Understanding the factors associated with mental health practitioners’ engagement in effective suicide prevention activities within an Improving Access to Psychological Therapies (IAPT) service

Background This thesis comprises of a systematic review and three empirical studies. It developed from efforts to encourage a culture within a primary care mental health service which maintained a focus on suicide prevention, despite the relative rarity of suicide deaths in any individual clinical setting. The service aimed to improve the knowledge and confidence of practitioners in this vital area and recognised the importance of supporting practitioners in the event of them losing a patient to suicide. Methods Three areas for study were selected which may be associated with practitioners’ engagement in suicide prevention efforts. A systematic review of the impact on mental health practitioners of losing a patient to suicide was followed by a qualitative study exploring the impact of such deaths on practitioners within an Improving Access to Psychological Therapies service. A survey of all staff in an NHS Mental Health Trust was conducted using the Attitudes to Suicide Prevention Scale (ASPS) and these data were used to perform a replication of the validation of the scale. A new scale was developed to measure practitioners’ confidence in assessing, formulating and managing the risk of suicide. This was administered to mental health practitioners to assess the psychometric properties of the scale. Results The systematic review included qualitative and quantitative studies (n=54) and found that the most common personal reactions included guilt, shock, sadness, anger and fear of blame. Impact on professional practice included self-doubt and being more cautious and defensive in the management of suicide risk. As quantitative study methodologies were heterogeneous, it was difficult to make direct comparisons across studies. However, across 13 studies (total n = 717 practitioners) that utilised the Impact of Event Scale, between 12% and 53% of practitioners recorded clinically significant trauma scores. The need for training focused on the impact of suicides and the valu