Understanding key issues in suicide prevention

Understanding the services that are available and the importance of avoiding stigmatising language can be key steps in contributing to suicide prevention, according to Dr Hayley Gorton, senior lecturer in pharmacy practice at the University of Huddersfield and suicide prevention researcher.

It is important to remember that self-harm is different and distinct from suicide. Self-harm and suicide are on a spectrum of behaviours. “Some people self-harm for different reasons, so for regulation of emotion, because they have suicidal intent, they may be ambivalent or it might be a mixture of all those things – so it’s really quite a complex set of behaviours”, explains Dr Gorton.  Some of the work undertaken by Dr Gorton’s team has recently contributed to a new NICE guideline on self-harm.¹ Increasingly, community pharmacy teams are being recognised as having a part to play in having conversations with people about self-harm.

The expression, ‘to commit suicide’ is no longer thought to be appropriate and is considered to be stigmatising. Until 1961 suicide was illegal in the UK and remains so in some other countries. The phrase ‘to commit suicide’ carries “connotations of crime and that’s not how we want people to feel, so the phrase ‘died by suicide’ is preferred. ……. The key message is that using the word ‘suicide’ is okay. It is okay directly to use the word ‘suicide’ and that is ….encouraged actually by some of the mental health charities”, says Dr Gorton.  During their research it was clear from some of the comments made that pharmacy staff were very conscious of the stigma that might still be attached to suicide and mental health problems, she adds.

Turning to the practical implications for pharmacy teams, Dr Gorton says, “I think the first message is not to be scared – we’re not trying to overwhelm pharmacy teams.  This is about having the conversations actually people are already having with their customers/clients/patients but perhaps in the safest and most effective way. So, it is okay to use the word suicide and ask people about suicide – and there’s some nice resources on both the Mind and Samaritans websites that can help people with those sorts of phrases”. In addition, the Zero Suicide Alliance training is helpful and maybe even practising having the conversations [about suicide] might help to increase confidence, she suggests.

What has emerged from the research is the importance of thinking about triage, referral and signposting to services. “People working in pharmacy do this all the time”, says Dr Gorton.  One useful resource in the UK, that some people may not have heard of, is called Hub of Hope. This is a resource that enables people to search by postcode for relevant services to do with different mental health problems but also some of the wider societal problems or personal difficulties that people might be facing. Dr Gorton is keen to recommend local referral pathways wherever possible. “If you imagine you have someone coming into your pharmacy that’s quite distressed – to start sending them off even two or three miles down the road might be quite difficult for them. So, thinking about what really is in that person’s community but also remembering perhaps online resources for some people might be suitable or remote resources – telephone resources for example”.  She also advises pharmacy teams to explore the local systems including primary care networks and integrated care boards with a view to understanding how they can work across sectors and together.

Reference

1. NICE. Self-harm: assessment, management and preventing recurrence. NICE guideline [NG225] Published: 07 September 2022

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Dr Hayley Gorton MPharm, PhD, PGDip (ClinPharm), MRPharmS, FHEA, CF is a senior lecturer in pharmacy practice at the University of Huddersfield. She is also a co-chair of the Association for International Association of Suicide Prevention special interest group on suicide prevention in primary care. At the recent FIP Congress (Seville, 2022) Dr Gorton gave a presentation entitled, Suicide prevention: Are pharmacy teams an overlooked and indispensable asset?