Abstract
Prevention of patient suicide is a major challenge for mental health services. This study applied both safety I and safety II approaches to gain an understanding of the detection and response process for suicide prevention in community mental health care in order to compare/contrast outputs from each approach. For safety I, 41 suicide incident reports were analysed using a systemic analysis approach. For safety II, interviews with 20 community-based mental health practitioners and managers were conducted asking their know-hows to successful suicide risk detection and response. The five key issues found from the Safety I approach were: (i) an inherent weakness in the interactions between patient and clinician with the presence of uncertainty in the risk detection; (ii) Poor patients’ engagement with services; (iii) Reliance on patients self-presenting in crisis and declining the offered support options; (iv) Delay in treating new patients; (v) Coordination, communication and process issues. On the other hand, the safety II approach revealed a complex decision-making process with the presence of uncertainty and trade-offs between patient clinical need, patient desire, legal and procedural obligations, and resource considerations. It also revealed a strong theme on the importance of peer-support. The results of this study indicate that safety II approach provides valuable insights into how to strengthen the system performance without challenging systemic issues, while system I approach identifies systemic issues and raise questions how to address them. These findings suggest the potential benefit of applying both approaches to quality and safety improvement in healthcare.
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References
Office for National Statistics: Suicides in GB (2016) Registrations—ONS. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/suicidesintheunitedkingdom/2016registration. Accessed 28 May 2018
Mulder R (2011) Problems with suicide risk assessment. Aust N Z J Psychiatry 45(8):605–607. https://doi.org/10.3109/00048674.2011.594786
Hollnagel E (2014) Safety-I and safety-II: the past and future of safety management. Ashgate Publishing, Farnham
Leveson N (2004) A new accident model for engineering safer systems. Saf Sci 42(4):237–270. https://doi.org/10.1016/S0925-7535(03)00047-X
Vincent C, Amalberti R (2016) Safer healthcare. Springer, Cham. https://doi.org/10.1007/978-3-319-25559-0
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Jun, G.T., Canham, A., Noushad, F., Gangadharan, S.K. (2019). Safety I and Safety II for Suicide Prevention – Lessons from How Things Go Wrong and How Things Go Right in Community-Based Mental Health Services. In: Bagnara, S., Tartaglia, R., Albolino, S., Alexander, T., Fujita, Y. (eds) Proceedings of the 20th Congress of the International Ergonomics Association (IEA 2018). IEA 2018. Advances in Intelligent Systems and Computing, vol 818. Springer, Cham. https://doi.org/10.1007/978-3-319-96098-2_56
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DOI: https://doi.org/10.1007/978-3-319-96098-2_56
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