Clinical management
Suicide in middle-aged males - opportunities for intervention
In the UK, males aged 40–54 years have the highest age-specific suicide rate. A national case series study found that 43% of middle-aged males who died by suicide had a GP consultation in the preceding 3 months - over half regarding a mental health problem - highlighting an opportunity for early intervention.
Clinical factors were identified that GPs should be alert to…
o Those who had recent GP contact before their suicide were more likely to have self-harmed in the 3 months before, compared to males who had no recent GP contact.
o Males with current physical illness, work-related problems, a recent history of self-harm, those who had attended for a mental health problem or were prescribed an SSRI/SNRI antidepressant, oral antipsychotic or benzodiazepine, were more likely to consult their GP shortly before dying by suicide.
Personalised holistic management may have a role in preventing suicide in these individuals.
WiseGP actions:
1. Who performs medication reviews in your practice? Do they feel confident exploring self-harm and suicidal thoughts? Are they able to assess risk and discuss appropriate tailored treatment/support? Could your practice team benefit from a clinical education session?
2. Consider allocating more time or arranging follow-up appointments to carefully assess middle-aged males, particularly for those who present with a new mental health problem or major physical illness and/or work-related problems, to explore the mental health impact and discuss support available.
Read more about research informing these recommendations here:
https://bjgp.org/content/early/2023/04/27/BJGP.2022.0589
Know how to support people bereaved by suicide
6000 suicides are recorded annually in the UK, with each death impacting on an estimated 135 people. Suicide bereavement is linked to a higher risk of mental health problems and suicide attempts. Therefore, provision of care to those bereaved by suicide is a key component of suicide prevention.
WiseGP actions:
Have a protocol to ensure any suicide is highlighted within your practice to the patient’s named/ usual GP.
Suggest a member of your PCN attends suicide bereavement training and shares their learning with the network.
Online modules: https://suicidebereavementuk.com/online-modules/
Training days: https://suicidebereavementuk.com/pabbs-training/
Conference - September 2023: https://suicidebereavementuk.com/suicide-bereavement-conference/
Read more about the research informing these recommendations here:
https://bjgp.org/content/70/691/e102
Know how to support young people who self-harm
Self-harm in young people is common, but there is a lack of evidence to inform GPs regarding how to support these people.
WiseGP action:
1. Listen and act when self-harm is disclosed. Explore the young persons’ self-harm behaviour, review medication and assess risk of overdose. Discuss treatment options tailored to the individual (psychological therapy/ medication) and arrange regular review.
2. Consider saving useful links to share, writing a text message with appropriate links or developing your own leaflet to share with young people who self-harm, containing advice on developing a safety plan and distraction techniques. Mind have useful resources on managing self-harm: https://www.mind.org.uk/information-support/types-of-mental-health-problems/self-harm/helping-yourself-now/
3. Consider sharing resources with parents to help them support a child who is self-harming. https://www.nationwidechildrens.org/family-resources-education/health-wellness-and-safety-resources/helping-hands/children-at-risk-for-self-harm-or-harm-to-others-home-safety-guidelines-for-families
Read more about the qualitative work informing some of these recommendations here:
https://bjgp.org/content/71/711/e744.long
Recognise self-harm in older adults
Self-harm is a major risk for suicide, which has highest rates amongst older adults. Self-harm is often concealed, even more so in older adults, due to stigma and shame.
WiseGP actions:
1. Review the RCGP toolkit for support diagnosing and managing mental health problems in older adults. https://elearning.rcgp.org.uk/mod/book/view.php?id=13115&chapterid=605
2. Consider a practice teaching session on self-harm and suicide risk assessment, with a focus on older adults. Here is a video on mental health problems in older adults which could support training: https://www.youtube.com/watch?v=G_qqCivAcCs
Read more about the research informing these recommendations here:
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(19)30095-1/fulltext
