Dr. Patrick McSharry - National Office for Suicide Prevention

NOSP 2012 Forum
Royal Hospital, Kilmainham Dublin 8.
Educating General Practitioners and
Primary Care staff to respond to
Suicidal Behaviour
Dr. Patrick Mc Sharry
General Practitioner, Enniscrone, Co. Sligo.
Suicide a reminder of the impact:
• In excess of 500 suicides every year in Ireland.
• 11,000 cases of DSH in Emergency Departments with
an estimated 50-60,000 managed in the community.
• Objective health indicators of burden using DALY
suicide is twice the burden of Diabetes (accounting for
2.3% of all disease worldwide)
• The impact on family, friends and community immense
and immeasurable.
• General Practice is well placed in the role of suicide
prevention.
Reach out- National strategy for Action on suicide
Prevention 2005-2014
- “agree, plan and deliver a programme of
education and training on suicide prevention
for the relevant members of the primary care
team. ”
- As part of this action the National Office of
Suicide Prevention (NOSP) and the ICGP are
developing such a course.
ICGP/NOSP Research
• Focus group meetings from August 2011-
January 2012 involving representatives from
relevant groups held in ICGP.
• Educational Needs Assessment of GPs and
primary care staff & patients on Suicide and
deliberate self harm with the research being
used to shape a course in Primary care.
International literature review
• International research shows physician
education in depression recognition and
screening and treatment reduces suicide
rates.
• Restricting access to lethal means (gun
law/medication legislation/barriers at high
risks locations) has also being shown to lead
to reductions in suicide rates.

Aim
• The aim of this research is to conduct a needs
assessment of members of the primary care
team in resect of dealing with patients who
present with suicidal ideation or deliberate
self harm.
Method
• Qualitative interviews with representatives from
groups followed by focus group discussion to
prioritise key items for inclusion in the
questionnaire.
( Focus Group: GPs & GPR, PNs,Patient Representative (SOS), Psychiatrists, Suicide Resource
officer, NOSP, ICGP Directors of Mental Health, Research, Education & Quality & Standards, )
• Delphi process 5 page online & postal
questionnaire sent to GPs, Practice Nurses, Allied
Health Professionals, Patients and Service Users
(through representative organisations)
Results
• 117 replies.
• GPs made up 51% of respondents with
Practice nurses accounting for 31%.
• Allied health professionals made up 5% and
patient representatives accounting for 13%
• 71% of the study population was female.
• 60% of professional respondents felt that a
suicide had impacted on their practice with
27% feeling it impacted on the subsequent
relationship with the deceased persons
relatives.
• Only one respondent reported having a
written practice protocol for dealing with the
suicide of a patient.

Comfort asking a patient about
suicidal thoughts
Current level of knowledge of suicide
risk assessment
100
90
80
70
60
50
40
30
20
10
0
GPs PNs AHPs
Comfortable
Uncomfortable
Not applicable
• 25 % of total group felt their level of
knowledge was below average.
• This varied greatly within the groups with only
2% of GP feeling their knowledge was below
average compared to 61% of Practice nurses.
Current level of knowledge of suicide
risk assessment.
Other key points
80
70
60
50
40
30
20
10
0
GPs PNs AHPs
Above average
Average
Below Average
• 2/3 had no member of their practice formally
trained in suicide risk assessment.
• 31% of GPs and 93% of PNs felt they did not have
adequate training in suicide risk assessment.
• 60% of all respondents felt they did not have
adequate information as to the best available
resources specific to their area (HSE & Voluntary)
• 93% felt Primary Care was not adequately
resourced for management of suicidal patients.
Format
• 85% felt that other members of the primary
care team had a role in suicide prevention
including the receptionist. Modules on suicide
awareness were therefore felt appropriate to
include support non clinical staff.
• 91% felt the need for structured training with
the same amount displaying a willingness to
partake. Time constraint being cited as the
reason for the non willingness to participate
Blended course comprising face to face modules
along with online e-learning covering :
• Suicide Awareness & Patient Testimony
• Assessment of suicide risk
• Problem Solving
• Crisis Prevention
• Consultation skills

How Long away from practice?
Total duration?
Where should modules be run?
In Conclusion
• International evidence to support structured
training reduces suicide rates
• Need for further ongoing education amongst GPs
& Primary Care team members
• GPs & primary care team members are eager to
partake in a blended course comprising (Elearning
and face to face modules)
• Preferably delivered at CME/CPD.
• Over 90% felt primary care was not adequately
resourced in dealing with suicidal patients.
• Suicide Prevention e-learning module
introduction video………………
http://www.screencast.com/t/g96H2Sm0z