Working together to prevent suicide

Women deep in thought

13 September 2019

Professor Carolyn Chew-Graham, Professor of General Practice Research, Keele University and Chair of the RCGP Scientific Foundation Board

Dr Elizabeth England, RCGP Clinical Champion for Mental Health

Suicide is among the top 20 leading causes of death globally for people of all ages. It is responsible for over 800,000 deaths annually - one suicide every 40 seconds.1 A number of resources, including an RCGP podcast and mental health toolkit, are available to support GPs whose patients present with risk factors associated with suicide.

Every life lost represents someone’s partner, child, parent, friend or colleague. For each suicide, approximately 135 people suffer intense grief or are otherwise affected. This amounts to 108 million people per year who are profoundly impacted by suicidal behaviour.

Suicidal behaviour includes suicide and encompasses suicidal ideation and suicide attempts. For every suicide, 25 people make a suicide attempt and many more have serious thoughts of suicide.1

'Greatly increased risk of dying prematurely by natural and unnatural causes'

Self-harm is the strongest risk factor for suicide.2 People who have harmed themselves are at greatly increased risk of dying prematurely by natural and unnatural causes, and especially within a year of a first episode. These individuals visit GPs at a relatively high frequency, which presents a clear opportunity for preventive action.3 GPs need to be particularly alert to people with previous self-harm behaviour, multimorbidities, mental health problems, and addictions.

Self-harm is often concealed due to stigma and shame, particularly in older adults, which may result reluctance to seek help and disclose self-harm.

Self-harm affects all age groups. GPs should be aware of its existence in older adults, and the heightened risk amongst those with comorbidities, so that adequate assessment, support and or referral can be provided.

‘Primary care has an important role in the assessment and treatment of people who self-harm’

NICE self-harm clinical guideline (CG16) states that ‘primary care has an important role in the assessment and treatment of people who self-harm’. 

The publication of NICE Quality Standard on Suicide Prevention coincided with World Suicide Prevention Day.

Two standards are particularly relevant to primary care:

  • Statement 4 - Adults presenting with suicidal thoughts or plans discuss whether they would like their family, carers or friends to be involved in their care and are made aware of the limits of confidentiality.
  • Statement 5 - People bereaved or affected by a suspected or confirmed suicide are given information and offered tailored support.

Take the disclosure of self-harm thoughts and episodes seriously

It is important that GPs take the disclosure of self-harm thoughts and episodes seriously. They must be vigilant in responding empathetically and with consideration and compassion towards the patient. This will facilitate rapport building and make people feel listened to and understood.

The Safer Prescribing toolkit produced by the National Confidential Inquiry into Suicide and Safety in Mental Health highlights three points relevant to patient safety following self-harm:

  1. encourage the safer prescribing of opioids
  2. ensure that there is a service in place for people with complex depression
  3. be alert to people with markers of risk such as frequent consultation, multiple psychotropic medication and specific drug combinations.

People bereaved by suicide are at increased risk of suicide. GPs have a role in postvention - an intervention conducted after a suicide, which largely involves supporting the bereaved (family, friends, professionals and peers). Training is available to provide professionals with an opportunity to build their confidence and skills in how to respond to and care for those bereaved by suicide.  

Resources to support you

The RCGP Mental Health Clinical Priority Team recently recorded a podcast to raise awareness of suicide and self-harming in older adults. The podcast features, RCGP Clinical Champion for Mental Health, Dr Elizabeth England, and Professor Carolyn Chew-Graham, Chair of the RCGP Scientific Foundation Board and RCGP Mental Health Curriculum Advisor, discussing the key characteristics around self-harm in older people and what GPs should do to when caring for those who self-harm. 

The RCGP has produced a mental health toolkit containing resources to assist GPs to recognise suicide risk and give guidance to support those who may be at risk of taking their own life. Visit the Suicide and Crisis Care section of our toolkit for more information.

 References:

  1. Preventing suicide: a global imperative. World Health Organisation. WHO, 2014. http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/ISBN 978 92 4 156477 9
  2. Cooper J, Kapur N, Webb R, et al. Suicide after deliberate self-harm: a 4-year cohort study. Am J Psychiatry 2005;162(2):297-303.
  3. Carr MJ, Ashcroft DM, Kontopantelis E, Awenat Y, Cooper J, Chew-Graham C, Kapur N, Webb RT. Premature death among primary care patients with a history of self-harm. Annals of Family Medicine 2017;15(3):246-254.
  4. Carr MJ, Ashcroft DM, Kontopantelis E, et al. The epidemiology of self-harm in the UK primary care patient population, 2001-2013. BMC Psychiatry 2016; 16:53.
  5. Troya I, Dikomitis L, Babatunde OO, Bartlam B, Chew-Graham CA. Understanding self-harm in older adults: a qualitative study. E_Clinical Medicine. 12 (2019) 52–61

Conflicts of Interest:

Professor Carolyn Chew-Graham:

  • Formal non-pecuniary interests: Standing member of NICE Quality Standard Advisory Group
  • In receipt of NIHR funding to study mental health interventions in primary care
  • Is a member of the team which developed PABBS suicide bereavement training
  • Is  a Trainer at the RCGP North West Faculty at mental health events.

 

 

 

 

 

 

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