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Do mental health facilities increase the risk of suicide?

Mental Health Facilities

A number of cases before the courts emanating from treatment in the Hunter region have drawn attention to the quality of care in our mental health facilities.

Over the course of the last few months, we have watched the consequences of the tragic death of 18 year old Ahlia Rafter being played out in the public domain both in an inquest into her death followed by an inquiry into the conduct of the nurses who cared for her at Calvary Mater Psychiatric Intensive Care Unit (‘PICU’).

It’s instructive to review how the case involving Ahlia Raftery and several others deal with the role of health care workers in psychiatric facilities.

The focus has generally been upon the avoidability of a death – patient or 3rd party – and, in that context, the standard of care provided by the psychiatric facility.

Ahlia Raftery was transferred between four mental health facilities in the six days before she took her own life.

Both in the inquest and then in the disciplinary hearing before the NSW Health Care Complaints Commission, the focus was on the care provided by four nurses who had been responsible for the care of Ahlia Raftery.

One of the results of the inquest into Ms Raftery’s death was a recommendation for one-to-one nurse to patient ratios in PICU.

The complaint brought by the HCCC alleged professional misconduct on the part of the nurses by having failed to undertake adequate observations of Ms Raftery in the hours before her death.

Two of the four nurses had their registration suspended for 12 months and the other two were reprimanded.

Much has been made since the HCCC findings of the poor work environment at the mental health ward and the “widespread and entrenched poor practices.” The nurses at the centre of the case have claimed systemic issues – inadequate staffing levels largely – played a major role in the outcome.

Some commentators argue that it is the psychiatric units themselves which cause the risk of suicide to increase.

In an article titled “Psychiatric hospitalisation and the risk of suicide” published in the British Journal of Psychiatry in 2018, Sydney psychiatrist Professor Matthew Large debates this issue with a British psychiatrist Professor Nav Kapur.

Professor Large asserts that the high rates of suicide in patients who have been admitted to a psychiatric facility is directly linked to their experience within the facility itself. He argues that the experience of being detained in a psychiatric hospital is so traumatic, that it is the hospital experience itself which causes the increased propensity to suicide either in hospital or shortly after discharge.

Professor Large writes that:

“[H]ospital treatment can be perceived as humiliating, stigmatising, coercive and traumatic.  Hospitalisation often results in a loss of social support and social role, and violent victimisation is frighteningly common. In-patients who are already vulnerable are likely to be particularly susceptible to these factors, which are known to be associated with suicide.”

Professor Kapur takes an opposite view and argues that just because there is a high correlation between detention in a psychiatric hospital and suicide upon release does not mean that it is possible to argue that the psychiatric hospital was the causative factor in the suicide as a correlation is not necessarily causative.

Further, the fact that a person is admitted to a psychiatric facility in the first place is because they have been assessed according to the provisions in the Mental Health Act 2007 (NSW) as needing to be protected from serious harm which the person might to do to himself or herself or other people. Therefore, it is arguable that psychiatric patients as a group have a higher propensity to suicide than the general population despite their experience in a psychiatric facility.

While Professor Large, acknowledges the relationship between psychiatric hospitalisation and the fact that the person was there in the first place because of their suicidal thoughts, he argues that this does not explain why there should be such a difference in the suicide rates of different psychiatric hospitals.

Professor Large argues that the variance in the reported studies on the number of suicides of psychiatric patients shows that it is the psychiatric facilities themselves which are responsible for this large variation.

It is possible to draw a conclusion based on Professor Large’s reasoning that poor quality care and unsafe psychiatric hospitals actually exacerbate the suicidal tendencies of an already suicidal person rather than reduce them.

Professor Kapur vehemently disagrees with Professor Large on most of his arguments and considers that psychiatric hospitals prevent rather than cause self-harm and suicide, but he concedes that variations in the quality of some hospitals might mean that patients receive ‘less-than –ideal care.’

Many would not agree with Professor Large’s proposition that an admission to a psychiatric hospital exacerbates the suicide risk of a person upon discharge.  There would, however, be likely to be general consensus that a poorly run and under-funded psychiatric facility, which provides, as even Professor Kapur concedes, ‘less-than –ideal care’ can play a role in exacerbating the risk of suicide of the patients it is charged to help.

Certainly where there has been a spike in the number of patients and ex-patients of a particular psychiatric facility turning to suicide, it should alert the authorities, that the care, that the particular facility is providing, requires urgent review.

If you or someone you care about needs support contact Lifeline Australia on 13 11 14

If you or a loved one has experienced an adverse outcome in relation to care from a psychiatric facility contact of our caring, health law team members, who are experienced in mental health legal cases and complaints, today to discuss your options for justice or compensation.

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