Improving Mental Health Crisis Care

Suicide Mitigation early intervention and averting crisis

Dr Alys Cole-King MB, BCh, DGM, MSc, FRCPsychRoyal College of Psychiatrists Spokesperson on Suicide and Self harm

Consultant Liaison Psychiatrist BCU HBClinical Director Connecting with People

@AlysColeKing

Objectives

• Combining compassion and clinical governance

• Risk management or risk mitigation?

• Safe and effective triage, referral and response to people at risk of suicide

• Safety Plans

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•Mortality elevated post self-harm – especially first year¾ Suicide - self-poisoning/other methods¾ Accident – incl by poisoning¾ Alcohol or drug related¾ Respiratory disease and lung cancer.

•Alcohol misuse or dependence strongest predictor mortality

Self-harm in Primary Care Patients

Take people who present with self-harm seriously. It is an opportunity to intervene and potentially save their life

• Huge primary care data set

• People who attend primary care following S-H have an increased mortality rate highest within first year

• People who attend primary care following S-H repeat

• 1 in 5 repeat within a year

Key Findings Self-harm in Primary Care Patients

Identification of suicide risk

Patients identified as high risk

Patients identified as low risk

Strategic aspects suicide prevention

Strategic suicide prevention

Classification of suicidal thoughts (Cole-King 2010)

Classification of suicidal thoughts (Cole-King 2010)

Passive Active Dangerous Dangerous &Imminent

Characteristics

Nature of thoughts

Perception of future

Planning

Preparation

Ability to resist

Safe triage & response required

Self-help leaflets

U Can CopeFeeling overwhelmed

and staying safe

Feeling on the edge helpingyou get through it

www.connectingwithpeople.org/

Safety plan

• Reasons for living • Safe environment

¾ Identify distress triggers ¾ removing ways to harm yourself

• Activities to calm/lift mood or distract• Contacts for general support• Specific suicide prevention support• Professional support • Emergency contact details• Personal commitment to follow safety plan

Thank you@AlysColeKing

www.connectingwithpeople.org

Staying safe if you’re not sure life’s worth living- to share hope, compassionate advice, practical ideas & links for people in distress http://www.connectingwithpeople.org/StayingSafe

U Can Cope 22m film and online resources - for people in distress and those trying to support them to share hope, useful strategies and national organisations for support http://www.connectingwithpeople.org/ucancope

RCGP free suicide prevention e-learninghttp://www.rcgp.org.uk/learning/online-learning/ole/suicide-prevention.aspx

References:• Cole-King A, Green G, Gask L, Platt S (2013) Suicide Prevention are we doing enough?

Advances in Psychiatric Treatment. 19:284-291

• Cole-King A, Garett V, Williams H, Hines K, Platt S (2013) Suicide mitigation embedding compassion in clinical care. Advances in Psychiatric Treatment. 19:276-283

• Hines K, Cole-King A (2013) ‘Hey Kid are you OK..a story of a suicide attempt’ Advances in Psychiatric Treatment. 19:292-294

• Cole-King A, Lepping, P Suicide mitigation: time for a more realistic approach. 2010. BJGP 3-4• Cole-King A, Lepping P (2010) Personal view: Will the new Government change our approach

to risk? British Medical Journal, July. 341: c3890.• Cole-King A, Green G, Peake-Jones G, Gask L (2011) The Assessment and Management of

Patients with Suicidal Thoughts in Primary Care: An introduction to the concept and practicalities of suicide mitigation. Innovaite Vol 4: issue 5, 288-295

• Cole-King A, Green G, Wadman S, Peake-Jones G, Gask L (2011)Therapeutic assessment of patients following self harm in primary care. Innovaite Vol 4: issue 5, p278 -287

• Cole-King A (2010) Suicide Awareness in Primary Care: How making the right connections can save lives. RCGP News p 6.

• 2009 4 RCPsych peer reviewed poster presentations of all clinical tools