Learning from clinicians\u2019 views of good quality practice in mental healthcare services in the context of suicide prevention: a qualitative study

Donna L Littlewood,Jane Graney,Pauline Turnbull,Roger T Webb,Navneet Kapur,Leah Quinlivan,Louis Appleby

doi:10.1186/s12888-019-2336-8

Abstract

BackgroundSuicide and non-fatal self-harm represent key patient safety events in mental healthcare services. However, additional important learning can also be derived by highlighting examples of optimal practice that help to keep patients safe. In this study, we aimed to explore clinicians’ views of what constitutes good practice in mental healthcare services in the context of suicide prevention.MethodsData were extracted from the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) database, a consecutive case series study of suicide by people in contact with mental healthcare services. A large national sample of clinicians’ responses was analysed with a hybrid thematic analysis.ResultsResponses (n = 2331) were submitted by clinicians across 62 mental healthcare providers. The following five themes illustrated good practice that helps to: 1) promote safer environments, 2) develop stronger relationships with patients and families, 3) provide timely access to tailored and appropriate care, 4) facilitate seamless transitions, and 5) establish a sufficiently skilled, resourced and supported staff team.ConclusionThis study highlighted clinicians’ views on key elements of good practice in mental health services. Respondents included practice specific to mental health services that focus on enhancing patient safety via prevention of self-harm and suicide. Clinicians possess important understanding of optimal practice but there are few opportunities to share such insight on a broader scale. A further challenge is to implement optimal practice into routine, daily care to improve patient safety and reduce suicide risk.

Highlights

Suicide and non-fatal self-harm represent key patient safety events in mental healthcare services
In the UK, this work is conducted systematically by the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), which collects detailed data pertaining to people who died by suicide and who accessed mental healthcare services during the preceding 12 month period
Responses were submitted by 62 mental health providers (57/62 = National Health Service [NHS] mental health service providers, 5/62 = independent providers)

Summary

Introduction

Suicide and non-fatal self-harm represent key patient safety events in mental healthcare services. Improvement in the quality and safety of mental healthcare services is a fundamental aspect of suicide prevention. Much of the work in this area is driven by post-suicide investigations that seek to review and glean insight from the antecedent clinical practice by identifying instances where care could be improved [1, 3]. In the UK, this work is conducted systematically by the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), which collects detailed data pertaining to people who died by suicide and who accessed mental healthcare services during the preceding 12 month period. NCISH has identified suboptimal clinical care and other relevant antecedents, and have made practice recommendations aimed at preventing future suicide.

Results

Discussion

Conclusion