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A framework for “negotiating meaning” was applied to a healthcare service to achieve a collaboratively developed suicide prevention clinical pathway.

The framework was originally developed during a previous study that drew on the theory of philosophical hermeneutics to enable a researcher to better understand the experience of older people. This approach was then applied to a healthcare setting and the development of a suicide prevention clinical pathway. Clinical front-line staff engaged effectively and meaningfully with each other, consumers, family members and management to develop a clinical guideline that reflected best practice and improved care provision. An additional outcome involved establishing a supportive culture in which the shared meanings underpinning the experience of working with people expressing suicidality were explored.

An evidence-based suicide prevention clinical pathway was developed collaboratively with clinicians taking the lead in the process, and leading to the agreement being reached on the final guideline and processes established. The negotiation process brought the perspectives of the different parties together enabling the sharing of underlying meaning inherent in the experience of losing a consumer tragically to suicide. A commitment to taking joint action to reduce the likelihood of further incidents occurring also grew from the shared understanding that developed.

This paper describes the approach that was applied to facilitate engagement processes between clinicians and service management that also challenged the power differentials that usually exist within healthcare and led to positive engagement that supported the safety and quality agenda.

The purpose of this mixed methods rapid study was to identify the barriers and facilitators to implement relational and environmental risk management approaches to manage suicidality in inpatient services.

To achieve this within a short timeframe, a rapid review approach was chosen. Both research (qualitative and quantitative studies) and non-research material (policies, guidance and reports) were retrieved. The review was conducted across five databases: MEDLINE, EMBASE, EMCARE, PsycINFO and CINAHL for English language citations within the last ten years (2009 –2019).

A total of 17 primary research papers and a further 73 reviews and grey literature were included. There was evidence that the removal of anti-ligature equipment, by which regular checks of the environment to identify and remove ligature points and increased levels of observation are carried out well, reduces suicide in hospital.

There is a gap in research investigating “engagement activities” eliciting exactly what they are and determining how they might be effective. There is a need for new innovative ways for managing risk of suicide in hospitals that bring together meaningful engagement and maintaining safety.

Keeping people safe during an inpatient stay in a mental health service is a core function of mental health practitioners. This paper brings together what is already known about risk management and highlights areas for further investigation.

Rates of self-harm are elevated in prison, and there is limited evidence to support the efficacy of brief risk screening at reception to predict and prevent self-harm. This study aims to examine the predictive validity of the self-harm/suicide screening items embedded in a prison mental health screening tool from two key domains strongly associated with risk: previous suicidal/self-harm behaviour, and recent ideation.

A sample of men and women were screened on entry to prison, with eight screening items covering the two key domains of risk. Follow-up data on self-harm incidents were collected for 12 months post-screening. The predictive validity of individual screening items, item combinations and cumulative screening score was examined for the overall sample and for men and women separately.

Individual screening items across the two domains were all strongly associated with self-harm in the follow-up period, with odds ratios varying from 2.34 to 9.24. The predictive validity of both individual items, item scores and item combinations demonstrated high specificity but low to moderate sensitivity, and modest area under the curves (AUCs). Predictive validity was generally better for men than women; however, differences were not statistically significant.

Identifying those at risk of self-harm in prisons remains challenging and brief universal screening at prison entry should be only one component of a broader prison risk assessment and management strategy.

To the best of the authors’ knowledge, this study is one of very few to prospectively examine self-harm behaviour following risk screening. Predictive validity was examined in a representative sample of individuals in custody, and for men and women separately.

The collaborative assessment and management of suicide (CAMS) is an evidenced-based therapeutic framework designed to facilitate a co-authored and collaborative approach to addressing suicidality (Jobes, 2009). The collaborative nature of this approach is fundamental to its success in delivering suicide specific and recovery-oriented mental health care to thousands of suicidal people to date. The purpose of this paper is to outline the CAMS model and propose it as a recovery-oriented approach to addressing suicidality in mental health care.

The CAMS model and its philosophy are reviewed in light of recovery principles.

It is proposed that the CAMS model is consistent with a recovery-oriented approach to mental health care for suicidal people.

As yet there are no specifically identified recovery-oriented approaches to addressing suicidality.

This paper seeks to describe the development of a real time suicide alert system and to identify how, as a result, organisations were able to respond in a timely way to an increasing trend in suicides within the County Durham and Darlington area.

Between October 2008 and August 2009 an unprecedented concentration of suicides occurred in County Durham, North East England. As a result, an independent review of these deaths was conducted in 2009/2010. Recommendations from the review were implemented and included the development of a real time suicide alert system.

Following implementation of the real time suicide alert system in autumn 2010 a further significant concentration of cases was immediately identified. A total of 24 deaths were identified between September and December 2010. There was a wide geographical spread across County Durham and Darlington. The case profiles revealed a number of risk factors including recent bereavement, relationship difficulties and financial problems. In addition sleeplessness, low mood and problems associated with housing were also identified. Men under the age of 50 years accounted for over 63 per cent of the cases. An organisational response in County Durham and Darlington was triggered by the information provided via the real time alert. The response was framed by the case profiles, evidence from the literature and lessons learned from other areas in the UK that had also experienced an escalation of suicide cases. In January 2011 there were no further potential suicides in County Durham and Darlington and the three‐month rolling average number of suicides returned to below expected limits, and this remains the case as of December 2011. No direct correlation between the work of the response team across County Durham and Darlington and rate of suicides resuming within normal limits can be claimed, indeed many of the initiatives are still being evaluated but the organisation now has much better control over the ability to respond, characterised by timely evidence based interventions and improved partnership working.

The development of a local real time suicide alert system can reduce the delay in the reporting of potential suicides and can identify trends; it can also provide the basis for a timely organisational response.

This paper describes an innovative multiagency approach to the problem of delay in the notification of suicides. This will be of interest to commissioners and providers who may want to develop similar systems so that they can immediately identify an escalation of deaths due to suicide and respond in timely manner.

The purpose of this paper is to evaluate provider outcomes in response to two modes of suicide prevention training (e-learning and in-person) and a control group. The Collaborative Assessment and Management of Suicidality (CAMS) was adapted for e-learning delivery to US Veterans Administration mental health providers. Outcomes include: self-evaluated beliefs, ability, and self-efficacy in managing suicidal patients.

This study used a multicenter, randomized, cluster design to test the effectiveness of e-learning vs in-person conditions CAMS for changes in provider outcomes.

Survey scores showed significant improvements for both the e-learning vs control and the in-person vs control between pre-intervention and post-intervention; however, the e-learning and in-person conditions were not significantly different from each other.

Limitations of the study include that there were drop-outs over the study period and the survey questions may not have captured all of the aspects of the CAMS training.

Results suggest that e-learning training modules can provide comparable outcomes to in-person training for suicide prevention.

More providers may have accessible training materials for managing suicidal patients.

Currently practicing providers now can choose between two equivalent training modalities for improving the management of suicidality in their patients.

The purpose of this paper is to explore risk and protective factors associated with suicidal ideation among law enforcement personnel.

The methodology employed is based on the “Best Evidence Synthesis” approach, whereby researchers systematically examine and integrate the most empirically sound available research on the topic under investigation.

Results of studies showed that the interaction of multiple risk factors had a cumulative effect in increasing the risk for suicidal ideation. In total, five prominent aspects of policing were associated with risk for suicidal ideation: organizational stress; critical incident trauma; shift work; relationship problems; and alcohol use and abuse. Studies also indicated that protective factors and preventative measures had stress‐buffering effects which decreased the impact of police stressors.

The model is limited because few studies have employed methodologically‐sound research designs to test risk and protective factors related to police suicide. This conceptual overview may facilitate theory development and provide directions for future research.

Law enforcement agencies which implement programs that assist police personnel in developing active coping styles, identify and access available social support systems, as well as utilize community‐based services may decrease risk for suicidal ideation. This review provides practical applications for law enforcement training, education, and program development.

The paper represents the most recent review of risk and protective factors related to suicidal ideation among police personnel. This integration of research provides police practitioners with an evidence‐based ecological framework that can be applied universally in police management settings.

This paper aims to provide an overview of current suicide prevention across the UK criminal justice system (CJS). It considers shortcomings in current provision and how improvements could be made by drawing on international practice. Recommendations for practice going forward and suggestions for future research are made based on the literature.

This paper provides an overview of suicide prevention research to date. Relevant literature was identified through a basic journal article search, including terms such as “probation”, “criminal justice system”, “suicide”, “suicide prevention”, “UK” and “suicide theory”.

This paper highlights opportunities to improve practice based on the current evidence base, making several recommendations and suggestions for practice, including improving multi-agency cooperation through clearer distribution of responsibilities, simplifying data sharing and investing in trauma-focussed suicide training for staff.

This paper considers how research and psychological theory has informed suicide prevention practice in the UK. Limitations and challenges in applying theory to practice are explored, in the context of research with frontline staff who use such policies. This review proposes potential improvements to suicide prevention implementation to reduce suicide across the wider CJS.

This article represents an overview of the existing literature as well as possible future ideas for policy. It is therefore a piece that represents the viewpoint of all involved authors.

The purpose of this paper is to explore the experiences of both staff and patients in a medium-secure mental health unit of the self-harm and/or suicidal behaviour of others. Suicide and self-harm is highly prevalent in forensic settings and evidence suggests that experiencing other people’s self-harm and suicidal behaviour can lead to negative outcomes, both for staff and patients. This is particularly important in hospitals where patients are highly dependent on staff for support.

Semi-structured interviews were conducted with five staff members and six patients in a medium-secure male mental health unit in the North of England. Data were analysed following interpretative phenomenological analysis guidelines.

Three dominant themes were identified during analysis: the impact of suicide and self-harm; the role of others; and the importance of understanding and experience. Various impacts were discussed including desensitization, negative emotions and the desire to help. Other people played an important role in protecting against negative impacts, with shared experiences and peer support reported as the biggest benefits. Experiences of self-harm and suicide were found to increase understanding resulting in more positive attitudes. Additionally, the importance of training and education was highlighted.

This paper provides an insight into the experiences of staff and patients in medium-secure male mental health unit, which has benefits to practitioners when considering support mechanisms.