In perspective - suicide watch

Specialist nurse Karen Lascelles argues that physio staff need to be more aware of suicide risks

Suicide prevention is everybody’s business.

Recent research indicates that suicide risk is particularly prevalent among people who have recently been discharged from acute hospitals.

It is also higher among those who either attend primary care settings very frequently or not at all.

Physiotherapists commonly work with people who experience suicidal ideation, which can be associated with chronic pain, significant sports injuries, traumatic brain injury, and spinal cord injury.

Suicide awareness training for physiotherapists is therefore essential.

A survey I carried out in 2013 identified that musculoskeletal physiotherapists in community health services do not routinely receive suicide awareness training.

In response, I delivered a pilot suicide awareness session to physiotherapists in Oxford Health NHS Foundation Trust.

The session, which lasted one hour, looked at topics such as risk factors for suicide, the relationship between self-harm and suicide and Thomas Joiner’s interpersonal theory of suicide.

This provided a helpful framework for conceptualising how some people develop suicidal feelings and helped to guide discussions about cases physiotherapists felt might be risky.

Joiner’s theory suggests that people who lack reciprocal supportive relationships, feel that they don’t belong and also believe that they are a burden are more likely to experience a desire for suicide.

This is particularly so when they feel hopeless about finding any kind of resolution.

Suicidal desire does not necessary lead to suicidal intent, however. According to the interpersonal theory, intent is associated with ‘acquired capability’.

Acquired capability can build up through various behavioural and psychological means and becomes dangerous when it leads to a belief that the pain and fear associated with dying by suicide will be less than that of continuing to live in one’s current state of mind.  

Acquired capability with physio patients may stem from, or be accelerated by, persistent pain and a loss of role, mobility and identity linked to the person’s physical condition.  

The physio staff said the suicide awareness training was relevant, interesting and helpful.

One, who had a high-risk individual on her caseload, said the session helped her to understand some less obvious risk issues. She also felt more confident about communicating her concerns to the patient and the GP.

Another said: ‘Very interesting discussion ... we all get patients who disclose suicidal thoughts or would be considered at risk of suicide, and it’s really good to have a bit of direction on where to go with it.’

The participants also said a pathway document, covering issues such as key risk factors, and referral and contact information would be helpful.

This is now being designed.

Karen Lascelles is suicide prevention lead nurse, Oxford Health NHS Foundation Trust.For more information, email:

Frontline Staff

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