Action 5.32

Predicting, preventing and managing self-harm and suicide

Action 5.32 states

The health service organisation ensures that follow-up arrangements are developed, communicated and implemented for people who have harmed themselves or reported suicidal thoughts

Intent

Adequate follow-up support is arranged and agreed by the nominated participants for when people who have self-harmed or reported suicidal thoughts leave the health service organisation.

Reflective questions

What procedures and processes are in place to ensure rigorous follow-up for people who have harmed themselves or reported suicidal ideation?

What partnerships have been developed with key agencies when responsibility for follow-up is transferred between agencies?

How does the health service organisation identify gaps in referral processes?

Key tasks

  • Develop a collaborative post-discharge treatment plan involving the person, their carers and family, and key service providers before the person leaves the health service organisation.

  • Communicate this plan verbally and in writing to all people who have a role in implementing the plan.

  • Ensure that plan is implemented.

Strategies for improvement

Hospitals

People who have recently attempted suicide are at increased risk of a subsequent attempt in the days and weeks following discharge from healthcare settings.5 People who have recently started antidepressant medicines are at increased risk of suicide. However, there is considerable variation in follow-up arrangements when people leave a health service organisation after a suicide attempt, with up to 30% of people leaving without any formal arrangements in place.

It is therefore essential that health service organisations ensure adequate follow-up for people who have harmed themselves or reported suicidal ideation. The Living is for Everyone framework underlines that ‘it is critical that the chain not be broken, as levels of risk can change rapidly’.2

Develop the post-discharge treatment plan

Ensure that development of the plan is collaborative and recovery oriented, using the principles of shared decision making outlined in the Partnering with Consumers Standard. Engage the person, their carers and family, and any other person involved in implementing the plan, and give them the opportunity to advise whether actions within the plan are feasible.

Post-discharge care may require cooperation across a number of different health and other service organisations in the community. Ensure that the roles and contact details are available to all key participants. If there is a person coordinating services, or if care is shared between different clinicians and services, include this information in the plan.

Communicate the post-discharge treatment plan

Ensure that communication of the plan is multimodal, using verbal, written and electronic means (where available). Confirm receipt of communication about the plan from key participants before discharge. Conduct all communications in respectful, non-judgemental language.

Implement the post-discharge treatment plan

Confirming implementation of the plan can present a challenge. For specialist mental health services, the rate of post-discharge community care within seven days is a nationally agreed performance indicator3, and follow-up can be confirmed internally within the organisation.

In situations in which clinical accountability is being transferred between services, support this process by establishing partnerships. For instance, when a person is being discharged from a private hospital, and they have an appointment with a private psychiatrist who has seen them in hospital and is sharing care with a general practitioner, processes can be implemented that specify when each clinician is reviewing the person, and how communication is being shared. Negotiate these arrangements such that they do not breach privacy legislation, but also such that privacy cannot be invoked and leave key participants uninformed of critical information.

The National Institute for Health and Care Excellence in the United Kingdom has developed guidelines for the longer-term clinical management of self-harm that align with the guidelines for short-term clinical response. These guidelines have been endorsed for use in Australia by the Royal Australian and New Zealand College of Psychiatrists.

Ensure that health service organisations working with recovery-oriented practice balance risk management with people’s stated preferences for care, particularly when a person has recently been identified as at high risk of self-harm or suicide.

Day procedure service

Day procedure services do not generally provide health care for treatment of self-harm or suicidal thoughts. In the rare event that a person discloses thoughts of self-harm or suicide in the day procedure setting, ensure that members of the workforce have access to local processes for notifying the referring doctor or referring the patient to specialist mental health services.

As identified in the endorsed national Living is for Everyone framework, suicide prevention requires a whole-of-community approach. If a workforce member at a day procedure service recognises that a person has thoughts of self-harm or suicide, ensure that follow-up is arranged. Do not assume that someone else or another agency has responsibility for this.

Refer to the hospitals tab for detailed implementation strategies and examples of evidence for this action.

MPS & Small Hospitals

People who have recently attempted suicide are at increased risk of a subsequent attempt in the days and weeks following discharge from healthcare settings.1 People who have recently started antidepressant medicines are at increased risk of suicide. However, there is considerable variation in follow-up arrangements when people leave a health service organisation after a suicide attempt, with up to 30% of people leaving without any formal arrangements in place.

It is therefore essential that health service organisations ensure adequate follow-up for people who have harmed themselves or reported suicidal ideation. The Living is for Everyone framework underlines that ‘it is critical that the chain not be broken, as levels of risk can change rapidly’.2

Develop the post-discharge treatment plan

Ensure that development of the plan is collaborative and recovery oriented, using the principles of shared decision making outlined in the Partnering with Consumers Standard. Engage the person, their carers and family, and any other person involved in implementing the plan, and give them the opportunity to advise whether actions within the plan are feasible.

Post-discharge care may require cooperation across a number of different health and other service organisations in the community. Ensure that the roles and contact details are available to all key participants. If there is a person coordinating services, or if care is shared between different clinicians and services, include this information in the plan.

Communicate the post-discharge treatment plan

Ensure that communication of the plan is multimodal, using verbal, written and electronic means (if available). Confirm receipt of communication about the plan from key participants before discharge. Conduct all communications in respectful, non-judgemental language.

Implement the post-discharge treatment plan

Confirming implementation of the plan can present a challenge. For specialist mental health services, the rate of post-discharge community care within seven days is a nationally agreed performance indicator3, and follow-up can be confirmed internally within the organisation.

In situations in which clinical accountability is being transferred between services, support this process by establishing partnerships. The health service organisation must be sure that, after a person has been treated for suicidal ideation, responsibility for engagement with the person has been effectively transferred. Negotiate these arrangements such that they do not breach privacy legislation, but also such that privacy cannot be invoked and leave key participants uninformed of critical information.

The National Institute for Health and Care Excellence in the United Kingdom has developed guidelines for the longer-term clinical management of self-harm that align with the guideline for short-term clinical response. These guidelines have been endorsed for use in Australia by the Royal Australian and New Zealand College of Psychiatrists.

Ensure that health service organisations working with recovery-oriented practice balance risk management with people’s stated preferences for care, especially when a person has recently been identified as at high risk of self-harm or suicide.

Hospitals

People who have recently attempted suicide are at increased risk of a subsequent attempt in the days and weeks following discharge from healthcare settings.5 People who have recently started antidepressant medicines are at increased risk of suicide. However, there is considerable variation in follow-up arrangements when people leave a health service organisation after a suicide attempt, with up to 30% of people leaving without any formal arrangements in place.

It is therefore essential that health service organisations ensure adequate follow-up for people who have harmed themselves or reported suicidal ideation. The Living is for Everyone framework underlines that ‘it is critical that the chain not be broken, as levels of risk can change rapidly’.2

Develop the post-discharge treatment plan

Ensure that development of the plan is collaborative and recovery oriented, using the principles of shared decision making outlined in the Partnering with Consumers Standard. Engage the person, their carers and family, and any other person involved in implementing the plan, and give them the opportunity to advise whether actions within the plan are feasible.

Post-discharge care may require cooperation across a number of different health and other service organisations in the community. Ensure that the roles and contact details are available to all key participants. If there is a person coordinating services, or if care is shared between different clinicians and services, include this information in the plan.

Communicate the post-discharge treatment plan

Ensure that communication of the plan is multimodal, using verbal, written and electronic means (where available). Confirm receipt of communication about the plan from key participants before discharge. Conduct all communications in respectful, non-judgemental language.

Implement the post-discharge treatment plan

Confirming implementation of the plan can present a challenge. For specialist mental health services, the rate of post-discharge community care within seven days is a nationally agreed performance indicator3, and follow-up can be confirmed internally within the organisation.

In situations in which clinical accountability is being transferred between services, support this process by establishing partnerships. For instance, when a person is being discharged from a private hospital, and they have an appointment with a private psychiatrist who has seen them in hospital and is sharing care with a general practitioner, processes can be implemented that specify when each clinician is reviewing the person, and how communication is being shared. Negotiate these arrangements such that they do not breach privacy legislation, but also such that privacy cannot be invoked and leave key participants uninformed of critical information.

The National Institute for Health and Care Excellence in the United Kingdom has developed guidelines for the longer-term clinical management of self-harm that align with the guidelines for short-term clinical response. These guidelines have been endorsed for use in Australia by the Royal Australian and New Zealand College of Psychiatrists.

Ensure that health service organisations working with recovery-oriented practice balance risk management with people’s stated preferences for care, particularly when a person has recently been identified as at high risk of self-harm or suicide.

Day procedure service

Day procedure services do not generally provide health care for treatment of self-harm or suicidal thoughts. In the rare event that a person discloses thoughts of self-harm or suicide in the day procedure setting, ensure that members of the workforce have access to local processes for notifying the referring doctor or referring the patient to specialist mental health services.

As identified in the endorsed national Living is for Everyone framework, suicide prevention requires a whole-of-community approach. If a workforce member at a day procedure service recognises that a person has thoughts of self-harm or suicide, ensure that follow-up is arranged. Do not assume that someone else or another agency has responsibility for this.

Refer to the hospitals tab for detailed implementation strategies and examples of evidence for this action.

MPS & Small Hospitals

People who have recently attempted suicide are at increased risk of a subsequent attempt in the days and weeks following discharge from healthcare settings.1 People who have recently started antidepressant medicines are at increased risk of suicide. However, there is considerable variation in follow-up arrangements when people leave a health service organisation after a suicide attempt, with up to 30% of people leaving without any formal arrangements in place.

It is therefore essential that health service organisations ensure adequate follow-up for people who have harmed themselves or reported suicidal ideation. The Living is for Everyone framework underlines that ‘it is critical that the chain not be broken, as levels of risk can change rapidly’.2

Develop the post-discharge treatment plan

Ensure that development of the plan is collaborative and recovery oriented, using the principles of shared decision making outlined in the Partnering with Consumers Standard. Engage the person, their carers and family, and any other person involved in implementing the plan, and give them the opportunity to advise whether actions within the plan are feasible.

Post-discharge care may require cooperation across a number of different health and other service organisations in the community. Ensure that the roles and contact details are available to all key participants. If there is a person coordinating services, or if care is shared between different clinicians and services, include this information in the plan.

Communicate the post-discharge treatment plan

Ensure that communication of the plan is multimodal, using verbal, written and electronic means (if available). Confirm receipt of communication about the plan from key participants before discharge. Conduct all communications in respectful, non-judgemental language.

Implement the post-discharge treatment plan

Confirming implementation of the plan can present a challenge. For specialist mental health services, the rate of post-discharge community care within seven days is a nationally agreed performance indicator3, and follow-up can be confirmed internally within the organisation.

In situations in which clinical accountability is being transferred between services, support this process by establishing partnerships. The health service organisation must be sure that, after a person has been treated for suicidal ideation, responsibility for engagement with the person has been effectively transferred. Negotiate these arrangements such that they do not breach privacy legislation, but also such that privacy cannot be invoked and leave key participants uninformed of critical information.

The National Institute for Health and Care Excellence in the United Kingdom has developed guidelines for the longer-term clinical management of self-harm that align with the guideline for short-term clinical response. These guidelines have been endorsed for use in Australia by the Royal Australian and New Zealand College of Psychiatrists.

Ensure that health service organisations working with recovery-oriented practice balance risk management with people’s stated preferences for care, especially when a person has recently been identified as at high risk of self-harm or suicide.

References

  1. National Health and Medical Research Council Centre of Research Excellence in Suicide Prevention. Care after a suicide attempt. Sydney: National Mental Health Commission; 2015.
  2. Australian Government Department of Health and Ageing. Living is for everyone. Fact sheet 12: working together for suicide prevention. Canberra: DoHA; 2007.
  3. National Mental Health Performance Subcommittee. Fourth national mental health plan: measurement strategy. Canberra: Australian Government Department of Health; 2011.
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