Quality standard

Quality statement 4: Suicide risk

Quality statement 4: Suicide risk

Quality statement

People who have a risk of suicide identified at preparation for discharge from an inpatient mental health setting are followed up within 48 hours of being discharged.

Rationale

Mental health practitioners should assess people's risk of suicide when preparing for discharge. This will take into account the person's risk on admission to the unit, throughout their stay and when discharged into the community. Everyone discharged from an inpatient mental health setting should receive follow-up, which should be within 48 hours for people who have a suicide risk identified. Follow-up can help to identify any further support they may need, such as access to a crisis service or other community support.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly.

Structure

a) Evidence of local arrangements to identify people at risk of suicide at preparation for discharge from an inpatient mental health setting and to record the risk for 48-hour follow-up.

b) Evidence of local arrangements to follow-up within 48 hours of discharge people who are identified as being at risk of suicide.

Data source: Local data collection, for example, hospital discharge protocols.

Process

Proportion of discharges from an inpatient mental health setting in which people are followed up within 48 hours of discharge if they are identified as being at risk of suicide.

Numerator – the number in the denominator followed up within 48 hours of discharge.

Denominator – the number of discharges from an inpatient mental health setting of people identified as being at risk of suicide.

Data source: Local data collection, for example, an audit of case notes or care plans.

Outcome

Number of suicides of people recently discharged from inpatient mental health settings.

Data source: National numbers of suicides within 3 months of inpatient discharge are published in the University of Manchester's National confidential inquiry into suicide and homicide by people with mental illness reports.

What the quality statement means for different audiences

Service providers (inpatient mental health settings) ensure that staff are trained to assess and monitor people's risk of suicide on admission to the unit, throughout their stay and when they are preparing for discharge into the community. They also ensure that staff are trained to follow-up people who are identified as being at risk of suicide within 48 hours of discharge, and that this follow up takes place.

Healthcare practitioners (mental health practitioners) work together to assess and monitor people's risk of suicide on admission to the unit, throughout their stay and when they are preparing for discharge into the community. They follow-up people within 48 hours of discharge from an inpatient mental health setting if they are identified as being at risk of suicide when preparing for discharge.

Commissioners (clinical commissioning groups) ensure that the services they commission have protocols in places to identify suicide risk throughout an admission and prior to discharge, and follow-up people at risk of suicide within 48 hours of discharge.

People leaving hospital after inpatient treatment for a mental health problem are contacted by someone from their care team to check how they are doing within 48 hours of their discharge, if the team are worried that they may be at risk of harming themselves.

Definitions of terms used in this quality statement

Follow-up

The communication method used for follow-up should be agreed in the person's care plan.

Equality and diversity considerations

Follow-up may be more difficult for people who are experiencing homelessness. This should be taken into account when considering discharge into the community. Housing needs should be discussed and arrangements for follow-up made before the person is discharged. This support may be available from the homelessness multidisciplinary team (for more information see NICE's guideline on integrated health and social care for people experiencing homelessness, recommendation 1.3.4).