“WHAT suicidal patients need more than anything is hope.”
These are the words of a consultant psychiatrist who spoke to The Detail during our research on suicide rates among mentally ill patients.
He and other practitioners in the field highlighted the importance of good communication to ensure that patients don’t fall between the cracks within the system.
Some processes have already been tightened but research shows there is still a need for much more to be done.
The national confidential inquiry into suicide of people with mental illness recommended better joined-up service delivery in Northern Ireland, enhanced in-patient observation, proactive follow-up of discharged patients, targeted alcohol/drug misuse interventions for people with mental illness and an assertive outreach into community mental services especially in relation to missed appointments.
A spokeswoman for the Department of Health said that the reduction in the number of beds available in hospitals for mentally ill patients (down 24% from 2006 to 2011) has to be viewed alongside investment in community mental health services.
She said: “This has a two-fold effect. Firstly, earlier intervention prevents people having to be treated in psychiatric hospitals. Secondly, people who do require inpatient psychiatric treatment can be discharged in a more timely fashion as there are supportive community services to facilitate their return home. Developments in community mental health services has reduced demand for psychiatric beds.”
There is a push from above for more mentally ill patients to be treated in their own community – but the Health and Social Care Board insists this is not a financially-driven move. Current thinking is that care outside of a hospital setting can be more successful in the long term.
People with a mental illness considered at risk to themselves can currently be detained under the Mental Health Act but mental health specialists concede that there is a dangerous grey area between initial assessment and detention.
Some people may be surprised to hear that not all patients who show up in accident and emergency units following a self-harm incident are given a mental health assessment.
A&E units in Northern Ireland use the Card Before You Leave scheme for patients who have self harmed but are assessed to be low risk and therefore considered not to be in need of an immediate mental health assessment.
The patient is provided with advice on keeping safe and useful telephone contacts. They are referred to mental health services and offered an assessment within 24 hours.
The South-Eastern Health and Social Care Trust gave us detailed information about how it deals with patients who are feeling suicidal.
It told us that its mental health services receive almost 7,000 referrals annually through its mental health assessment centres and that many of the patients present with some level of suicidal ideation and/or behaviour.
The spokeswoman said that after a comprehensive assessment an individual treatment plan is developed based on the needs of each patient.
Mental Health teams are available 24 hours a day to provide a two hour response for patients who present with a mental health crisis, including those patients with suicidal ideation and behaviours.
She said that emergency departments also work closely with mental health services to ensure both the medical and mental health needs of people who have attempted suicide or self harm are attended to.
Access to hospital admission, home treatment, home treatment house, day hospital, community nursing and social work supports, addictions and psychological therapies is prioritised on assessed risk factors.
For those people who require admission and, on discharge require a continuing care plan, the trust ensures that their first follow up appointment occurs within seven days of discharge.
The trust also employs a suicide prevention co-ordinator who works with a range of local community groups and individuals to work to prevent suicide.
People presenting with “social” rather than mental health causation (for example relationship breakdown, job loss, addiction etc) are offered counselling.
THE FOCUS ON YOUNG MALES
For now the political and media attention continues to focus on the massive increase in suicides among young men.
Almost 77% of the 313 suicides in Northern Ireland in 2010 were male.
A recent Public Health Agency (PHA) study looked at suicidal behaviour among men aged 16 to 34. The findings highlighted the importance of implementing a package of measures targeted specifically at the ‘at risk’ population of young men. It also stressed that young men have to ‘turn up’ for care in order for that care to have a chance of being effective.
The report warns: “They will continue not to attend services they perceive as both stigmatised and stigmatising irrespective of the quality of care these services may provide.”
Mary Black is Assistant Director of Public Health, Health and Social Wellbeing Improvement at the PHA. She described every suicide as “a tragedy for individuals, families and communities” and acknowledged that people known to mental health services are at a statistically greater risk of taking their lives.
“Promoting mental health and suicide prevention is a priority not only for the Public Health Agency and our partner organisations, but also for every local community across Northern Ireland,” she said.
The suicide report published by the PHA in December recommended a holistic approach to suicide prevention, across many sectors and touching on all aspects of individual, social and community life.
Ms Black continued: “This report told us that suicide prevention is not just about clinical intervention in recognised mental health facilities, but that young men need a more holistic approach that will enable them to develop coping strategies and life-skills, available in both formal and accessible community settings.”
A Northern Ireland Registry of Deliberate Self-Harm has been piloted in Northern Ireland since 2007. It extracts and collates anonymised data from existing records of self-harm attendances at accident and emergency/urgent care departments.
The 2009 annual report for the Western Trust area reports that 988 people were treated for 1,266 episodes of self-harm during 2009 in the Western Trust area alone. Almost one in five (22%) were repeat presentations of self-harm. The highest rates of self-harm were among 15 to 19-year-old females and 20 to 24-year old males.
Pilot projects are also being run in a bid to access hard-to-reach young males.
One example is the Northern Area Young Men’s Support Project which has worked with over 220 men in the 16 to 25 age group since July 2010. Run by two experienced youth workers and funded by the PHA, the initiative focuses on building resilience and coping skills with vulnerable or hard to reach young men.
The PHA is also involved in work to develop suicide cluster early identification and emergency response plans. This involves each health and social care trust area developing a community response plan.
The aim is to monitor and prevent the potential development of clusters of suicide occurring within local areas. Early detection of clusters or community concerns should then result in a timely response by all sectors of the community to address any needs and prevent further deaths occurring.
The massive death toll from suicide shows this is an issue which must be taken seriously and it is clear that giving mentally ill patients hope for the future could mean the difference between life or death.
• People who feel that they or someone they know is in distress or despair can call Lifeline confidentially on 0808 808 8000. It is available 24 hours a day, seven days a week. There is also a website at www.lifelinehelpline.info
• The PHA mental health promotion website is at: www.mindingyourhead.info
• The Samaritans can be contacted by telephone on 08457 90 90 90 or email firstname.lastname@example.org