Abstract
Nirui and Chenoweth's [1] recent paper, ‘The response of healthcare services to people at risk of suicide: a qualitative study’, is mistitled. Even allowing for the admitted small size and the unrepresentative nature of the sample, the identified cases are ‘completed’ rather than ‘at-risk’ suicides, and any extrapolation to the far larger and broader population is misplaced. This is not to say that their conclusions are invalid: those conclusions are presented explicitly as the suggestions of the bereaved relatives and relate largely to better assessment and follow up of those presenting with suicidal ideas or behaviour. There is theoretical support for such an intervention in, perhaps, the first month after presentation, although the benefit drops rapidly thereafter [2]. In practice there is little evidence that such interventions have much effect on population suicide rates, although it is reasonable to suppose they might improve overall psychiatric morbidity.
The authors might also have taken note of their initial experience in recruiting ‘attempters’, where ‘it became clear that these people were not interested in participating in the study’. In my experience this is a not uncommon response from patients assessed after presentations with deliberate self-harm.
The paper refers to negative attitudes to psychiatric patients documented in other studies, and implies but does not confirm that a similar problem exists with this sample.
Sample bias aside, negative attitudes are likely enough to occur, and I am sure my own service and I myself have been guilty at times. The solution lies in a combination of things, including staff education, emotional maturity, experience, and reduced workloads. They are only partly amenable to change.