Evaluation of official procedures for suicide prevention in hospital from a forensic psychiatric and a risk management perspective

Ferracuti, Stefano; Barchielli, Benedetta; Napoli, Christian; Fineschi, Vittorio; Mandarelli, Gabriele

doi:10.1080/13651501.2020.1759647

Cited by 7 publications

(6 citation statements)

References 21 publications

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“…Furthermore, although Law 24/2017 affirms the importance of clinical risk prevention by public and private health and social-health facilities, for some specific issues, such as suicide prevention, protocols are often generic, lacking risk stratification, specific indications for different risk degrees or diagnoses and standardized tools for risk assessment ( 7 ).…”

Section: Discussionmentioning

confidence: 99%

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Vox clamantis in deserto: a survey among Italian psychiatrists on defensive medicine and professional liability

Scognamiglio,

Morena,

Di Fazio

et al. 2023

Front. Psychiatry

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Due to recent events, professional liability for psychiatrists in Italy is currently a matter of lively debate. Specifically, overwhelming pressure on psychiatrists’ duties has been brought by regulatory developments, such as the closure of forensic psychiatric hospitals, with the consequent return of offenders to community-based care, and the mental health consequences of the pandemic. According to Italian courts, psychiatrists are not only responsible for diagnostic and therapeutic appropriateness but also for the effects of their interventions on patients, and their behaviors. The aim of this study was to explore the attitude and behaviors of Italian psychiatrists regarding defensive medicine and professional liability. A total sample of 254 psychiatrists was surveyed by means of a quantitative online questionnaire. Most psychiatrists reported practicing defensive medicine (no. 153/254, 60.2%) and felt that their position of guarantee compromised their work in healthcare for patients (no. 138/253, 54.3%). Age correlated inversely with acknowledgment of defensive practices (r = −0.245, p < 0.001), with younger physicians more prone to defensive medicine (p = 0.013), particularly for patients at risk of suicide or violence. Psychiatrists in ‘closed’ settings (hospital wards, residential and rehabilitation centers, mental health service units in prison) reported more malpractice claims (p = 0.037) and complaints (p = 0.031), as well as a greater propensity to act defensively. In the treatment of patients with violent behavior, suicidal ideation, dual diagnoses, and criminal convictions, defensive practices were associated more with perceived legal risks (r = 0.306, p < 0.001) than actual legal involvement (p > 0.05). Anxiety, anger, and restlessness were common reactions to legal complaints, involving no. 50/254 (19.7%) respondents, with 40% reporting impaired functioning. Most psychiatrists (no. 175/253, 68.9%) were concerned about both civil and criminal laws regarding their professional responsibility, but many were not fully informed about recent legislative regulations and younger physicians resulted scarcely trained in risk management (p < 0.001). In conclusion, our findings suggest that defensive medicine is a common phenomenon among psychiatrists and their position of guarantee drives this attitude. Education on legal implications and risk management should be provided starting from the university and continuing over time, to improve the knowledge of young and senior doctors on professional liability and inform their decision-making processes. This would also reduce defensive practices and improve the quality of healthcare. Considering the concerns of younger physicians, as well as of professionals working in acute and high-intensity medical care facilities, there is also an urgent need for a revision of the medical liability to ensure the sustainability of the National Health Service.

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Section: Discussionmentioning

confidence: 99%

“…Under PoG, psychiatrists are required to forecast patients’ future behaviors and what their intervention will elicit ( 6 ). In recent years, the Italian Supreme Court has frequently held psychiatrists criminally liable for the behaviors of their patients ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Vox clamantis in deserto: a survey among Italian psychiatrists on defensive medicine and professional liability

Scognamiglio,

Morena,

Di Fazio

et al. 2023

Front. Psychiatry

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“…Finally, it seems that as for the procedures for patient’s suicide prevention in hospitals, there is scarce implementation of the Ministerial Recommendations at local level (Ferracuti et al , 2020), this can be traced back to a critical issue of the absence of specific instructions to address the pertinent territorial and staff support needs in Ministerial Recommendations.…”

Section: Discussionmentioning

confidence: 99%

Managing and preventing acts of violence against health workers: results of a review evaluating hospital control procedures

Ferracuti

Barchielli

Napoli

et al. 2022

JACPR

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Purpose Violence against health-care workers represents a public health issue that affects individuals, organizations and may have legal consequences. In Italy, workplace violence (WPV) constitutes a “sentinel event”, defined as a particularly serious, potentially avoidable adverse event, which may result in death or serious harm to health-care workers, and which leads to a loss of public confidence in the health-care system. In 2007, the Italian Ministry of Health issued Recommendation No. 8, “Preventing acts of violence against health workers”, inviting each Italian Hospital to develop procedures and guidelines for dealing with and preventing acts of aggression. This study aimed at investigating the appropriateness of the procedures and guidelines developed by the Italian hospitals. Design/methodology/approach Procedures on preventing violence against health-care workers published by 29 Italian Hospitals between 2007 and 2020 were collected retrospectively via Web searches and further evaluated according to their compliance with the 2007 Italian ministerial recommendations. Findings A total of 9 documents out of 29 were fully compliant with the 2007 Ministerial Recommendation, 18 were partially compliant, while 2 were totally non-compliant. A total of 24 documents explicitly addressed the management of verbal and physical aggression, whereas 20 set appropriate training on de-escalation techniques for nurses and medical staff. Psychological support was fully considered in 11 procedures, partially considered in 14, while not included at all in 4. Originality/value Public procedures on preventing violence against health-care workers in Italian hospitals are scarcely compliant with the Ministerial Recommendations. The absence of specific instructions to address the needs at territorial level and the lack of support provided to health-care workers is a weak point in the effective management of WPV.

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“… 12 Psychiatric hospitals should also have appropriate administrative and structural devices in place. 13 A recent study conducted in the Eastern Cape, revealed a disparity in the knowledge of suicide management, which was linked to a lack of training. 14 This further highlights the need for authorities to prioritise upskilling of front-line workers in suicide prevention and assessment.…”

Section: Introductionmentioning

confidence: 99%

The effects of inpatient suicide on nurses at Weskoppies Hospital: A qualitative study

Zola,

Mtetwa,

Khamker

2024

South African Journal of Psychiatry

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Background: Inpatient suicide is a serious adverse event in psychiatric wards. Suicide can cause severe trauma to both patients and health professionals, who may develop maladaptation with poor coping skills. Healthcare practitioners are the second victims and historically, this concept has been overlooked. The psychological effects and lack of support have not been sufficiently explored.Aim: The emotional well-being and clinical practice of nurses who experienced inpatient suicide at Weskoppies Psychiatric Hospital was explored.Setting: Weskoppies Psychiatric Hospital, South Africa.Methods: In this qualitative case study, 12 nurses who had lost a patient to inpatient suicide some time during their employment were purposefully selected. Data were collected through individual in-depth interviews, which were audio recorded and transcribed. The data were thematically analysed.Results: Nurses were negatively affected by inpatient suicide resulting in a range of emotional and psychological effects, including fear, anger, sadness, flashbacks, guilt, and difficulty in coping. Clinical practice factors included being doubtful and extra vigilant. Although nurses received psychological support from the institution, they recommended in-service training with periodic reviews to prevent and manage inpatient suicide.Conclusion: Inpatient suicide is a serious adverse event, and mental health practitioners become second victims. These events do not only impact the psychological well-being of nurses but also influence the clinical practice. Mental health practitioners should receive adequate training and support in preventing and handling inpatient suicide.Contribution: This study provided insights into nurse’s perspectives on the effects of inpatient suicide and how they can be supported.

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Evaluation of official procedures for suicide prevention in hospital from a forensic psychiatric and a risk management perspective

Cited by 7 publications

References 21 publications

Vox clamantis in deserto: a survey among Italian psychiatrists on defensive medicine and professional liability

Vox clamantis in deserto: a survey among Italian psychiatrists on defensive medicine and professional liability

Managing and preventing acts of violence against health workers: results of a review evaluating hospital control procedures

The effects of inpatient suicide on nurses at Weskoppies Hospital: A qualitative study

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