Sunday, 6 May 2018

Suicide Prevention

Rising to the Challenge of Suicide Prevention: Psychological Approaches.

Stockport's April meeting heard from Yvonne Awenat, a Research Fellow at the, University of Manchester, Division of Psychology & Mental Health, School of Health Sciences.  She discussed her team’s research into suicide prevention.

In the UK there is one death from suicide every 90 minutes, so each year about 6,000 people die by suicide, and there are about 140,000 suicide attempts - that’s one attempt every 4 minutes.  These figures have only slightly reduced over the last 30 years.

There are various risk factors for suicide based on Demographics; History of suicidality and Mental Health Problems. There is an increased risk associated with: Psychiatric hospitalisation / Imprisonment, Depression, Psychosis, Trauma (PTSD), personality disorder, substance and / or alcohol misuse, adverse life events.

There is no accurate method of predicting who will die by suicide. Static risk factors cannot be reduced (E.g. gender). Current practices are flawed – most patients who died by suicide had been assessed at No or Low Risk. Suicide risk assessment scales have limited clinical utility and may waste valuable resources and are no longer recommended (NICE, 2011; Quinlivan et al, 2017)

Psychological treatments are effective in reducing repetition of suicidal behaviour and Cognitive Behaviour Therapy (CBT) is one of the most promising treatments. Psychological treatments are effective in reducing repetition of suicidal behaviour. Cognitive Behaviour Therapy (CBT) is one of the most promising treatments but should have a specific focus on treating the underlying psychological mechanisms specific to Suicide involving: Attention Broadening, Thought Challenging, Problem Solving Training, Mood Management, and Improving Self-Esteem & Resilience.

Qualitative Research involves semi-structured in-depth interviews to investigate participant or other stakeholder’s: ‘Real-world’ subjective experiences; views, perspectives, attitudes; understandings; needs, priorities, preferences. Interviews are audio-recorded, transcribed and analysed.

Qualitative Analysis involves a systematic rigorous method to identify patterns (or themes) within participants’ narratives, reading & re-reading transcripts, line-by-line coding, clustering similar codes together and Identifying tentative themes, then collapsing tentative themes to form final themes.

In experimental intervention, treatment is given by a qualified clinical psychologist or CBT therapist employed for the clinical trial over a period of 4 – 6 months, once or twice a week. There are normally 20 -24 sessions each of 30-60 minutes. 

One particular study was Cognitive Behavioural Suicide Prevention (CBSP) in Psychosis, also known as the Recovery Trial. It took patients aged 18-65 years on the schizophrenia spectrum who had previous suicide attempt and/or current suicidal ideation. There was improvement in suicidal ideation. A reduction in suicide probability, and an increase in self-esteem. However there was increased risk of depression. 

Another study (PROSPeR) for the prevention of suicide in Prisoners aimed to demonstrate the feasibility of conducting an RCT of CBT for suicide prevention in a prison setting showed a reduction in self-injurious behaviour in the therapy group given CBT.

A randomised controlled trial of CBT for suicide prevention in inpatient settings (THE INSITE study) suggested that CBSP may be cost effective.

The CARMS trial: Cognitive Approaches to coMBatting suicidality is ongoing and has not as yet yielded any results.

Future studies will build on and extend exiting research on suicidal prisoners and psychiatric inpatients and explore new areas such as: suicide and bipolar disorder, suicide and alcohol or substance misuse, suicide and sleep problems.

There are the following sources of help for sufferers;

NHS - GP; A&E; NHS Direct 111, or 999.
Samaritans – Phone 116 123 24 hrs. all year 
NHS Choices – more resources 
The Sanctuary – Phone: 0300 003 7029      8pm – 6am overnight support