This Research Page is used to inform EPSO members and others about follow up or interesting research projects related to the EPSO working groups or to topics discussed at the EPSO conferences in the past.

The Research projects at this page must have a relation to EPSO.

Project

Mark van Twist News Media attention for supervisory organisations

Mark van Twist Presentation on Public Managers and Media Attention

Mark van Twist  NSOB research proposal - supervisory organizations in health services    .......................and media

Project

Sandra Eismann on EPSO Patient safety report

Project

Annemiek Huisman PhD research on supervision of suicides in mental health care in the Netherlands

Annemiek Huisman recently finished her PhD on supervision of suicides in mental health care in the Netherlands at the VU University Amsterdam. For her research, she studied 505 suicide notifications sent to the inspectorate, and interviewed clinicians, mental health care directors and inspectors about the effects of the notifications procedure.

Results of the study into suicide notifications files showed that in 26% of the 505 suicide notifications, the clinicians involved or the medical director reported that lessons were learned after the suicide, or that policy changes were installed. Most frequently, these lessons concerned improving communication among clinicians and continuity of care, improving suicide risk assessment procedures or more involvement of relatives in the treatment.
In the total sample, 227 notifications received follow up by the inspectorate: for 104 notifications this concerned requests for further information, for 106 notifications inspectors gave remarks or suggestions for improvement, and for 17 notifications the clinicians or services involved were contacted. Responses made by inspectors most frequently addressed whether a suicide had been evaluated by the clinicians involved, and what the results of this evaluation were. Also, the adequacy of treatment for psychiatric disorders, use of treatment guidelines and collaboration with other practitioners or services were important themes in the responses made by inspectors. Follow-up by the inspectorate was more likely when a suicide involved a patient treated in a mental health care setting for less than a year, or when the notification was accompanied by the mental health institution’s plans for improving its policies. Further questions or remarks posed by the inspectorate occurred less often when a patient was discharged from inpatient care in the three months before the suicide. Compared to 1996-2001, responses made by the inspectorate more frequently emphasized the importance of suicide risk assessment in the period 2002-2006. In conclusion, the Dutch inspectorate might improve supervision on suicides in mental health care by continuing their emphasis on systematic suicide risk assessment, and by giving more attention for the treatment for patients recently discharged from inpatient care, and more focus on a restrained use of no-suicide contracts.

Results of the interview study indicate ambivalence in both medical directors and clinicians concerning the effectiveness of the suicide notification procedure. The evaluation of events and care preceding a suicide of a patient was unanimously seen as positive in the interviews. Supervision by the inspectorate was experienced to underline the importance of suicide prevention and to keep both the medical directors and clinicians alert. Another positive aspect of the procedure according to the interviewees was that the supervision system provides external monitoring of quality of care, ensuring detection of malfunctioning institutes or clinicians if necessary. In addition, the inspectorate has stimulated the development of policies for the treatment of suicidal patients. The main criticism on the suicide notification procedure provided by both medical directors and clinicians concentrates on the atmosphere of guilt or blame surrounding suicides in treatment settings. It is concluded that the inspectorate has a stimulating role, motivating mental health care directors to critically self reflect, and opening discussion about suicide risk assessment, use of no-suicide contracts, continuity of care and the involvement of family members in the treatment of suicidal patients. Main points of criticism seem to center around the issue of guilt implied by the preventability driven work of the inspectorate and the focus on individual notifications instead of structural problems.

Based on the results of the several studies, Huisman has proposed a new model for supervision. In this new model, it is recommended that mental health care services employ a suicide prevention committee and thoroughly implement guidelines for the care of suicidal patients. Furthermore, in the proposed model there is less attention and emphasis on individual notifications and more emphasis on structural problems in mental health care provision and general suicide prevention policies within mental health care services.

For further information: Annemiek Huisman, a.huisman@psy.vu.nl.

Project

Paul Robben accepted his professorate at the University of Rotterdam ( ERASMUS UNIVERSITY) Click here to see his presentation