Suicide risk assessments, experts by experience and me

By Sophia Fedorowicz

As a first year PhD student I wanted my inaugural blog post to outline the area I am interested in and how I came to be here, I am a product of my experiences after all. My first love is psychology. My undergraduate degree was BSc Psychology Single Honours and so psychological thinking underpins the way I think about and approach my research. My second love is mental distress, which may sound like a strange way to phrase that area of interest. I evolved as a researcher at the same time as I was going through a personal journey of recovery out of profound mental distress and towards contentment. This has led to my own experiences influencing my interests and my interests influencing my research. My MSc dissertation, which centred around experiences of mental health services in my local area of Stoke-on-Trent, was inspired by the time I spent attending peer support groups. Similarly, the decision to study suicide for my PhD was influenced by the profound loss experienced by myself and people close to me as a result of living in a city with a high suicide prevalence; of knowing people who have died by suicide and others who have attempted and planned for it.

Suicidal thoughts and feelings are complex in origins spanning socio-economic, health, material, psychosocial and behavioural factors [1,2]. Recognising and managing suicidal thoughts and feelings are equally as complex and the difficulty of this task is often unacknowledged. Responsibility of recognising suicidal thoughts and feelings a person may be experiencing often falls on health care professionals. Being able to identify people who are experiencing suicidal thoughts and feelings, and determining the extent to which an individual is life is “at risk” as a result of these thoughts and feelings, is thought to be part of their job [3]. It is widely assumed that health professionals are good at this task, that they understand suicide and that the level of risk allocated to a person accurately represents the level of care that is necessary to ensure a person’s safety and wellbeing [3,4]. However, this is rarely the reality of the situation. There is evidence that the tools which health care professionals use to estimate the level of risk, and therefore determine the type of care and support a person will benefit from, are insufficient for the job [3]. The Assessment of Clinical Risk in Mental Health Services brought together experiences of suicide risk assessment tools from the perspective of health care professionals and people who use health services to find that only 62% of these assessments recommended incorporating the views of the person experiencing suicidal thoughts and feelings. In addition, only 35% were aware that a risk assessment was taking place. This survey highlighted an extremely important oversight in the provision of care. That people disclosing suicidal thoughts and feelings are not being encouraged to be a part of their own care planning despite the promotion of shared decision making in health care practice. Further to this my own database searches have yielded little research developing assessments with the inclusion of experts by experience.

There is a lot of value in bringing experts by experience into the research process, particularly into research focussed on understanding suicide. Public and patient involvement and engagement has been shown to have positive impacts on research. Members of the public with experience of the topics being researched bring interpretative insight that is different to that of the research team. They are more likely to focus on the emotions and feelings of the people experiencing the phenomenon under study, comparatively researchers tend to focus on their knowledge of the processes involved [5]. In addition to this outlook, bringing experts by experience into research focusing on understanding suicide is an ethical essential in order to address power imbalances, issues surrounding autonomy and the right to have a voice in what kind of care and support options are appropriate for them [6].

References

1. Skalická, V., Van Lenthe, F., Bambra, C., Krokstad, S., & Mackenbach, J. (2009). Material, psychosocial, behavioural and biomedical factors in the explanation of relative socio-economic inequalities in mortality: Evidence from the HUNT study. International Journal of Epidemiology, 38(5), 1272-1284.
2. Marmot, M., & Bell, R. (2012). Fair society, healthy lives. Public Health, 126, S-S10.
3. Gale, T. M., Woodward, A., Hawley, C. J., Hayes, J., Sivakumaran, T., & Hansen, G. (2002). Risk assessment for people with mental health problems: A pilot study of reliability in working practice. International Journal of Psychiatry in Clinical Practice, 6(2), 73-81.
4. Large, M., Kaneson, M., Myles, N., Myles, H., Gunaratne, P., & Ryan, C. (2016). Meta-analysis of longitudinal cohort studies of suicide risk assessment among psychiatric patients: Heterogeneity in results and lack of improvement over time. PloS One, 11(6), e0156322.
5. Gillard, S., Borschmann, R., Turner, K., Goodrich‐Purnell, N., Lovell, K., & Chambers, M. (2010). ‘What difference does it make?’Finding evidence of the impact of mental health service user researchers on research into the experiences of detained psychiatric patients. Health Expectations, 13(2), 185-194.
6. Ives, J., Damery, S., & Redwod, S. (2013). PPI, paradoxes and plato: Who’s sailing the ship? Journal of Medical Ethics, 39(3), 181-185.

Sophia Fedorowicz (@Soph_Fedorowicz) is a PhD student at the Centre for Health and Development, Staffordshire University, England (sophia.e.fedorowicz@gmail.com).

Featuring Photo by Steve Halama on Unsplash.