Supporting the Reduction of Suicide in the General Population of Wales
Research type
Research Study
Full title
Supporting the Reduction of Suicide in the General Population via the Use of Structured Professional Judgement
IRAS ID
248959
Contact name
Nicola Gray
Contact email
Sponsor organisation
Swansea University Research Engagement & Innovation Services
Clinicaltrials.gov Identifier
N/A, N/A
Duration of Study in the UK
5 years, 0 months, 1 days
Research summary
Research Summary
Each year in Wales, between 300 and 350 people die from suicide and approximately 5,500 people are admitted to hospital for self-harm related injuries (Office of National Statistics, 2015). 75% of people who complete suicide are not known to mental health services. Instead, people at risk of suicide present to services such as Accident and Emergency Departments. Cross-government strategy has recently highlighted the role of primary and secondary care in preventing suicide.
This project aims to implement and evaluate a new approach to the risk assessment and subsequent management of suicide within two Accident and Emergency Departments in Wales. The Structured Professional Judgment approach originates from forensic psychology where it has had great success in the risk assessment and management of violence and sexual offending. The Risk of Suicide Protocol (RoSP) is a Structured Professional Judgment specifically designed to assess and manage the risk of suicidal behaviour.
This project will work with the Crisis Liaison Teams at the Royal Gwent Hospital (Newport) and the Nevill Hall Hospital (Abergavenny) and will compare overall effectiveness of the RoSP and 'assessment as usual'.
This project will use a longitudinal design. This means that three months and then one year after patients are assessed by the Crisis Liaison Team, there will be a search of hospital records, public records, Coroner's inquest reports and a follow up telephone interview to assess the extent to which the patient was at risk of death from self-injury. After patients have been followed up, the RoSP and 'assessment as usual' will be compared on their ability to predict future risk of death from self-injury, their reliability, how appropriate their safety planning recommendations were and how easy they were to use. This project will run for approximately five years.
Summary of Results
Title: Supporting the Reduction of Suicide in the General Population via the Use of Structured Professional Judgement
Who: This research was carried out by a PhD student at Swansea University for part of their thesis.
Where: This research took place at the Royal Gwent and Nevill Hall Hospitals within the Aneurin Bevan University Health Board. The researcher was working with the psychiatric liaison teams working within these hospitals.
When: The study took place between May and September 2019
Why was the research needed: The research was trying to improve the process of risk assessment for individuals attending hospital after experiencing self-harming thoughts, engaging in self-harming behaviours or experiencing psychiatric distress. Improving the assessment and treatment process for individuals attending hospital after self-harm can help prevent future self-harm and suicide.
What were the main questions studies: When individuals attend hospital after experiencing self-harming thoughts or engaging in self-harming behaviours they receive an assessment with a hospital-based psychiatric team to assess whether they are safe to return home and to identify other forms of help and support that they may require. This study aimed to evaluate a new method of assessing patient safety (the Risk of Suicide Protocol; RoSP) and compare it to the current method of assessment.
Who participated in the study: Individuals who attended hospital after experiencing self-harming thoughts or engaging in self-harming behaviour are typically referred for an assessment with the on-site psychiatric liaison team. Participants for this study were individuals who attended either the Royal Gwent or Nevill Hall hospital and were referred to the on-site psychiatric liaison team for an assessment. All participants gave their fully informed consent prior to taking part in the research. In total 107 participants took part in this research.
What happened during the study: Once participants agreed to take part in the research, they received an assessment interview with the on-site psychiatric liaison team and the researcher. After this assessment, the psychiatric liaison staff completed their currently used risk assessment (assessment as usual), whilst the researcher completed their RoSP risk assessment. After completing their respective assessments, both the researcher and the psychiatric liaison staff were asked to evaluate the likelihood that the patient would attempt suicide over the next three months.
**All decisions around the safety and treatment of the patient were made by the psychiatric liaison team. The researcher was there in an observational capacity only.**
Three months later, the patient was then followed up via a telephone interview and a check of their hospital records, to identify whether they had attempted suicide in the three months since their initial assessment.
What were the results of the study: The findings from the study showed that risk judgements made using the RoSP were significantly better at identifying future suicide attempts compared to assessment as usual.
How has this research helped patients and researchers: This research provides initial evidence that the Risk of Suicide Protocol is an effective method of assessing and managing the risk of suicide within an hospital-based psychiatric liaison team. This tool can be used to ensure improved identification of risks and effective safety planning for patients attending hospitals after experiencing suicidal thoughts or engaging in self-harming behaviours.
Next steps for the research: So far, this research has demonstrated that the new method of risk assessment and management (the RoSP) is slightly better at identifying individuals who go on to attempt suicide compared to assessment as usual when it is used by a researcher operating in the background to everyday clinical practice. The next step will aim to train the hospital-based psychiatric liaison team in how to use the RoSP, and then examine whether the RoSP can be implemented and used effectively within clinical practice.
REC name
Wales REC 3
REC reference
19/WA/0002
Date of REC Opinion
14 Mar 2019
REC opinion
Further Information Favourable Opinion