Analysis

Nurse training targeted in effort to reduce suicide rate

New three-year programme aims to reduce suicides in England by 10%; funding focused on hotspots

A new three-year programme aims to reduce suicides in England by 10%, and the part nurses can play is receiving more attention

  • Initiative will focus on eight suicide hotspots in England
  • It is particularly targeted at men and those in financial difficulties
  • Aim is to provide better care after discharge and improve self-harm services
  • Suicide prevention training is part of the new nurse education standards

Picture: iStock

One person dies by suicide every 90 minutes in the UK. This shocking figure is one of the statistics driving a new programme to reduce suicide rates across England.

The three-year £25 million programme was announced in May as part of the government’s commitment to reduce suicides in England by 10% by 2021. It will support the target of zero suicides among mental health inpatients, announced by health secretary Jeremy Hunt in January.

Targeting hotspots

The new funding has been allocated to eight suicide hotspots across the country (see box) and will be particularly targeted at men and those in financial difficulties, as well as better care after discharge and improved self-harm services.

6,000

Almost 6,000 people a year die by suicide in the UK.

Source: Office for National Statistics

Sustainability and transformation services will use the money to improve suicide prevention strategies, signposting and surveillance and collection of data on suicide, attempted suicide and self-harm.

Anne Prendergast, clinical risk and suicide lead at Coventry and Warwickshire Partnership NHS Trust, says the extra money allocated to her area will help it to focus on driving down high rates of suicide among men.

The trust will continue an awareness campaign that involves information leaflets being distributed at sports events. There are also plans to set up a new crisis café where people feeling isolated and potentially suicidal can drop in, and services for people bereaved by suicide, as they are deemed to be at higher risk of taking their own lives.

‘This awareness is needed by all nurses, but training and education is going to take time to catch up’

Annessa Rebair, RCN representative on suicide prevention steering group

Staff training is also targeted. ‘We have a video on ligature awareness and we are looking at rolling out more sessions on suicide awareness and on those who are at risk, especially to staff in emergency departments,’ Ms Prendergast says.

Men most at risk

While the most recent figures show fewer people are taking their own lives – down 3.6% in 2016 compared with the previous year – almost 6,000 people a year in the UK die by suicide.

Two thirds of those who take their own lives are not in touch with mental health services. Men are most at risk, accounting for two thirds of deaths.

200,000

Around 200,000 people attend emergency departments in England each year due to self-harm

A report by the Commons health select committee on suicide prevention, published last year, said the current rate of suicide is ‘unacceptable and is likely to under-represent the true scale of this avoidable loss of life’.

The MPs on the committee said too many clinicians fail to recognise when patients are suicidal.

Nurses discussed suicide prevention in a debate at RCN congress in May. The college said that despite a great deal of work significant gaps remain across services, with many nurses still lacking basic knowledge around suicide and knowing what to do, when to share and when to step in.


Annessa Rebair: All nurses have
a fundamental role to play. 
Picture: John Houlihan

RCN’s representative on the steering group for the National Suicide Prevention Alliance Annessa Rebair says the inclusion of suicide prevention training in the new education standards for pre-registration nursing students across all four fields of practice is a significant and positive change.

The eight suicide hotspots

  • Kent and Medway
  • Lancashire and South Cumbria
  • Norfolk and Waveney
  • South Yorkshire and Bassetlaw
  • Bristol, North Somerset and South Gloucestershire
  • Cornwall and Isles of Scilly
  • Coventry and Warwickshire
  • Durham, Darlington, Teesside, Hambleton, Richmondshire and Whitby

At a crossroads

‘Nurses have a fundamental role as they are front-line staff, and we have gone beyond the point of thinking that suicide is the responsibility of mental health services,’ says Ms Rebair, a senior lecturer in mental health at Northumbria University. ‘We are at a bit of a crossroads at the moment, with everyone recognising that this awareness is needed by all nurses, but training and education is going to take time to catch up.’

Currently, access to continuing professional development can be difficult, and varies around the country. But organisations such as the Samaritans, Papyrus, which focuses on prevention of suicide in young people, and Grassroots Suicide Prevention all provide valuable resources that nurses can seek out, Ms Rebair says.

Training and knowledge among NHS staff is an important issue in suicide prevention. A study published in Emergency Nurse journal in May of the attitudes of 38 emergency nurses to supporting suicidal people found a correlation between suicide prevention training and nurses’ perceived competence to triage these people.

Psychiatric liaison team senior nurse Salena Williams says staff training has been an essential part of work at Bristol Royal Infirmary to improve the care of people who self-harm. An initiative in the Bristol area, the improving care in self-harm health integration team, known as STITCH, has gained national interest for its success in developing ground-breaking data on people who self-harm and improving their care.

‘We involve patients talking about their own experience, and that really is dynamite’

­­Salena Williams, psychiatric liaison team senior nurse


Picture: iStock

Self-harm accounts for around 200,000 emergency department attendances each year, Ms Williams says. A fifth of all people who take their own lives attend an ED in relation to self-harm in the year before their death and more than a third have a history of self-harm. Ms Williams says that when people come to the ED after self-harm there is a ‘golden moment to prevent suicide’.

Bite-size training

The Bristol Self-Harm Surveillance Register found that 57 people who presented for self-harm at the Bristol Royal Infirmary between 2011 and 2015 went on to die by suicide. However, the proportion of people receiving a psychosocial assessment was 20% lower for self-injury than for self-poisoning.

20%

of people who take their own life attend an emergency department for self-harm in the year before their death.

Ms Williams says initiatives undertaken by the STITCH team include running weekly early morning 20-minute education sessions in the ED for six weeks. ‘We do bite-size training, and we have six different sessions including on self-harm and personality disorder.

‘We involve patients talking about their own experience, and that really is dynamite. These include very local data from the surveillance and, crucially, involve people who have self-harmed.’

‘When people come to the emergency department after self-harm there is a golden moment to prevent suicide’

Salena Williams

The STITCH team has also trained general practice staff teams and paramedics.

More than anything, experts say, nurses need to be ready to reach out to people who may be suicidal. Ms Rebair says: ‘It is very much about engaging with the person, and as nurses we have those skills already.

‘What is fundamentally needed at the point of contact is the warmth and ability to build communication with someone quickly. We don’t have to be heavily trained to do that. Allow people to have that conversation and ask the question about suicide.’

Active listening: how to help people talk about their problems

The Samaritans promote active listening to help people talk through their problems. Active listening involves acting as a sounding board.

What you say doesn't influence what the other person has to say, it just helps them talk.

The Samaritans suggest using open-ended questions such as ‘how are things going?’ to keep people talking.

Show you understand

Summarise what someone has said to you to show that you've listened and understood what's been said.

Repeating back a word or phrase can encourage people to go on. If someone says, ‘It’s been really difficult recently,’ you can keep the conversation going by repeating ‘In what way difficult, can you tell me more about that?’

If the person you’re talking to glosses over an important point, saying ‘Tell me more about…’  or ‘…sounds like a difficult area for you’ can help them clarify the points, not only for you but for themselves.

Sympathy is vital

When you react, you don’t have to be completely neutral. If whoever you’re talking to has been having a dreadful time, sympathy and understanding is vital. ‘That must have been difficult,’ ‘You've had an awful time’ – this helps.

For information on the Samaritans’ in-depth training on suicide prevention click here

For help in dealing with suicidal thoughts contact the Samaritans’ free helpline on 116 123 or visit NHS Choices: Help for suicidal thoughts


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