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Suicide prevention guidelines for health workers

26 June 2003 Media statement

New suicide prevention guidelines for health workers welcomed

Associate Health Minister Jim Anderton says new suicide guidelines for emergency health workers will help save lives.

Emergency department and mental health service staff in hospitals will get new practical, evidence-based guidelines offering "how to" advise, assess and manage people who arrive at hospitals with suicidal thoughts, or after a suicide attempt.

The Ministry of Health commissioned the New Zealand Guidelines Group (NZGG) to develop these guidelines. The NZGG, in co-operation with a wide range of expert professional and consumer groups, worked on the guidelines which aim to reduce the risk of people making further suicide attempts after discharge from hospital.

"Suicide is a serious public health problem for New Zealanders of all ages, and people who end up in emergency departments with suicidal thoughts or after having made a suicide attempt, are at increased risk of making further attempts," says Jim Anderton.

"These people require serious attention, and emergency department workers who conduct risk assessments and or care for people at risk until further assessment by mental health services, are in a position to save lives.

"Therefore, it's important that staff are guided by evidence and best practice, and the guidelines released today will act as a tool. Suicide prevention requires a range of interventions across a number of settings, and the guidelines call-on emergency department staff to work collaboratively with mental health staff when follow-up care is needed."

These guidelines replace the Ministry of Health's 1993 guidelines for the management of suicidal patients which were focussed on mental health services. The new guidelines summarise the latest research evidence available on the assessment and management of people at risk, and are endorsed by the New Zealand College of Emergency Medicine, The Royal Australian and New Zealand College of Psychiatrist, the Mental Health Commission, the Council for Mental Wellbeing, and the New Zealand Nurses Organisation.

A key message for emergency departments is that anyone who talks about suicide must be taken seriously.

The guidelines also state that a suitably trained mental health clinician should be contacted to assist someone who has attempted suicide, or expressed suicidal thoughts.

Suicide and deliberate self-harm is one of the six major injury areas identified in the New Zealand Injury Prevention Strategy, also launched today.

"The test will be for the health sector to pick-up the guidelines and use them. To that end, the Government will be funding training for DHB staff on the guidelines, in line with the Ministry's Mental Health Workforce Development Plan. Resources will also be provided or developed for people who have suicidal thoughts so they know where to get help. Families of those who have lost a loved one to suicide or who have family members who have committed suicide will also be given assistance. They are at risk themselves in such an environment," says Jim Anderton.

Questions and Answers

Who developed the guidelines?

The guidelines were developed by the New Zealand Guidelines Group (NZGG). NZGG set-up a team of individuals from a wide range of professional and consumer groups (from mental health, from emergency departments, and including consumer, and family member perspectives) which reviewed the evidence and developed the key recommendations, which can reduce the risk of suicide in mental health and emergency health settings.

The information in the guidelines summarises the latest research evidence available on the assessment and management of people at risk for suicide by emergency departments. It was developed after an extensive systematic review of the literature overseen by international suicide researcher, Dr Annette Beautrais (Canterbury Suicide Project).

Key experts were also commissioned to review the document and write specific sections for Maori, Pacific people, Asian populations, Indian people, refugees, elderly people and children and adolescents. They also specifically deal with working with Maori at risk of suicide and Pacific People. What they offer that other guidelines do not is a discussion of other large ethnic groups including Asian people, Indian people and refugees.

The guideline content has been extensively peer reviewed and endorsed by professional and interest groups, local and international experts.

Who will use these guidelines?

The New Zealand Guidelines Group will provide emergency department and mental health staff with the guidelines. The strength of these guidelines is that they offer clinicians detailed and practical "how to" advice on suicide assessment and the management of people at risk.

Copies of the guidelines are available from the New Zealand Guidelines Group, and can be downloaded from its website: www.nzgg.org.nz.

What are latest figures on how many people attempted suicide in New Zealand in 2000/01 (for all ages)?

More females are hospitalised for intentional self-harm than males. In 2000/01, there were 1800 males hospitalisations, and 3260 females hospitalisations.

What are some of the key messages for emergency departments?

* Anyone who talks about suicide should be taken seriously.
* People who present following a suicide attempt are usually in a state of extreme distress.
* Training in suicide assessment improves staff performance, appropriate referrals and overall care.
* Information from significant others is helpful when assessing a young person provided this does not compromise safety.
* A suitably trained mental health clinician should be contacted whenever anyone seeks assistance following an act of deliberate self-harm, or expressing suicidal ideation.
* A safe environment should be provided for people who are intoxicated/cognitively impaired by drugs until they are sober. Then they should be further assessed.

When a person presents in an emergency department with a suspected suicide attempt, or with suicidal thoughts, what do the guidelines say staff should determine?

1. Whether the person's injury was caused by self-harm
2. How serious the deliberate self-harm was (including the seriousness of intent)
3. The key precipitants to self-harm/ideation
4. The current level of risk
5. The urgency for assessment by mental health services
6. The best way to keep the person safe and supported until further assessed.

What do the guidelines say about discharging someone from an emergency department?

Any person expressing suicidal ideation should be assessed before they are allowed to go home. If risk remains, emergency department staff should work collaboratively with mental health services to complete the handover.

* Suicidal intent is not present and the acute crisis has in some way been diminished
* The person is medically stable
* The person is not intoxicated (intoxicated people are at an increased risk of acting impulsively)
* Attempts have been made to ensure objects that could be used to self-harm have been removed from the person
* Whanau/family have been consulted and informed as appropriate.

Arrangements have been made for the person to return to a safe environment and advice given about removing ropes, guns, medications and chemicals from the home.
* Social supports/case workers/counsellors ideally have been consulted, informed and mobilised (if the person is being discharged out of work hours, ensure that the contact information is available for the next working day)
* The person has been given information about medications, emergency contact persons or services and some strategies to deal with continuing problems.
* Some treatment for the underlying psychiatric illness has been arranged, including referral to mental health services.

What are the key tasks for assessment in the guidelines?
* Establish rapport and work to develop a therapeutic relationship
* Involve whanau/family/support people in assessment and treatment planning (if appropriate and available)
* Ensure whanau/family/support people have access to 24-hour emergency contact numbers
* Consider the person's cultural, spiritual and religious values and beliefs. Offer relevant available services to the suicidal person
* Consult with colleagues or multidisciplinary team. Involve them when reviewing changes to risk, and in management planning.


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