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Suicide & Self Harm

This information is intended for action by all members who are in practice, including accredited and registered practitioners and members who work clinically. There is a need for us all to implement NICE Guideline NG225 on Self-harm: assessment, management and preventing recurrence which was published in September 2022.

Many of our members are already acting in accordance with this and are ensuring that training and clinical practice are up to date.

It is important to note that as mental health professionals, we are accountable and will encounter risk in our clinical practice, even if it is not the main purpose of our role. We must ensure that we assess and formulate risk in every assessment, and ensure plans are in place to support safety in line with this guidance. This should be done even when referring to another mental health professional.

The guidance clearly shows that risk assessment tools and risk stratification do not accurately predict risk, and are more likely to be inaccurate than not. We support the changes needed to make sure that we use more person-centred approaches to safety planning for people with mental health needs. The key messages are:

  • Do not use risk assessment tools and scales to predict future suicide or repetition of self-harm
  • Do not use risk assessment tools and scales to determine who should and should not be offered treatment or who should be discharged
  • Do not use global risk stratification into low, medium or high risk to predict future suicide or repetition of self-harm
  • Do not use global risk stratification into low, medium or high risk to determine who should be offered treatment or who should be discharged
  • Focus the assessment on the person's needs and how to support their immediate and long-term psychological and physical safety
  • Mental health professionals should undertake a risk formulation as part of every psychosocial assessment

As an organisation, we are reviewing our key guidance and standards documents to ensure that they accurately reflect these. Our guidance for independent practitioners already includes a link to the NICE guideline. We are taking steps to provide specific CPD in support of this guidance. We will also support training providers, students, applicants and accredited and registered members to make sure all are appropriately trained and updated, and ensuring that diverse needs, accessibility, equity, equality and inclusion are taken into account.

After publication of the guidance, the National Clinical Director for Mental Health, NHS England Dr Tim Kendall, wrote to support the culture and practice change needed to move towards more person-centred approaches to safety planning for people with mental health needs. A full copy of his letter can be found here.

The Chief Coroner’s newsletter in the summer of 2022 gives guidance to all coroners to include investigating the quality of the risk assessment carried out by mental health services when there has been a death by suicide. The extract from this newsletter can be found here.

Dr Adrian Whittington, National Clinical Lead for the Psychological Professions, NHS England also wrote to psychological professions organisations calling for action to implement this guidance, and reiterating that we owe it to families bereaved by suicide to ensure that we are up to date in our approach. A copy of his letter can be found here. He states:

"Of the approximately 17 people who take their own lives every day in the UK, five are in contact with mental health services and four of those five as assessed as low or no risk of suicide at their last contact. It is therefore vitally important that assessments of risk are not based on stratification into "low, medium or high risk", or the use of scales, but are based on a more comprehensive assessment and risk formulation."

We recognise that some of our members will be personally affected by the issues raised here, and while this can be taken to clinical supervision, they may also wish to access support outside the workplace.

Other resources

Keynote - Rory O'Connor 'Understanding the transition between suicidal thoughts and suicidal attempts' (2018)

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