In the March 2024 edition of Magnify – the Journal Club blog from BJPsych – Dr Angharad de Cates and Dr Merryn Anderson chair a journal club in collaboration with Cornwall Partnership Trust, discussing ‘Suicide and other causes of death among working-age and older adults in the year after discharge from in-patient mental healthcare in England: matched cohort study’. They are joined by a group of early career psychiatrists who presented an appraisal of the paper, and who have written a blog post discussing their reflections on the process. An expert panel, including the senior author of the paper, also joined the discussions.

When Sarah Badger and I were approached last summer to present a paper at the BJPsych Journal Club in November 2023, we might have admitted to a certain trepidation, but also a desire to fly the flag for Psychiatry in Cornwall (where we are both core trainee doctors) and thus accepted the challenge!

Together with Merryn Anderson, a registrar in Old Age Psychiatry, we focused initially on the obvious first task: article selection. Foremost in our minds was the international audience and the importance of selecting a paper that might reflect the universality of experience in our audience, from all points of the triangle of care.

We settled quickly on Merryn’s excellent suggestion of a paper published in the BJPsych in August 2022: “Suicide and other causes of death among working-age and older adults in the year after discharge from in-patient mental healthcare in England: matched cohort study.” This paper spoke to us as one for appraisal and reflection as it provided robust new cohort data from the UK on a topic of urgent relevance to all those with experience of the mental health system. We were both genuinely shocked by the relative risk of death by suicide, particularly within three months of in-patient discharge, in working-age patients. We were keen to present this emotive topic so that we could, in a small way, shine a light on it, and to encourage discussion about possible strategies for addressing the stark reality of all-cause increased risk of mortality after in-patient admission.

Our initial meetings once we had selected the paper were around general discussion of the topic and wider reading around the current literature and then breaking down the sections of the study for appraisal – a task we found relatively straightforward, given the logical methodology and honest self-appraisal the paper presented.

Sarah and I then met to arrange the division of the preparation of the presentation and met virtually (always the easier option in a rural county like Cornwall) to critique our work and ensure we made best use of our time: we were cognisant that we wanted to ring-fence a substantial portion of the hour for expert reflection and also a period for discussion and audience questions. Merryn and Angharad de Cates (from the BJPsych editorial team) kindly gave up their time to be a test audience when we rehearsed it for the first time, and made some really useful suggestions, particularly about the best way to conceptualise statistical concepts such as relative risk for our wide audience. We also tried to weave into the material some of our own experiences around attempts to optimise the therapeutic benefit of the in-patient environment, such as our experience of the work of the Hospital Rooms Charity.

On the day itself, despite the excellent behind-the-scenes preparation by the BJPsych editorial team, the Zoom technology wasn’t without gremlins, thus adding to the nerves of presenting to an international audience and indeed the lead author of the paper, Rebecca Musgrove!

However, we managed to stick to our timings (just!) and thus leave time for brief reflections from Rebecca as well William Lee, an epidemiologist, Jason Hancock, a liaison psychiatry consultant with an interest in medical education and Diane Goslar, a patient experience representative. These reflections then led naturally into a stimulating debate around the possible factors that might be influencing the outcome of increased all-cause risk of death following in-patient admission.

There was a recognition that more research in this area was desperately needed, for example, comparison between the in-patient population and those patients who are acutely managed in the community with support from crisis teams. It was a sobering experience reflecting on the statistics around this emotive topic, and it reinforced the gravity of the issue and the collective responsibility we all have as healthcare professionals to address it.