1493594112633 - Suicides of patients in mental health care reflect complex needs

Suicides of patients in mental health care reflect complex needs

Patients at risk of suicide are not getting their complex mental health needs met, a Nelson psychologist says.

Recent figures show 12 people have died in suspected suicides while in mental health care over the last four years in Nelson Marlborough.

Te Whare Mahana Trust clinical manager Shelley Harvill​ said for some it was not an issue of getting access to treatment, but ensuring patients were getting the right kind of treatment.

“Systems, as with people, don’t get it right all the time.”

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The figures released to the Labour Party by the Health and Quality Safety Commission show in the four years to 2015-16, 506 patients around the country took their life by suspected suicide. 

In Nelson Marlborough, there were 16 incidents during that time which involved serious adverse behaviour, self harm and suspected suicide. 

Of those incidents, 12 were outpatient suspected suicides which indicated the patient had been in recent contact with mental health services. 

Te Whare Mahana is a mental health non-governmental organisation in Takaka. It is the only residential facility in the country that offers a dialectical behaviour therapy (DBT) programme for people who have been diagnosed with multiple and complex disorders. 

“For people who have a history of a chronic pattern of suicide or self-harm, that is particularly a pattern of behaviour that is very difficult for the regular system to work with for lots of different reasons,” Harvill said. 

DBT is a cognitive behavioral treatment that was originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder.

Earlier this year, US pyschologist and DBT expert Dr Alan Fruzzetti​ was in Nelson to educate mental health professionals on how to offer the treatment. 

Fruzetti said at the time that Te Whare Mahana was a real anchor point for New Zealand, treating people with severe problems who had not had success elsewhere.

Harvill was aware there were other DBT outpatient programmes around the country that were under pressure.

“I think DHBs are pressured to be cost-effective so it can be hard to maintain DBT teams … it is a real challenge, because to keep up that level of expertise means an investment in people’s training.”

Having worked in the mental health system in Canada, she said there were similarities in their statistics so it wasn’t the case that New Zealand “had it all wrong”.

“I think healthcare systems in general have difficulty working with people effectively, especially with chronic suicidal patterns.”

Ministry of Health mental health director Dr John Crawshaw said any suicide was a tragedy but the rate of suspected suicides in relation to population growth was “holding steady”.

“A suicide by someone who may have been in contact with a mental health provider can indicate … that the service had been working with an individual who was already seriously unwell.”

All suspected suicides by mental health service users were fully investigated by the coroner and the mental health service concerned, Crawshaw said.

Nelson Marlborough Health general manager of mental health, addictions and disability support services Jane Kinsey said the health board conducted an internal review of all suspected suicides and serious adverse events where patients were injured.

The HSQC data estimated the Nelson Marlborough population to be 145,680 in 2016 and Kinsey said there were more than 30,000 people in the region with mental health records.

That showed there were a huge number of seriously unwell and vulnerable people who were successfully treated, supported and protected.

Each mental health patient had a unique care plan in place, many had a schedule of follow-up appointments and were assigned a case manager who offered oversight to support recovery.

Kinsey said in addition to having a case manager and a care plan, mental health outpatients were encouraged to visit their GP who could connect them with secondary mental health specialist services and community support services.

She said most people who died by suicide in New Zealand were not current clients of a mental health service and many had never had contact with mental health services.

“This is why it is so important that family, friends, employers – all community members – reach out to someone who is clearly unwell, distressed, or acting out of character. Talking and listening are very important, as is helping someone to get the support they need, to take the first step.”

Kinsey said it was important to acknowledge that suicide prevention was not possible in all cases – despite high levels of quality intervention and support. 

WHERE TO GET HELP

Lifeline (open 24/7) – 0800 543 354

Depression Helpline (open 24/7) – 0800 111 757

Healthline (open 24/7) – 0800 611 116.

Samaritans (open 24/7) – 0800 726 666

Suicide Crisis Helpline (open 24/7) – 0508 828 865 (0508 TAUTOKO). This is a service for people who may be thinking about suicide, or those who are concerned about family or friends.

Youthline (open 24/7) – 0800 376 633.

For further information, contact the Mental Health Foundation’s free Resource and Information Service (09 623 4812).