Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Suicide - care in the community
- David G Connell (16 June 2000)
-
Drs. are not immune.
- Bryan Williamson (30 June 2000)
-
Do not forget the impact on General Practitioners
- Brian Ferguson, Trevor Mills, John Milton (4 July 2000)
-
Amplification of the Mental Welfare Commission's role
- James A T Dyer (19 July 2000)
-
AND JUST WHEN YOU THOUGHT IT WAS OVER
- D M Hambidge (9 August 2000)
|
|
|||
|
David G Connell
Send response to journal:
|
Editor - Alexander et al. describe the impact on Consultant Psychiatrists of suicide by patients in their care. (1). Needless to say these effects are also felt in general practice but the frame of reference may be different. In my own practice I well understand the support offered by family and colleagues in this situation. The benefits offered by supportive significant event review cannot be overemphasised. The sharing of information with Consultant Psychiatrists is beneficial I believe to both GP and Consultant. However the ripples of suicide travel far in a local community. Families and friends of the deceased have to be cared for. I would suggest this care is reciprocal. I understand the authors noted "anxiety about the reactions of the patients' families". Nonetheless suicide will leave behind grief in those who have lost and a need for care. It is crucial that General Practice offers this support and shoulders its due responsibility in this chain of pain. Only by doing so can we continue to care for those families who are faced with the apparently insurmountable task of rebuilding their lives - but in doing so we expose ourselves to perhaps our greatest source of support - the compassion, acceptance and understanding offered to us by the bereaved. David G Connell General Practitioner Fyvie Oldmeldrum Medical Group, The Medical Centre, Oldmeldrum AB51 0BF 1 Alexander DA, Klein S, Gray NM, Dewar IG, Eagles JM. Suicide by patients: questionnaire study of its effect on consultant psychiatrists. BMJ 2000; 320: 1571-1574. (10 June) |
|||
|
|
|||
|
Bryan Williamson, Staff Nurse, RMN HM Prison Service
Send response to journal:
|
I read your article with great interest on the Helix site at my place of work. I feel that it needs to be recognised that psychiatrists are not "Super Human". They possess the same emotions as any other individual and are just as prone to the anxieties exacerbated by life's experiences as anyone else. Whilst psychiatric training offers a significant degree of in-sight, it does not give immunity and mental ilness is no respecter of person. |
|||
|
|
|||
|
Brian Ferguson, Consultant Psychiatrist Stonebridge Centre, Trevor Mills, John Milton
Send response to journal:
|
Alexander et al's study on the effects of patient suicide on consultant psychiatrists is welcome and timely. Given the present public attitude towards NHS consultants and the new intiatives contained within the National Service Framework for Mental Health, it is right that we should consider the well-being of our consultant colleagues. Less well understood is the impact of suicide on General Practitioners(GPs). In view of the fact that the majority of suicide victims have consulted their GP shortly before death, the family doctor is in an equally vulnerable position, especially if working in a small primary care team where professional support may be low or non-existent. We carried out an audit of all suicides in Nottingham over a 13 month period using the methods of the National Confidential Inquiry. During that period 61 suicides took place. A postal quetionnaire was sent to each GP, 85% of whom responded. Of those doctors who replied, 90% reported experiencing a sense of hoplessnes at some point. Only one doctor felt that he had not worried about his patient and a significant proportion described feeling of frustration (55%) and rejection (23%). 19% described feeling guilty and many reported that they had lost all therapeutic hope for their patient prior to the death. Of importance was the finding that only 2% of doctors felt that suicide was preventable. Fifteen GPs described clinical reviews after the fatal incident but only in two of these did minor changes in clinical practice take place. In psychiatry, it is now standard practice to engage in formal debriefing, case audit and managerial review after an unexpected death. The GPs in our study indicated that mostly they were left to their own devices with little outside support. In view of the close involvement of GPs in the lives of their patients and families, it is vital for such support and review procedures to be developed in primary care. As with Alexander's experience, this should adopt an understanding, non- threatening manner which facilitates appropriate professional development and helps avoid psychological injury to all the staff involved. The resent structure of PCG/PCTs and the rapid development of GP postgraduate education through the introduction of Practice Professional Development Plans provides an excellent opportunity for change. Critical Event Review combined with meaningful peer support is essential. It should lead to greater mental health protection for primary care staff who are as likely as consultants to experience psychological injury as a result of a patients suicide. |
|||
|
|
|||
|
James A T Dyer
Send response to journal:
|
EDITOR - Alexander et al.(1) asked Scottish Consultant Psychiatrists about the helpfulness of various proceedings and events after the suicide of patients. The intervention of the Mental Welfare Commission was found to be unhelpful and is referred to along with other enquiries as contributing to a blame culture. While no doubt accurately reporting views expressed, this gives a misleading impression of the Commission's role and practice. At one level, the statement is unexceptional; after all, the Commission was not set up to be helpful to psychiatrists, but to protect the welfare of patients. To associate the Commission's involvement with the fostering of a blame culture, however, is mistaken. The Commission has a statutory duty to protect the welfare of those vulnerable through mental disorder, and to enquire into possible deficiency in care. In carrying out this duty it seeks reports on patients who commit suicide when in contact with mental health services or who have recently been in contact. It receives about 100 reports each year, and these are considered at meetings of the Commission. In a minority of cases, there may be follow-up questions to obtain additional information. Sometimes concerns are expressed by relatives. In the great majority of cases the Commission finds no concern about deficiency in care and carries out no enquiry. In a small number of cases, enquiry may be needed into deficiency in individual practice or service provision or both. Such infrequent enquiries are conducted in a spirit of finding solutions rather than culprits. The Commission is as concerned as anyone else about the negative effects of a blame culture, which is often encouraged by the media. It does not wish to be tarred by the media's brush. In Scotland, the Millan Committee is currently reviewing the Mental Health (Scotland) Act 1984, and, as part of that, the role of the Mental Welfare Commission. Interestingly, the Royal College of Psychiatrists in Scotland,in its response to the second consultation, has said that the Commission should undertake investigations into complaints about healthcare more frequently, and that it should have an independent power to publish its deficiency in care reports and more power to enforce its recommendations. Maybe it is human to support having a watchdog but to feel uncomfortable when it turns in your direction, especially in the aftermath of a distressing experience like suicide. James A T Dyer Director Mental Welfare Commission for Scotland, Argyle House, 3 Lady Lawson Street, Edinburgh. EH3 9SH 1 Alexander DA, Klein S, Gray NM, Dewar IG, Eagles JM. Suicide by patients: questionnaire study of its effect on consultant psychiatrists. BMJ 2000;320:1571-4. |
|||
|
|
|||
|
D M Hambidge, Parttime Consultant Psychiatrist Mid Cheshire Hospitals NHS Trust, Crewe
Send response to journal:
|
I have only just become aware of the article by Alexander et al,1, concerning the impact of patient suicide on the consultant psychiatrist. Perhaps the fact that so few responses have been posted says something about our professional attitudes to such disaters. Having been there, may I extend the discussion to include the impact of completing the, eventual, National Confidential Enquiry form for Professor Appleby's team at Manchester. This document arrives long after all the other enquiries and meetings and, inevitably, reopens all the personal emotional responses, when you think you have come to terms it all. The NCE is important, but will "somebody", "somewhere" remember to consider the mental state of the consultant left to complete the paperwork ? 1. Suicide by patients: questionnaire study of its effect on consultant psychiatrists. BMJ 10 June 2000, 1571-4 D.M.HAMBIDGE
|
|||