Julia Hagen

Connecting with suicidal patients in psychiatric wards: Therapist challenges

ABSTRACT In this qualitative interview study, the authors investigated how therapists experience and view treatment and care for suicidal patients in psychiatric wards. The focus is on aspects that may contribute toward shaping and possibly constraining therapists’ connections with suicidal individuals. They conducted semistructured interviews of 4 psychiatrists and 4 psychologists and analyzed the data by means of thematic analysis. The findings suggest that high emphasis on diagnostics and standardized suicide risk assessments, limited direct care of suicidal patients, and fragmented mental health services may challenge therapists’ connections with suicidal patients.

Guidelines do not prevent suicide

The guidelines, in particular the recommendation of frequent assessments of suicide risk, have been widely criticised (3, 4). Nevertheless, the Norwegian Directorate of Health recently published an instructional memo that stressed that patient safety can be increased by better implementation and follow-up of protective measures and suicide risk assessment, and that implementing national guidelines in local procedures is part of the enterprise’s obligation to maintain internal control (5).

Former suicidal inpatients’ experiences of treatment and care in psychiatric wards in Norway

ABSTRACT Purpose: The purpose of this study is to explore how former suicidal inpatients experienced treatment and care in psychiatric wards in Norway following the implementation of the National guidelines for prevention of suicide in mental health care. The focus of the analysis was on aspects of treatment and care with potential for improvement. Method: We interviewed five former inpatients and analysed the data by means of Interpretative Phenomenological Analysis. Results: Experiencing a sense of companionship with the staff and receiving individualized treatment and care was important for the participants. This involved establishing trusting connections with mental health workers who treated them with respect, made them feel valued, and who recognized their suffering and needs. The formerly suicidal patients experienced being in a recovery process, which was promoted by the support of mental health workers. Although the participants reported mostly positive experiences, there were examples of insufficient care. Sometimes, they felt that their suffering and suicidality were not sufficiently recognized. Conclusion: Our study indicates that although there has been increased focus on suicidality in the mental health services, among other through clinical guidelines, some mental health workers still lack competence and should focus more fully on how to provide individualized care for suicidal inpatients.

Suicide prevention in mental health care--time for new ideas?

We have previously pointed out that the Nasjonale retningslinjer for forebygging av selvmord i psykisk helsevern [National guidelines for the prevention of suicide in mental health care] (1) may have unintended and detrimental consequences for clinical practice (2). However, Mehlum and collaborators (3) and Emblemsvåg (4) defend the guidelines by comparing suicide prevention in mental health care to safety measures in road traffic. This reinforces our concern that the ability to see each individual will be overwhelmed by the standardised assessments of risk factors that are emphasised in the guidelines. Straume appears to share our concern when asking, based on the guidelines’ clear recommendations for emphasising risk factors in assessment of suicide risk: «What would be the effect of alternative use of time in terms of suicide prevention?» (5).