Hostname: page-component-5cf477f64f-rdph2 Total loading time: 0 Render date: 2025-04-08T11:08:58.376Z Has data issue: false hasContentIssue false
  • English
  • Français

Suicide by mental health in-patients under observation

Published online by Cambridge University Press:  11 April 2017

S. Flynn ,
T. Nyathi ,
S.-G. Tham ,
A. Williams ,
K. Windfuhr ,
N. Kapur ,
L. Appleby  and
J. Shaw
S. Flynn*
Affiliation:
The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, UK
T. Nyathi
Affiliation:
The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, UK
S.-G. Tham
Affiliation:
The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, UK
A. Williams
Affiliation:
The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, UK
K. Windfuhr
Affiliation:
The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, UK
N. Kapur
Affiliation:
The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, UK
L. Appleby
Affiliation:
The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, UK
J. Shaw
Affiliation:
The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, UK
*
*Address for correspondence: S. Flynn, Ph.D., The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Observations in psychiatric in-patient settings are used to reduce suicide, self-harm, violence and absconding risk. The study aims were to describe the characteristics of in-patients who died by suicide under observation and examine their service-related antecedents.

Method

A national consecutive case series in England and Wales (2006–2012) was examined.

Results

There were 113 suicides by in-patients under observation, an average of 16 per year. Most were under intermittent observation. Five deaths occurred while patients were under constant observation. Patient deaths were linked with the use of less experienced staff or staff unfamiliar with the patient, deviation from procedures and absconding.

Conclusions

We identified key elements of observation that could improve safety, including only using experienced and skilled staff for the intervention and using observation levels determined by clinical need not resources.

Keywords

In-patientSuicideObservationIntermittentConstant
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 13 , October 2017 , pp. 2238 - 2245
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Björkdahl, A, Nyberg, U, Runeson, B, Omérov, P (2011). The development of the Suicidal Patient Observation Chart (SPOC): Delphi study. Journal of Psychiatric and Mental Health Nursing 18, 558–561.Google Scholar
Bowers, L, Gournay, K, Duffy, D (2000). Suicide and self-harm in inpatient psychiatric units: a national survey of observation policies. Journal of Advanced Nursing 32, 437–444.Google Scholar
Bowers, L, Whittington, R, Nolan, P, Parkin, D, Curtis, S, Bhui, K, Hackney, D, Allan, T, Simpson, A (2008). Relationship between service ecology, special observation and self-harm during acute in-patient care: City-128 study. British Journal of Psychiatry 193, 395–401.Google Scholar
Bowles, N, Dodds, P, Hackney, D, Sunderland, C, Thomas, P (2002). Formal observations and engagement: a discussion paper. Journal of Psychiatric and Mental Health Nursing 9, 255–260.CrossRefGoogle ScholarPubMed
Cleary, M, Jordan, R, Horsfall, J, Mazoudier, P, Delaney, J (1999). Suicidal patients and special observation. Journal of Psychiatric and Mental Health Nursing 6, 461–467.Google Scholar
Cutcliffe, JR, Barker, P (2002). Considering the care of the suicidal client and the case for ‘engagement and inspiring hope’ or ‘observations’. Journal of Psychiatric and Mental Health Nursing 9, 611–621.Google Scholar
Duffy, D (1995). Out of the shadows: a study of special observation of suicidal psychiatric inpatients. Journal of Advanced Nursing 21, 944–950.Google Scholar
Gournay, K, Bowers, L (2000). Suicide and self-harm in in-patient psychiatric units: a study of nursing issues in 31 cases. Journal of Advanced Nursing 32, 124–131.Google Scholar
Green, JS, Grindel, CG (1996). Supervision of suicidal patients in adult inpatient psychiatric units in general hospitals. Psychiatric Services 47, 859–863.Google Scholar
Hales, BM, Pronovost, PJ (2006). The checklist – a tool for error management and performance improvement. Journal of Critical Care 21, 231–235.Google Scholar
Haynes, AB, Weiser, TG, Berry, WR, Lipsitz, SR, Breizat, AHS, Dellinger, EP, Herbosa, T, Joseph, S, Kibatala, PL, Lapitan, MCM, Merry, AF (2009). A surgical safety checklist to reduce morbidity and mortality in a global population. New England Journal of Medicine 360, 491–499.Google Scholar
Helmreich, RL (2000). On error management: lessons from aviation. British Medical Journal 320, 781–785.Google Scholar
Hodson, H (2016). A watchful eye. New Scientist 232, 22.Google Scholar
Hunt, IM, Windfuhr, K, Shaw, J, Appleby, L, Kapur, N (2012). Ligature points and ligature types used by psychiatric inpatients who die by hanging. Crisis 33, 87–94.Google Scholar
Hunt, IM, Windfuhr, K, Swinson, N, Shaw, J, Appleby, L, Kapur, N (2010). Suicide among psychiatric in-patients who abscond from the ward: a national clinical survey. BMC Psychiatry 10, 1.Google Scholar
Kettles, AM, Paterson, K (2007). Flexible observation: guidelines versus reality. Journal of Psychiatric and Mental Health Nursing 14, 373–381.Google Scholar
Langenbach, M, Junaid, O, Hodgson-Nwaefulu, CM, Kennedy, J, Moorhead, SR, Ruiz, P (1999). Observation levels in acute psychiatric admissions. European Archives of Psychiatric and Clinical Neuroscience 249, 28–33.CrossRefGoogle ScholarPubMed
MacKay, I, Paterson, B, Cassells, C (2005). Constant or special observations of inpatients presenting a risk of aggression or violence: nurses’ perceptions of the rules of engagement. Journal of Psychiatric and Mental Health Nursing 12, 464–471.Google Scholar
Manna, M (2010). Effectiveness of formal observation in inpatient psychiatry in preventing adverse outcomes: the state of the science. Journal of Psychiatric and Mental Health Nursing 17, 268–273.Google Scholar
Muralidharan, S, Fenton, M (2006). Containment strategies for people with serious mental illness. Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD002084. doi:10.1002/14651858.CD002084.pub2.Google Scholar
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (2015 a). Annual Report: England, Northern Ireland, Scotland and Wales July 2015. University of Manchester: Manchester (http://research.bmh.manchester.ac.uk/cmhs/research/centreforsuicideprevention/nci/reports/NCISHReport2015Bookmarked3.pdf). Accessed December 2016.Google Scholar
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (2015 b). In-patient Suicide Under Observation. University of Manchester: Manchester (http://research.bmh.manchester.ac.uk/cmhs/research/centreforsuicideprevention/nci/reports/ipobsreport.pdf). Accessed December 2016.Google Scholar
National Institute for Health and Clinical Excellence (NICE) (2005). Violence: the Short-term Management of Disturbed/Violent Behaviour in In-Patient Psychiatric Settings and Emergency Departments. Clinical Guideline CG25. NICE: London.Google Scholar
Neilson, P, Brennan, W (2001). The use of special observations: an audit within a psychiatric unit. Journal of Psychiatric and Mental Health Nursing 8, 147–155.Google Scholar
Office for National Statistics (2015). Suicides in the United Kingdom, 2013 Registrations (http://www.ons.gov.uk/ons/dcp171778_395145.pdf). Accessed November 2015.Google Scholar
Porter, S, McCann, I, McGregor Kettles, AM (1998). Auditing suicide observation procedures. Psychiatric Care 5, 17–21.Google Scholar
Stewart, D, Bilgin, H, Bowers, L (2012). Special Observation in Psychiatric Hospitals: a Literature Review Report from the Conflict and Containment Reduction Research Programme. Section of Mental Health Nursing, Institute of Psychiatry (http://www.kcl.ac.uk/ioppn/depts/hspr/research/ciemh/mhn/projects/litreview/LitRevSpecObs.pdf). Accessed December 2016.Google Scholar
Tully, J, Hearn, D, Fahy, T (2014). Can electronic monitoring (GPS ‘tracking’) enhance risk management in psychiatry? British Journal of Psychiatry 205, 83–85.Google Scholar
Vråle, GB, Steen, E (2008). The dynamics between structure and flexibility in constant observation of psychiatric inpatients with suicidal ideation. Journal of Psychiatric and Mental Health Nursing 12, 513–518.Google Scholar
Whitehead, E, Mason, T (2006). Assessment of risk and special observations in mental health practice: a comparison of forensic and non-forensic settings. International Journal of Mental Health Nursing 15, 235–241.Google Scholar