Identifying the impact of a colleague’s suicide on NHS staff, and their support needs, to inform postvention guidance.

Background

There were 18,998 deaths attributed to suicide in England between 2011 and 2015 in the general population, constituting 12 deaths for every 100,000 people per year. Amongst health professionals, the suicide rate is 24% higher than the national average, largely explained by the increased risk of suicide in female nurses (four times the national average), male paramedics and female doctors.

Those affected by suicide are at greater risk of mental ill health and suicide. The impact on staff is unknown and there is currently no postvention guidance to assist NHS organisations or managers to support staff; this research will fill this gap. Aim

To understand the impact of a colleague’s suicide on NHS staff and their support needs, in order to inform postvention guidance. Objectives 1. To undertake a rapid review of suicide impact and postvention interventions in other settings 2. To explore the impact of colleague suicide on staff wellbeing and grief reactions to such an event

3. To explore staff views about risk factors, relevant contextual factors, and warning signs, which may have contributed to the likelihood of suicide in their NHS colleagues

4. To identify what helps and hinders bereaved colleagues to seek support, to characterise supportive work cultures, and to identify staff preferences for future support

5. To explore how managers respond to and support their employees and colleagues following a death by suicide, and to identify current postvention activity 6. To use the findings to:

a) develop evidence based postvention guidance for NHS organisations and managers on how to support and respond appropriately and effectively to bereaved or affected employees

b) apply for further funding, to develop, and evaluate the appropriateness and effectiveness of, an empirically informed postvention support package for use across the NHS. Methods

WP 1 A rapid review of primary research to explore evidence of the impact of suicide in the workplace, including postvention policies and evaluations in other settings.

WP2 A qualitative study using a case-study approach: In-depth interviews will explore the experiences of staff bereaved by suicide (n=50) and the views of managers / staff who provided support (n=20). 6-8 cases will be identified through existing information on cases reported in the media, those identified by the research team, stakeholders and through snowballing. An inductive, iterative approach to analysis will be undertaken.

WP3 Co-design workshop. Findings of WP1 and WP2 will be analysed and triangulated by the research team with PPIE support, and presented to an expert consensus group to identify key components of the postvention guidance. WP4 Co-production of postvention guidance with the Samaritans Timelines Four work packages over 22 months. Ethics and HRA will be sought before the start of the study.

Anticipated impact and dissemination

The guidance will enable NHS employers and managers to provide support and respond appropriately and effectively to employees bereaved or impacted by colleagues’ suicide. The Samaritans hosts and co-chairs National Suicide Prevention Alliance (NSPA) with over 300 members, and is well-placed to support dissemination. Co-applicants will disseminate across their networks: Appleby (National Confidential Inquiry into Suicide); Chew-Graham (RCGP); Grayling (HEE).

Stakeholders: Mortimer, Chief Executive, NHS Employers, Pace, Association of Ambulance Chief Executives