Running head: Mental illness and Suicide 1

Suicide prevention among mentally ill patients in a psychiatric hospital

Student Name: Jojo Thomas

ID number:

Unit code and title: Clinical Project

Title of Assignment: Clinical project assignment 2

Name of Unit Coordinator:

Due date: 31/03/19

Word count: 3000

Mental illness and Suicide 2

Suicide prevention among mentally ill patients in a psychiatric hospital

Introduction

Prevention of suicide among mentally ill patients of the psychiatric hospitals in the

selected clinical learning need and the clinical area is an acute psychiatric ward in a mental

health hospital. The patients who live in a mental health facility have got a high possibility of

suicide. Managing them in the clinical setting is a challenging task for health care workers.

Many individuals are at high risk of repeat suicide attempts because of the lack of proper

treatment. Many studies have shown that patients with suicidal ideation have treated with the

same level management of mentally ill patients (Shahtahmasebi, 2017). Attempted suicide is a

serious problem that often results in repeated suicide attempts (Alonzo, 2016). In my mental

health work setting, during admissions, I can hear the word suicidal ideation and suicide very

often, but no training was provided to the staff members to manage the patients with suicidal

idea effectively. One of the patients in my ward attempted to hang using a bedsheet, and another

one had escaped from the ward and committed suicide. 29% of men had committed suicide

when they were under treatment for their mental illness (mental health nursing, 2015). This

incident made me conscious about the seriousness of the circumstances what I am experiencing.

I have decided to improve my knowledge of suicide prevention in mentally ill patients, which

may benefit me to improve my professional qualities moreover it would protect my clients from

suicide. The incidents of absconding from the hospital and doing suicide are happening very

often in mental health hospital settings. Researches have shown that these patients have more

serious and complex life events with mental illness such as homelessness. Drug abuse is also a

contributing factor to suicide attempts (Hunt, Clements, Saini, Rahman, Shaw, Appleby,
Mental illness and Suicide 3

Windfuhr, 2016). How to improve the measures to prevent the suicide of patients in psychiatric

hospital settings is the main purpose of this project. This could be achievable through the

management of multiple risk factors of suicide. The use of local policies, Training for nursing

staffs, psychological counselling, cognitive behavioural therapy and the social worker`s

involvement are some effective measures to prevent suicide (Pederson, Gorman-Ezell,

Hochstetler-Mayer 2017).

The relevance of the Project

How to reduce suicide among people whoare under treatment in psychiatric hospitals is a

key issue. Leaving or absconding from the hospital ward without the permission of the nursing

staff is a common feature of mental health nursing care and also a risk factor of suicide. Learning

this skill can reduce the number of suicides among inpatients in psychiatric hospitals. 1 to 10

days before, more than half of the individuals have conveyed verbal or non-verbal clues

regarding the suicide and that was evident to nearby individuals (Tsai, Lin, Chang, Yu, & Chou,

2011). Studies have reviled that the nurses who attended the training programs regarding the

suicide awareness have shown more awareness of suicidal warning signs and referred the

patients to professional counselling. By learning this skill, the nurse can effectively recognize

the clues of the suicidal ideation and prevent it. It improves the knowledge about the suicidal

risk factors, and it allows the psychiatric nurse to identify the suicidal behavioural easily (Tsai et

al., 2011). So mastering this skill can help the nurses to reduce the suicidal rates in psychiatric

hospitals.

I am working in a mental health hospital. One day one of our patients had escaped from

the ward settings and committed suicide by hanging on a tree. The nurses had to face legal

actions because of this incident.

Mental illness and Suicide 4

This was a shocking incident for m, and I was sad to hear the poor patient death. I felt

that I am insecure in that setting because I may have to face legal actions if this incident happens

in my shift. I felt that my patients are not safe because their illness can make fatal effects on

them. This patient was being treated for depression, and doctors have informed nurses about the

suicidal ideations of the patient.

For me the patient safety is important, and I have learned that the current settings of the

ward and the protocols are ineffective unless this would not have happened. This incident has

helped me to learn to manage the patients with suicidal ideation. Some wards in the hospital are

built for general patients, and it is not suitable to keep the mentally ill (Hunt et al., 2016). I have

learned how to monitor the patients with suicidal ideation and how I have to change my nursing

practice and the importance of including local policies, psychological counselling, cognitive

behavioural therapy and the social workers to prevent suicide in hospitals (Pederson et al., 2017).

I could have done close monitoring of the patient who was escaped. I could have alerted

the security staff to monitor the doors and to make sure that all the doors are locked and secured.

I could have told my colleagues to do frequent rounds to monitor the patients. Nurses have

greatest chances to monitor and intervene with the patient with suicidal thought. Unfortunately,

no nurse does not have the training to assess, evaluate, treat or refer the patient (American Nurse,

2015)

In future, if there is a patient with suicidal ideation in my ward, I would suggest the ward

in charge to assign a nurse full time to monitor that patient and closely monitor the staff through

closed-circuit cameras. I would make sure that this patient is getting adequate support from the

social worker and the psychologist, along with hi medication. The studies suggest that once if
Mental illness and Suicide 5

the nurses are trained with the suicidal assessment, they can help the patient with suicidal

ideation (American Nurse, 2015).

The effective management of patients with suicidal behaviour is an important factor in

my workplace because, in my ward, there are patients with mental illness and drug abuse history.

Substance misuse patients often reported with depression and other mental health issues. The

illicit substance use is one of the common risk factors of suicide. Substance misuse has been

marked as one of the risk factors closely following depression and other mood disorders (Artenie,

Bruneau, Roy, Zang, Lespérance, Renaud, Jutras-Aswad, 2015). Knowing how to manage the

patients with suicidal ideation can help me to work in my clinical area effectively by identifying

risk factors and evaluating the safety standards of the ward. Screen every patient and review for

any personal or family history of suicide risk factors (The Joint Commission issues Sentinel

Event Alert on preventing suicide in all settings, 2016). Learning about suicide prevention can

help me to learn more about legal and ethical issues and also help the patients with their

requirements by assessing their condition. This can help me to coordinate the care of multi-

disciplinary teams such as Doctors, social workers and psychologists for a better outcome.

Nurses can create a caring environment which includes care, education, health and guidance,

through primary prevention strategies, and it can encourage the patient to adopt a social and

behavioural change, and it can rule out new possibilities of a re-attempt (Seixas Santos,

Albuquerque, dos, Brêda, Bastos, Silva, Tavares, 2017). The nurse can work out on the potential

of people under psychological distress and directing them to a meaningful life. This can help me

to manage evidence-based treatment and a discharge plan that directly target suicide, and it helps

to reduce the number of suicides

Mental illness and Suicide 6

Objective

The main objective of this project is to learn preventive measures of suicide in psychiatric

hospital wards. It will help me to improve the safety and quality of patient care. Suicidal

ideation can be managed using a mixture of several aspects or methods study suggested that

health personals knowledge should be reinforced in hospital settings and it also indicates that

education of clinical staff directly involved in patient care is useful to prevent suicide (Tsai et al.,

2011)

The aim of this objective is the safety of the patient. Obtaining a good knowledge in the

management of patients with suicidal ideation can improve the patient safety and quality of care.

Educating the staff nurses about the preventive measures of suicides can contribute to their care

delivery to improve understanding of suicidal behaviour of the patients and their adherence to the

treatment (Jincy, Linu, Binil,2011). Developing this skill can help the nurse to identify the needs

and the risk factors of the patients with suicidal ideation. It allows the nurses to understand clues

from the patients and manage the patients accordingly. This is one of the important knowledge a

psychiatric nurse must have because the nurse practice on the frontline has the greatest number

of opportunities to identify and treat suicidal patients. Most nurses have no idea on how to

assess, evaluate, treat or refer the suicidal patients. Training the nurse to assess and evaluate is

the key to reduce suicide in hospitals (Bolster, Holliday, Oneal, Shaw,2015). So this is relevant

to learn about this objective to care the patient with suicidal ideation and mental illness.

Education and knowledge of nursing staff about suicide prevention have an important

role in preventing suicide in hospitals. Evidence suggests that lack of knowledge, lack of training

and poor attitude towards the suicidal patient have an unfavourable impact on the health care

delivery system and the patient’s safety (Bolster et al., 2015). Psychosocial barriers of the nurses

can affect suicidal patients negatively. The psychosocial factors can be described as emotions,
Mental illness and Suicide 7

personal, experience, values, and judgment and these factors can impact on the nurse’s ability to

screen, prevent, and refer the patients with suicidal thoughts for treatment (Bolster et al., 2015).

Steps involved to achieve this skill are continuing education and improvement in

communication skills, literature reviews, self-reflection, assessment of risk factors, evaluation of

current methods, knowledge of cognitive behavioural therapy and social workers involvement

Continuing education and improvement in Communication Skill

Appropriately trained nurses are a demand of the psychiatric hospitals to provide

compassionate care to the patients who are at the risk of suicide. It will enable the nurse to

provide care and treatment in equal importance (Mendes, 2018). In the mental health setting

suicide prevention strategies are required because the mentally ill patients are considered as the

group who is at risk of suicide however they are not the only the group at risk of suicide so that

all nurses should have the knowledge and relevant awareness regarding the prevention of suicide

(Mendes, 2018). Dedicated training is needed to improve understanding, care and treatment.

Appropriate training programs have shown that they have improved the awareness, knowledge,

and skill of the nurses in suicide prevention; however, their attitude also impacts on patient care.

The awareness will help health professionals to avoid their own personal beliefs about suicide,

and it also avoids the inadvertent judgment of patients and their choices (Mendes, 2018). Staff

training is associated with suicide prevention has a greater role in achieving the objectives

(Mendes, 2018). Many nurses do not know how to respond to the patient’s statement about

suicide, and they may remain silent. Literature reviews have shown that many nurses have

thought that their lack of experience in dealing with suicidal patients may lead to further harm

(Mendes, 2018).
Mental illness and Suicide 8

The Literature Review

Review of different literature supports the staff to improve the evidence-based patient

care and skills. Scientific, integrative, systematic, and Meta-analytic literature reviews are

considered as powerhouse publications, and they are the foundation of evidence-based practice

because it includes results of multiple studies of the same problem (Cowell, 2015). Knowing

that the literature reviews are providing important evidence the authors are forced to publish

these literature reviews based on their studies (Cowell, 2015). So the literature reviews

regarding the prevention of suicide can contribute to the evidence-based practice for effective

prevention of suicides in psychiatric hospitals.

Assessment of Risk Factors

The majority of the patient have suicide ideation have psychiatric disorders mainly

depression, a bipolar disorder, drug-induced disorders and schizophrenia other risk factors are

suicidal history in the family, stressful life events, low income, unemployment, sleeplessness,

and hopelessness (Lappann Botti, Conceição, Pereira, Cantão, Castro, Araújo, Silva, 2018).

Male users of illicit substances are reported as one of the risk factors of suicide among patients

are being treated in psychosocial support centres (Cantão & Botti, 2016). An assessment of

these risk factors can help the nurse to plan strategies to prevent suicide and combining of

different professional risk assessment can provide a more comprehensive assessment of risk

(Barlow,2016).

Evaluation of Current Method

Evaluation of current methods used to prevent suicides is important to plan or select

effective suicide prevention methods according to the patient. Commonly used precautions

include one to one observation by hospital staff, psychiatric evaluation, controlled environment,
Mental illness and Suicide 9

and no harm or safety contracts. Observation by hospital staff is very often recommended

method recommendations concerned that the distance kept by the observer is contradictory.

Researchers found that no harm contract is only useful in the therapeutic relationship, and

psychiatric assessment is another component for the intervention for the patient who is suicidal

(Adams, 2013). In the controlled environment, the patient will be placed in a room away from

all objects that can be used to commit suicide, with a roommate near the nurse’s station (Adams,

2013).

Knowledge of Cognitive Behavioral Therapy and Social Workers Involvement

Cognitive behavioural therapy (CBT) aims to establish links between the patient’s

emotions and feelings and correction of misconceptions and irrational beliefs. It is one of the

treatment intervention for patients with suicidal ideation and substance misuse (Singer, Brien, &

Cloux,2017). This is observed that poor social integration enhances the risk of suicide in older

people, and it is suggested that people who have difficulties in their daily life have to be referred

to the social worker assessment. In older people, more specific risk factors of suicides are

financial difficulties and the accommodation problem (Manthorpe & Iliffe 2011).

Barriers

Psychosocial barriers of the nurses can play an important role in the resistance to suicide

evaluation and assessment they can be described as emotions, feelings, personal experiences,

values and judgments. These values can impair risk assessment and management (Mendes,

2018). Consequences of the nurse’s attitude impacted on the quality of care patients received

and resulted in a patient feeling of worthlessness, hopelessness, and rejection (Mendes, 2018)
Mental illness and Suicide 10

Time Frame

First Week

The first week has been spent to collect the required journal articles

Second Week

The second week has been spent to review the articles collected

Third Week

The third week has been spent for the understanding of the methods which is using in a

psychiatric hospital for suicidal prevention

Fourth Week

Formulation of the project and its evaluation based on the literature review took place.

The learning of this objective, preventive measures of suicide in psychiatric hospital

wards, made me confident about the assessment of suicidal ideation of the newly admitted

patients. After learning the objective I feel satisfaction because I feel that I can provide quality

nursing care to my clients. Now I feel confident that I can assess the suicidal ideation of the

clients quickly as they express their mind. It helped me to develop a relationship with the

patients to increase the willingness to talk about suicide. I have learned how to look for the

warning signs while I talk to the patients. I have earned how to collaborate with the colleagues

and patients to make care plans, including the management of anxiety and negative thoughts. I

have learnt how to involve family members and friends. I have learnt how to classify the risk

factors and assess them to find out the clues of suicide in patient’s communication. I have
Mental illness and Suicide 11

learned how to utilize the current suicidal prevention methods and also what are the Gaps in the

current methods to do effective suicide prevention.

This learning can help me to provide quality care to my patients and, it enhances my

abilities to provide more patient-centred care for my patients. Communication techniques can

help me to feel my patient’s needs becoming an active listener, and through open-ended

questions, I can search for unrelieved hints of suicide moreover, it helps me to provide holistic

care based on the assessment of every patient and find the factors that may influence the suicidal

ideation of clients and eliminate. This learning can help me to coordinate the care for my patients

from different departments according to their needs to eliminate their suicidal ideation (Mendes,

2018).

The training program for nurses to assess the suicidal ideation is the future

recommendation. This training is not mandatory, even in psychiatry hospitals. It should be

mandatory in the future. Through training, the nurses can improve the speed of assessing the

suicidal changes in the behaviour of the patients. The outcome measure of a training program

which was provided to some nurses in Hong Kong has shown significant improvement in the

nurse’s attitude and competence in managing suicidal prevention (Mendes, 2018).

Conclusion

Suicide risk is not constant, and it can vary with individual circumstances. Screening for

suicide prevention begins with identifying the patients who are potentially at risk and referring

them to appropriate personals for further management. All nurses need to know the importance

of suicidal screening, especially those working in psychiatric hospitals, for the safety of the

patients. Effective suicidal screening is the key to suicidal prevention. I could achieve my

objective on time. However, there were fewer articles which describe the suicide assessment and
Mental illness and Suicide 12

prevention in psychiatric hospital wards, which are published in the last five years. After

learning the objective, I feel confident to undertake tasks to assess the suicide intention of the

patients. I feel that I can save my patients by effectively preventing them from suicide. I feel

assurance that I can apply my skill in my clinical practice. Now I feel that I have gained some

positive attitude towards the patient with the suicide intention. I have learned how to avoid my

personal feeling while I care for a psychiatric patient. This learning objective helped me to find

the gaps in my department’s current suicide preventive methods. This can help me to create a

safe environment for my patients as well as my colleagues. A positive attitude towards the

patients which I have gained from this study can prevent the patient from completing suicide.

This study helped me to reduce the emotional expression on suicide, and this will help me to

identify all the possibilities of a clue from the patient regarding suicide. The evidence suggests

that lack of knowledge and training can affect the patients unfavourably. Level of education,

religion, and previous experience with suicidal patients are some other factors which may effect

the attitude of nurses to the patients with suicide intention. The nurses can act in favour of

suicide prevention when getting close to the family to gather information about the person’s

behaviour in suicide tendency. The best preventive methods can be used on the patient- family

integration together with the multidisciplinary team; the result will be better nursing care. The

nurses can establish a caring environment based on education, health and guidance through

primary prevention strategies. It will help the patient to adopt a social and behavioural change.

The training of nursing professionals on preventive measures of suicide is the recommendation,

and it can improve the effectiveness of the nursing care of a person with suicidal intentions.
Mental illness and Suicide 13

References

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