Inexperienced, distracted mental health staff increase risk for suicide among patients under observation

Inexperienced staff may increase risk for suicide among patients with suicidal behaviors seeking treatment in mental health hospitals, according to a report from the University of Manchester.

Researchers from the University’s National Confidential Inquiry into Suicide and Homicide by People with Mental Illness reviewed data for all suicides that occurred while the patient was under observation within the United Kingdom during a 7-year period. Online survey responses from patients and staff on their experiences with observation were also assessed.

Observation was typically defined as checks every 10 to 15 minutes, but 9% of patients in the study cohort were intended to be under constant observation.

During the study period, 18 patients per year died by suicide while under observation.

Louis Appleby

Fifty percent of deaths occurred when checks were conducted by less experienced staff or agency staff who were unfamiliar with the patient. Further, deaths occurred when staff were distracted by disruptions within the ward, during busy periods or in poorly designed wards.

“The current observation approach is not working safely enough,” Louis Appleby, MD, director of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, said in a press release. “This is an important part of keeping patients safe, but we found that where deaths occurred, responsibility had often been given to less experienced members of staff. Deaths also occurred when the protocols were not followed. Observation is a skilled task, not an add-on that can be delegated to anyone available.”

Appleby and colleagues recommend that suicide under observation be considered an NHS “never event” in England and Wales and be subject to independent investigation.

“Observation should not just be about watching the patient, but an opportunity to engage with them as part of a comprehensive care plan. New models for observation need to be developed and tested to cut the number of deaths,” study researcher Jenny Shaw, MSc, PhD, of the University of Manchester, said in the release.

For more information:

Visit http://www.bbmh.manchester.ac.uk/cmhs.