual trusts are expected to investigate if it is thought the death of an employee is related to their work or any failing in care and well-being’

NHS Digital spokesperson

The risk of suicide among female nurses is 23% higher than the national average, according to a 2017 Office for National Statistics (ONS) study and other research.

The causes are multifactorial and include access to the means to carry out suicide, workplace pressures, and, in some cases, the stress of fitness to practise proceedings (see box below).

Why are employers not recording cause of death?

One of the reasons is there is no mechanism for recording the cause of death on the electronic staff record (ESR).

NHS Digital, which runs the ESR, says the only reason death in service is entered on the system is to enable necessary administration to take place.

‘If information was recorded centrally, it could allow the NHS to learn important wider lessons about suicide’

Kim Sunley, RCN national officer

A spokesperson says: 'Suicide is a legal verdict delivered by a coroner, often many months after the person has died, so there is no official confirmation of a suicide at the time when the ESR is filled in and it is not intended to capture the cause of death for future analysis.


Kim Sunley, RCN national officer.

'Individual trusts are expected to investigate if it is thought the death of an employee is related to their work or any failing in care and well-being.'

However, RCN national officer Kim Sunley says: ‘Given that an inquest is held in the case of any death where suicide is suspected – meaning that the information is already in the public domain – it would seem sensible for trusts to record suicide as a cause of death.

‘If that information was recorded and submitted centrally, it could allow trusts, and the NHS as a whole, to learn important wider lessons about suicide.’

What support is available?

University Hospital Southampton NHS Foundation Trust deputy director of nursing for quality Juliet Pearce highlights a number of initiatives to 'ensure the right support at all times'.

'These include our independent employee assistance programme overseen by occupational health, which can be accessed all year round; dedicated well-being discussions during appraisals; a health and well-being forum and practitioners trained in debriefing staff after traumatic events.'

Oxford Health NHS Foundation Trust, which reported a possible four deaths by suicide among staff, says its head of spiritual and pastoral care and a nurse consultant are working on guidance for managers.

'This has followed staff deaths and is informed by interviews we carried out with managers who had experienced possible staff suicides,' the trust says.


Danny Mortimer, chief executive of
NHS Employers.

NHS Employers chief executive Danny Mortimer says trusts must reassure staff there is a range of support available to those struggling with mental ill health and contemplating taking their own life.

He adds: ‘In a team where a staff member died by suicide, it is very important for trusts to follow up with colleagues and provide ongoing support where needed.’

A number of NHS organisations said they have trained mental health first aiders to help identify and support those staff in distress, as well as offering access to counselling, reflective practice and supervision, and employee assistance programmes on stress and resilience.

The Samaritans charity has been involved in developing suicide prevention toolkits for employers with Public Health England (HEE) and Business in the Community.

What is being done to improve support?

HEE has been running the first stage of a commission on the mental well-being of NHS staff and students.


Nursing student Lucy de Oliveira
took her own life in 2017.

The commission is reviewing mental health support and has focused on suicide prevention.

It has also examined:

  • What aspects of NHS or university culture might undermine mental well-being.
  • What can be done to support mental health in the NHS workforce.
  • Whether staff fear revealing their mental ill health might harm their career.

Mr Mortimer says the commission's recommendations, due to be reported to be published in the new year, ‘will be very important'.

Government adviser on suicide prevention Louis Appleby said the commission had heard ‘agonising stories of suicide and distress at work’ but also positive support, on which it hopes to build.

Why nurses are at higher risk of suicide

Means and workplace pressures

The Office for National Statistics says attempting to explain suicide by occupation is complicated because a number of factors are likely to act together to increase risk, and may include access to the means and job-related pressures such as low pay.

RCN national officer Kim Sunley adds: ‘It’s important to remember we don’t know the extent to which any of these deaths are work-related. Experts say the higher rate of suicide among nurses may be because they, like others in occupations with a higher than average risk, have access to the means to do so.’

As with the general population, important influences include alcohol and substance misuse, feelings of desperation, helplessness or absence of hope.

Stress of disciplinary proceedings

RCN figures show 32 out of 88 nurses (36%) who were receiving counselling via the college's service in 2017 and had been referred to the NMC had considered suicide. The figure was 17% (17 out of 99) in 2018. 


Charge nurse Amin Abdullah
who took his life in 2016. 

Imperial College Healthcare NHS Trust charge nurse Amin Abdullah died after setting fire to himself outside Kensington Palace in 2016, following a hospital disciplinary process that resulted in his dismissal.

Although not subject to NMC proceedings, Mr Abdullah had experienced a mental breakdown over how his NHS employer handled his dismissal, an inquest heard.

Imperial's chief nurse Janice Sigsworth says the case was 'very sad and complex' and triggered 'a wholesale review' of the organisation's disciplinary processes.

'This has resulted in ensuring managers have the skills, support and confidence to address problems quickly at an informal level. This avoids reliance on formal processes that generally take longer to resolve and create more stress for everyone involved.'

Getting help

 


Further reading

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