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17th European Symposium on Suicide and Suicidal Behaviour

13 Nov

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by Donna Littlewood

Researchers from the PSTRC Mental Health work stream attended the 17th European Symposium on Suicide & Suicidal Behaviour in Ghent, Belgium to share findings from a range of different research projects.

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Roger Webb presents at ESSSB

Professor Roger Webb presented findings from a national Danish study using data links to estimate the risks of adverse outcomes following first discharge from inpatient psychiatric care.  Data showed elevated risks post-discharge across all the adverse outcomes that were examined (all-cause mortality, suicide, non-fatal self-harm, accidental death, homicide perpetration and victimisation, violent criminality, and hospitalisation due to interpersonal violence). The greatest increase in risk occurred during the first three months following first discharge from an inpatient psychiatric unit.

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Leah Quinlivan presents at ESSSB

Dr Leah Quinlivan shared findings from focus-group research examining healthcare professional and patient views on treatment refusal and advance decisions to refuse treatment in the context of suicidal behaviour. Healthcare professionals found evaluating mental capacity following self-harm challenging, due to the subjective nature of the assessments, lack of patient history, and environmental constraints. Treatment refusal was seen as challenging given that levels of distress fluctuate, and people may change their minds regarding their wish to die. Healthcare professionals reported less experience of advanced decisions and expressed anxiety regarding the legality of such decisions, the need for verification, and associated time constraints. Some participants were more supportive of advanced decisions, as they could increase patient autonomy and provide clarity to complex clinical situations.

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Donna Littlewood presents at ESSSB

Dr Donna Littlewood presented results on the short- and long-term impact of participating in suicide-related research. Participants described more positive than negative outcomes of taking part in research, such as improved self-understanding and a sense of altruism. For some individuals these benefits lasted months after taking part in the research. However, a small number of participants reported a short-term delayed lowering of mood that occurred a few hours or days after taking part in the research. Participants explained that they saw this as a somewhat inevitable consequence from discussing their difficult experiences, and hence was not distinct to the research setting. Findings from this study emphasise the importance of including provisions to optimise participant well-being and safety both during and following participation in suicide-related research.

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Nav Kapur presents at ESSSB

Finally, in the closing session, Professor Nav Kapur participated in a debate on a key safety issue in suicide prevention, the use of risk assessments to predict suicide. Drawing on data from the National Confidential Inquiry into Suicide and Safety in Mental Health, Nav illustrated that in the final contact before suicide, 86% of mental health patients were rated as having ‘low’ or ‘no risk’ of suicide. He also drew on earlier work led by Leah, which showed that risk scales are no more accurate than clinician or patient ratings of risk. Nav concluded by presenting a series of alternative approaches, including the need to focus on the therapeutic aspects of assessment. Further research will be conducted on the role of psychosocial assessments by the PSTRC mental health work stream, led by Dr Leah Quinlivan.

What can we learn from North America about the role of community pharmacy teams in suicide awareness and prevention?

10 Sep
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Hayley Gorton (r) with Bloom pharmacist Melissa at Haliburton Pharmacy, Antigonish

by Hayley Gorton

It is the NIHR Greater Manchester PSTRC I have to thank for starting the metaphorical journey that is my study of community pharmacy teams in suicide prevention. I joined the original Greater Manchester PSTRC in 2014 to undertake, and later complete, a PhD in the epidemiology of suicide and self-harm (epidemiology looks at how often and where diseases or healthcare events happen). Throughout my time, I was acutely aware of my profession and practice as a community pharmacist: “how would I help someone with thoughts or actions of suicide or self-harm in my pharmacy practice?” I didn’t know, but made it my mission to find out.

This summer, I spent a month in the USA and Canada exploring this question, thanks to a fellowship from the Winston Churchill Memorial Trust (WCMT) and support from the Greater Manchester PSTRC. There is too much to cover in one short blog, but you can find out about each leg of my trip by reading my own blog series. I’ve been back for a month and only now getting some clarity on which (of my many) research questions to pursue, fostering collaborations with those people I met en route and looking at how I can inform UK policy and practice with my WCMT findings. It was a brilliant experience in chronological order from grassroots research to mandatory training.

Knowledge sharing tools for inpatient mental health settings

2 Aug

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by Natasha Tyler, Research Associate in Safer Care Systems and Transitions theme

It is increasingly recognised that the coordination of care within and between care settings involves the sharing of information, knowledge and know-how between different professionals and service users. The extent of knowledge sharing, shared decision-making and care coordination is shown to influence the quality and safety of patient care.

There is growing interest in promoting better knowledge sharing in mental health services, especially at the care transition points along the care pathway. Care transitions can refer to either those that take place within a hospital environment (i.e. handover from one shift to the next) or when moving from one environment to another (i.e. admission or discharge from/to hospital). However, there has been very little research looking at the effect of interventions that aim to improve knowledge sharing and patient safety at care transition points in mental health.

The current study looks to explore the impact of implementing two co-designed knowledge sharing tools into mental health inpatient wards in one NHS Foundation Trust.  The first will seek to aid the admission process from the community to hospital and the second the nursing handover process from one shift to the next.

The catalysts for this work are numerous adverse safety incidents.  For example, a service user on the older adults mental health ward had a fall, but this information was not communicated to the staff on the next shift. The individual suffered adverse patient safety outcomes; which would not have occurred if his fall was communicated to the next shift. Researchers in the NIHR Greater Manchester PSTRC, based at the University of Nottingham, will work with staff on wards to co-produce a handover tool that ensures essential service user information is communicated effectively, and as a matter of course, between shifts.

The second admissions tool will be co-produced with staff in the same way; however this will look to capture important patient information from external organisations (such as primary care, the police, community teams) before the patient arrives on the ward. It is expected that this will reduce safety incidents, as important knowledge will be shared before the patient is admitted, allowing staff to better understand the patient’s history. It is expected that implementing the tool will have implications across the care pathway, as the tool will capture information about factors such as housing, past readmissions etc. which will also be necessary for reducing negative patient safety outcomes at discharge.

For more information on this project, you can contact Natasha Tyler via email at natasha.tyler@nottingham.ac.uk.

ReVerse: creative conversations between mental health service users and staff

6 Jun

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by Bella Starling

Mental health service users, carers and staff have much in common these days coping with stress and distress, especially at a time of huge pressure on services.

ReVerse workshops aim to equalise the space between mental health service users and staff, to creatively nurture insight, dialogue and healing relationships about patient safety in mental health services and research.

We think a good way to do this is through poetry and spoken word. Creative formats can provide a different angle and unique insight into ourselves, others and our collective wellbeing, and provide those who often feel they are not heard with an opportunity to express their voices. Exploring metaphor and meaning can offer new dimensions to personal and professional health and research relationships.

The workshops are open to mental health service users, carers and staff (including clinical, research, managerial, administrative and support staff). We aim to have an equal mix of staff and service users. ReVerse workshops will include:

  • Examples and readings of poetry and/or spoken word, drawing from different experiences of mental health 
  • Discussions and reflections
  • Having a go: producing your own poetry or prose.

The ReVerse initiative is a collaboration between David Gilbert (poet, Patient Director and mental health service user) and Bella Starling (Wellcome Trust Engagement Fellow, Director of Public Programmes Team, Manchester University NHS Trust) and the NIHR Greater Manchester PSTRC.

For more information behind the workshops, see David’s recent blog post.

Our first workshop takes place in Ziferblat Media City on Tuesday 3 July, register your interest on our Eventbrite page. Registration is free, but requires a commitment to attend.

These workshops are pilots as part of an exciting new initiative. Those involved will help to shape the future development of this ReVerse Programme.