Despite the number of best practice guidelines for working with those at risk of suicide, there remains a paucity of research pertaining to the realities of clinical practice. The aim of this study was to develop a grounded theory of how clinicians respond to those at risk of suicide in UK community mental health settings. Semi-structured interviews were conducted with eleven members of staff including social workers, nurses, psychologists, psychiatrists and occupational therapists. A theory grounded in the resulting data was developed. Results: Anxiety, uncertainty and practitioners’ perceived responsibility for preventing suicide influenced their attributions in relation to a client’s distress. Findings indicated that clinicians most often attributed low responsibility to clients for both the cause and the solution. Therefore, clinicians sought solutions to suicidal presentations within services, rather than attending to contextual or environmental ‘triggers’ to offer a resolution, potentially increasing dependency on services. Feeling supported and an environment of psychological safety enhanced professionals’ capacity to tolerate the uncertainty inherent in this work which allowed professionals to ‘hand the responsibility back’. This highlights the importance of services creating an environment of psychological safety in order for clinicians to tolerate the uncertainty of working with those who present with suicide risk.

The overall aim of the research is contribute to a reduction in suicides within mental health services. This study will explore the learning process for mental health services following patient suicides in Northern Ireland (NI). It will focus on how the recommendations contained in Serious Adverse Incident reports, which are completed following all patient suicides, are translated into practice. The study will examine all SAI reports completed from January 2015 to December 2016. Focus groups with mental health professionals throughout NI will then be used to increase understanding of the enablers and barriers to effective implementation of these recommendations within mental health services.

Orientador: Neury Jose Botega / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-06T23:30:18Z (GMT). No. of bitstreams: 1 Cais_CarlosFilintodaSilva_M.pdf: 11229550 bytes, checksum: a9dd21a89813b1247415690cf31f50e2 (MD5) Previous issue date: 2006 / Resumo: A quase totalidade dos dados sobre indivíduos que repetem tentativas de suicídio provêm de países desenvolvidos. O objetivo deste estudo é descrever o perfil clínico de 61 indivíduos que deram entrada no Pronto Socorro do Hospital das Clínicas da Universidade Estadual de Campinas por uma tentativa de suicídio que era, pelo menos, a terceira de suas vidas. Tal descrição foi feita através da comparação com 102 indivíduos que deram entrada no mesmo pronto socorro pela primeira tentativa de suicídio de suas vidas. Dados sociodemográfícos e clínicos foram coletados através do questionário WHO/SUPRE-MISS, o qual continha também diversas escalas psicométricas. No grupo dos repetidores havia maior proporção de mulheres (83.6% vs 56.8%; OR= 4,47), indivíduos na faixa etária entre 25 e 44 anos, em pior situação ocupacional e com maior disfunção no desempenho de papéis sociais (OR= 2,5; 3,1 e 1.05 respectivamente). Repetidores também apresentaram mais sintomas depressivos. Talvez em nossa cultura mulheres tenham melhor retomo em termos de pedido de socorro e/ou mudança de ambiente após a tentativa de suicídio, o que encorajaria a repetição do ato / Abstract: The great majority of data regarding individuals with repeated suicide attempts were obtained from developed countries- The aim of this study is to describe the clinical profile of 61 Brazilian individuals who attempted suicide at least three times and compare them to 102 who were brought to a university hospital for their first suicide attempt. Socio-démographie and clinical data were collected using the WHO/SUPRE-MISS questionnaire, which also comprises several psychometric scales. In the repeaters' group, there were more women (83.6% vs 56.8%; OR= 4,47), 25-44 year-old subjects, worse occupational status and social role performance disability (OR= 2.5, 3.1 and 1.05 respectively). Repeaters also had higher scores on depression. Maybe in our culture women would obtain better feedback with such behavior, that is, help and/or change in the environment, which would encourage the repetition of the act / Mestrado / Saude Mental / Mestre em Ciências Médicas