K. Gournay et L. Bowers, Suicide and self-harm in in-patient psychiatric units: a study of nursing issues in 31 cases, J ADV NURS, 32(1), 2000, pp. 124-131
A significant number of incidents of suicide and self-harm occur whilst pat
ients are in receipt of care as in-patients. This audit comprises 31 cases
which were referred to the first author for expert opinion, each case being
the subject of legal action brought by patients and/or their families. The
cases were referred from 31 different NHS trusts across England. All conce
rned suicide/serious self-harm in people in receipt of in-patient care. The
aims of this audit were to carry out a detailed assessment of the 31 indiv
idual cases, so as to provide a nursing dimension to already established en
quiries in this area and also to examine whether specific issues might be t
he subject of more systematic research. Further, this paper aims to provide
some insights in the area of litigation, where nurses are becoming increas
ingly involved. The same broad approach to information-gathering and analys
is was used, comprising a systematic review of case records, trust policies
, expert reports and, where appropriate, inquest transcriptions. The sample
comprised 12 suicides and 19 cases of serious self-harm. Factors associate
d with these events include: being male, having a dual diagnosis of mental
illness and drug/alcohol abuse, and age between 21 and 30 years. Of the 12
deaths, five occurred in hospital, four by hanging and one by drowning. The
audit highlighted environmental factors associated with these events which
, arguably, could be simply addressed. There was a considerable variation i
n the content and quality of observation policy and practice. The results o
f this audit point to the need for further research but, above all, provide
evidence requiring urgent action by the Department of Health regarding the
setting of national standards.