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Staff experiences and perceptions of working with in-patients who are suicidal: qualitative analysis

  • Yvonne Awenat (a1), Sarah Peters (a2), Emma Shaw-Nunez (a3), Patricia Gooding (a4), Daniel Pratt (a5) and Gillian Haddock (a5)...

Suicidal behaviour is frequent in psychiatric in-patients and much staff time and resources are devoted to assessing and managing suicide risk. However, little is known about staff experiences of working with in-patients who are suicidal.


To investigate staff experiences of working with in-patients who are suicidal.


Qualitative study guided by thematic analysis of semi-structured interviews with mental health staff with experience of psychiatric in-patient care.


Twenty Staff participated. All had encountered in-patient suicide deaths or attempts. Three key themes were identified: (a) experiences of suicidality, (b) conceptualising suicidality and (c) talking about suicide.


Suicidal behaviour in psychiatric wards has a large impact on staff feelings, practice and behaviour. Staff felt inadequately equipped to deal with such behaviours, with detrimental consequences for patients and themselves. Organisational support is lacking. Training and support should extend beyond risk assessment to improving staff skills in developing therapeutic interactions with in-patients who are suicidal.

Corresponding author
Yvonne Awenat, University of Manchester, Division of Psychology and Mental Health, School of Health Sciences, Zochonis Building, Brunswick St, Manchester M13 9PL, UK. Email:
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Declaration of interest

Y.A. is a trustee for a North-West England branch of the charity Mind.

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1 Office for National Statistics. Statistical Bulletin: Suicides in the United Kingdom: 2014 Registrations. ONS, 2016.
2 National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH). Annual Report: England, Northern Ireland, Scotland and Wales. University of Manchester, 2015.
3 Stewart, D, Ross, J, Watson, C, James, K, Bowers, L. Patient characteristics and behaviours associated with self-harm and attempted suicide in acute psychiatric wards. J Clin Nurs 2012; 21: 1104–13.
4 Appleby, L, Shaw, J, Kapur, N, Windfuhr, K, Ashton, A, Swinson, N, et al. Avoidable Deaths: Five-year Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental illness (NCISH). University of Manchester, 2006.
5 Bowers, L, Banda, T, Nijman, H. Suicide inside. A systematic review of inpatient suicides. J Nerv Ment Dis 2010: 198: 315–28.
6 Cleary, M, Hunt, G, Horsfall, J, Deacon, M. Ethnographic research into nursing in acute mental health units: a review. Issues Ment Health Nurs 2011; 32: 424–35.
7 Department of Health. NHS Staff Health and Wellbeing: Final Report. Department of Health, 2009.
8 Johnson, S, Osborn, D, Araya, R, Wearn, E, Paul, M, Stafford, M, et al. Morale in the English mental health workforce: questionnaire survey. Br J Psychiatry 2012; 201: 239–46.
9 Cutcliffe, J, Stevenson, C. Feeling our way in the dark: the psychiatric nursing care of suicidal people – a literature review. Int J Nurs Studies 2008: 45: 942–53.
10 Haddock, G, Davies, L, Evans, E, Emsley, R, Gooding, P, Heaney, L, et al. A study to investigate the feasibility and acceptability of a cognitive behavioural suicide prevention therapy for people in acute psychiatric wards: the rationale and design of the ‘INSITE’ randomised control trial. Trials 2016; 17: 79.
11 Peters, S. Qualitative research methods in mental health. Evid Based Ment Health 2010; 13: 3540.
12 Tracey, S. Qualitative quality: Eight “Big tent” criteria for excellent qualitative research. Qual Inq 16: 837–51.
13 Braun, V, Clarke, V. Successful Qualitative Research: A Practical Guide for Beginners. Sage, 2013.
14 Jenkins, R, Elliott, P. Stressors, burnout and social support: nurses in acute mental health settings. J Adv Nurs 2014; 48: 622–31.
15 Grad, O. The sequelae of suicide: survivors, in International Handbook of Suicide Prevention: Research, Policy and Practice (eds O'Connor, R, Platt, S, Gordon, J): 561–76. Wiley-Blackwell, 2011.
16 Bowers, L, Simpson, A, Eyres, S, Nijman, H, Hall, C, Grange, A, et al. Serious untoward incidents and their aftermath in acute inpatient psychiatry: the Tompkins Acute Ward Study. Int J Ment Health Nurs 2006; 15: 226–34.
17 Wurst, F, Mueller, S, Petitjean, S, Euler, S, Thon, N, Wiesbeck, G. Patient suicide: a survey of therapist's reactions. Suicide and Life-Threat Behav 2010; 40: 328–36.
18 Strobl, J, Panesar, S, Carson-Stevens, A, Mclldowie, B, Ward, H, Cross, H, et al. Suicide by Clinicians involved in Serious Incidents in the NHS: A Situational Analysis. Salford Royal NHS Foundation Trust Clinical Leaders Network, 2014.
19 Bowles, N, Dodds, P, Hackney, D, Sunderland, C, Thomas, P. Formal observations and engagement: a discussion paper. J Psychiatr Ment Health 2002; 9: 255–60.
20 Cole-King, A, Green, G, Gask, L, Hines, K, Platt, S. Suicide mitigation: a compassionate approach to suicide prevention. Adv Psychiatr Treat 2013; 19: 276–83.
21 Gilburt, H, Rose, D, Slade, M. The importance of relationships in mental health care: a qualitative study of service users' experiences of psychiatric hospital admission in the UK. BMC Health Serv Res 2008; 8: 92.
22 National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH). In-patient Suicide Under Observation. University of Manchester, 2015.
23 Mind. Listening to Experience: An Independent Inquiry into Acute and Crisis Mental healthcare. Mind Publications, 2011.
24 Taylor, PJ, Awenat, Y, Gooding, P, Johnson, J, Pratt, D, Wood, A, et al. The subjective experience of participation in schizophrenia research: a practical and ethical issue. J Nerv Ment Dis 2010; 198: 343–8.
25 Bee, P, Richards, D, Loftus, P, Baker, J, Bailey, L, Lovell, K, et al. Mapping nursing activity in acute inpatient mental healthcare settings. J Ment Health 2006; 15: 217–26.
26 Cleary, M, Freeman, A. The cultural realities of clinical supervision in an acute inpatient mental health setting. Issues Ment Health Nurs 2015; 25: 489505.
27 Tarrier, N, Kelly, J, Gooding, P, Pratt, D, Awenat, Y, Maxwell, J. Cognitive Behavioural Prevention of Suicide in Psychosis: A Treatment Manual. Routledge, 2013.
28 National Institute for Health and Care Excellence. Self-Harm: Longer-Term Management (CG133). NICE, 2011 (
29 Kapur, N, Stegg, S, Turnbull, P, Webb, R, Bergen, H, Hawton, K, et al. Hospital management of suicidal behaviour and subsequent mortality: a prospective cohort study. Lancet Psychiatry 2015; 2: 809–16.
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Staff experiences and perceptions of working with in-patients who are suicidal: qualitative analysis

  • Yvonne Awenat (a1), Sarah Peters (a2), Emma Shaw-Nunez (a3), Patricia Gooding (a4), Daniel Pratt (a5) and Gillian Haddock (a5)...
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