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‘Zero suicide’ goal risks blame culture if applied ‘clumsily’


Government calls for a “zero suicide” approach to mental health care could risk nurses being blamed if patients take their own life, it has been warned.

The goal was welcomed by the Royal College of Nursing, but it said the target must not be “clumsily applied,” adding that staff might worry about being criticised if they failed to meet it.

Deputy prime minister Nick Clegg earlier this week urged “every part of the NHS” to bring in new strategies aimed at ensuring no patient under their care took their own life.

He said these measures could include continuing contact with patients once they have been discharged, or providing information to friends and families about who to contact if they need help.

“What we’re talking about here is not simply an attractive piece of aspirational rhetoric”

Ian Hulatt

Mr Clegg said suicide was preventable and pointed to mental health trusts that had already put plans in place to meet the goal.

Ian Hulatt, RCN professional lead for mental health, said: “What we’re talking about here is not simply an attractive piece of aspirational rhetoric but something that appears to be evidence-based and that is encouraging.”

Nick Clegg

Nick Clegg

However, he said that reducing suicide was a task for all health and social care professionals – not just mental health nurses.

He said he would like to see the same focus on suicide prevention that has been given to dementia, which included a major roll-out of awareness training for NHS staff.

“All health professionals from health visitors to district nurses and across the piste should have a degree of training so they feel comfortable in raising this issue,” he said. “If we can do it for dementia we can do it for the 4,500 or so people who take their lives each year and those they leave behind.”

One organisation highlighted by Mr Clegg for introducing a “zero suicide” mental health programme was Mersey Care Trust, which has established a dedicated team to develop personalised safety plans for patients.

Its director of commissioning, Carol Bernard, who is a nurse, stressed her trust had a “no-blame culture”. She said: “We’re in this together from the chief exec to all the board members to all members of staff.

“It is an ambitious thing to say. If we don’t achieve it then we will certainly have prevented a lot more people committing suicide than we would have done if we had taken no action at all. There will be no criticism of any individual or team,” Ms Bernard added.

“We’re in this together from the chief exec to all the board members to all members of staff”

Carol Bernard

Mersey Care Trust hopes to reduce the number of suicides among people known to its mental health services to zero within just 18 months, after adopting an approach developed in Detriot, US which achieved this within seven years.

Ms Bernard said Detroit was different to Merseyside in terms of demographics, economics and the way the healthcare system worked. However, she said, the trust had been inspired by the scheme’s principles and goal of preventing all suicides.

“In health services we tend to have targets that might be 95% or 98% but if your relative was one of the 5% that went on to commit suicide then that wouldn’t be good enough,” she said.

She admitted the approach had taken time to embed because it involved a change in mindset and challenged some commonly-held beliefs among workers, who believe suicide is inevitable.

The trust has been developing the strategy since April last year including a stronger presence in A&E departments, delivering suicide prevention training to primary care services and a 24-hour mental liaison team.


Readers' comments (5)

  • michael stone

    This is complicated, because all politicians react whenever a mentally-ill person commits suicide, after having been apparently 'turned away' by the NHS.

    But suicide isn't illegal, and the fact that someone is 'suicidal', or even has taken an overdose of something with the intention of suicide, doesn't automatically indicate mental illness (or, more accurately, doesn't necessarily indicate the absence of the mental capacity needed to, for example, refuse treatment for such an overdose).

    Clearly the NHS should not be criticised by politicians, if it fails to prevent 'legal suicides' - it would be better, if somehow we could arrange society, so that less people felt the need to consider suicide.

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  • I notice that the Henry Ford health systems "model" is mentioned again.

    It should be pointed out that their model excludes most of the highest risk groups by dint of being a typical American insurance-based model, ie one must be able to either afford to pay directly or pay for health insurance in order to be treated by them. Their figures which apparently show a reduction in suicides should be treated with extreme caution as their client group is affluent enough to be able to afford treatment and are actively seeking treatment.

    The NHS is not able to exclude high risk groups in this way...

    Oh, and to back up a point made by Mr Stone: when I did overdose assessment for a living I only ever asked a psychiatrist to see 10% of my patients and only half of those had a diagnosable mental illness...

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  • This is part of the increased pressure on staff at a time when mental health services are bearing a disproportionate part of cuts being made. The irony is that some Trusts put their own staff at risk of suicide because of their bullying and abusive management. We know this only too well in Worcestershire where some of us are about to form a new group Betrayed By Their Trust to offer mutual support to staff and their families who are the victims of this.

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  • our psychiatrists say if somebody expresses wishes to them of suicide it is their choice and they cannot stop them! such an attitude probably makes them think and is preventative.

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  • Another unachievable target imposed in a climate when it's easier, as was famously quoted recently 'to find a kennel for a dog than a mental health bed for a seriosly ill patient'. This sort of nonsense is yet another example of politicians taking a stance on issues of which they clearly have no understanding in an attempt to win brownie points.

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