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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.

Improving patient safety: linking PSTRC research and expertise to policy and practice

14 Mar

Nav Kapur

Linking up with policy-makers and clinical services is an important part of the work of the NIHR Greater Manchester PSTRC.  Nav Kapur, who is a Professor at the University of Manchester and one of the Research Leads for the Centre, really values the wider engagement he has had with NICE (he chaired the NICE self-harm and depression guidelines), the Department of Health and Social Care,  and Health Education England amongst others.  

Nav says: “We are proud to be a leading centre for research into self-harm and suicide and it’s been a privilege to inform policy and practice.  As an academic, being involved in guideline development allows you to get a wider view of the worldwide literature and its impact on patients.  As a clinician, I like the fact that being involved in guidelines and policies allows you to improve the care of all patients, not just the patient in front of you.”

He continues: “As part of my role as a member of the National Suicide Prevention Strategy Advisory Group for England I contributed to the new suicide prevention strategy, particularly its emphasis on self-harm, as well as contributing to initiatives on confidentiality and responding to new methods of suicide.  My work with Health Education England aims to develop competencies for all NHS staff in the assessment of patients who present with suicidal thoughts or self-harm.” 

Nav also values his role contributing to the induction of new chairs for NICE Guidelines. He explains: “In some ways I find it quite strange that I am now one of the most experienced guideline chairs!  But I really enjoy sharing my experiences of chairing groups and guideline development with people just embarking on the process and I hope they find it helpful too.” 

Nav and colleagues including Roger Webb and Caroline Sanders who lead the Safety in Marginalised Groups theme are looking forward to contributing further to guidelines and policy and practice.  In particular the planned work on the management of self-harm, the safety of mental health services, and improving care for marginalised groups could have a major impact on patient safety and patient care.        

PhD fellow focus: Lukasz Cybulski

2 Feb

In this series, we meet our new PhD fellows to find out what they will be researching and what they hope to achieve.

Lukasz Cybulski started his PhD in September 2017. He has a background in research and mental health work with an interest in the synthesis of public health policy, the use of research findings in the ‘real-world’ and ways of increasing research transparency and reproducibility. The opportunity to combine these interests is what drew him to the projects at the Greater Manchester Patient Safety Translational Research Centre.

His PhD will focus on self-harm and suicide in children, adolescents and young adults. The epidemiology (the study of how diseases affect the health and illness of populations) of self-harm and suicide has not been extensively studied among registered primary care patients. The majority of people diagnosed with a mental health disorder, including conditions such as depression, anxiety disorders and eating disorders, are rarely referred to, or treated by, specialist mental health services.

Lukasz will investigate this topic using a nationally representative group of primary care patients,  linking with routinely collected clinical datasets and national mortality records. This will provide a unique platform for investigating people diagnosed with ‘mild to moderate’ mental health problems, their clinical management across healthcare sectors, and their subsequent risks of nonfatal and fatal suicidality and other causes of premature death. Epidemiological studies of this nature allow for the identification of populations at particular risk, and aid the development of clinical guidelines that maximise patient safety.

Self-harm in children and adolescents

1 Feb

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Self-harm is any act of self-poisoning or self-injury whether intentional or not. Self-harm is the strongest risk factor for possible future suicide, with suicide being the second most common cause of death before the age of 25 worldwide.

In recent years, there has been a rise in suicide rates in children and adolescents, as well as a marked increase in psychological distress. The purpose of this study was to identify how the rates of self-harm have changed, and how these changes compare in different genders, as well as among different age groups. The Clinical Practice Research Datalink (CPRD) database was used to identify 16,912 records of children or adolescents presenting to their GP after self-harming between 2001 and 2014. Researchers then looked at what proportion had been referred to mental health services and what drugs, if any, were prescribed in the 12 months following the self-harm.

The most notable trends were:

  • A 68% increase in incidence of self-harm in girls aged 13-16
  • Those who lived in socially deprived areas were 23% less likely to be referred in the 12 months following self-harm
  • Children and adolescents who self-harmed were at increased risk:
    • 9 times more likely to die of unnatural causes
    • 17 times more likely to die by suicide
    • 34 times more likely to die through alcohol or drug poisoning.

 Read more in the full paper in BMJ, or the plain English publication summary.

Development of a resource to reduce self-harm

1 Feb

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Recent work led by The University of Manchester has developed and tested a brief theory-based psychological intervention (the “volitional help sheet” or VHS) that significantly reduces suicidal ideation and behaviour among people admitted to hospital following an episode of self-harm (Armitage et al., British Journal of Psychiatry, 2016).  However, it is not yet known whether the intervention is acceptable to, and effective in, preventing suicidal ideation and behaviour among the broader population.

The goal of this research is to translate these findings into a resource that will meet the needs of people at risk of self-harm and/or suicide who may not have been admitted to hospital with self-harm.

As people at risk of self-harm and/or suicide may present at any point in any care pathway, we will be investigating multiple physical and mental health conditions in both primary and hospital care. The focus of the research will be on understanding expressions of intent to self-harm and/or suicide and in gauging patient and health care professionals’ reactions to using the VHS as a tool to promote patient safety, with a view to refining and optimising the VHS.