It has been apparent to the interested observer for some time that implementation of standard 7 of the national service framework for mental health was making heavy weather. Not so much from a lack of intention as from a shortage of ideas. Now Professor Louis Appleby has come up with a specific initiative aimed at saving up to 60 lives a year ('Mental health 'czar' demands zero suicides on acute wards', news, page 10, 19 October).
This is to be welcomed, of course, but Graham Shelton and Chris Heginbotham are quite right to point out that this is hardly the nub of the problem. Attention has to focus much more on how patients are feeling about themselves - what are their guts telling them? Not all that easy to find out, but the following points are a start.
Staff-patient inter-relations: how and to what extent do ward staff inter-relate with the patients in their care?
Sometimes this is very good - individual staff members positively exude empathy. But many do nothing of the kind; some even seem to regard the task as one of containment, and in these circumstances individual patient morale can be expected to be low. The most persistent complaint from patients and former patients is: 'No-one will listen to me', followed by: 'No-one will believe me'. Many patients need to talk and talk and talk again - hard to take, but to be brushed off with: 'I'm too busy, got all this paperwork to do' or, worse still: 'See me later, I'm going for a smoke, ' is just the slap in the face that an anxious patient could do without.
Incidentally, when is the government's anti-smoking campaign going to focus on NHS staff, especially those in mental health?
Discharge arrangements: it is well established that the first few weeks after discharge present extra risk of suicide, especially among patients who live alone. And in far too many areas there is still insufficient co-ordination between ward staff and community workers.
One suspects that it isn't only a matter of talking to each other but of too few resources in community teams. Blocked beds are easy to identify, individuals in the community are hidden - out of sight, out of mind. Perhaps primary care trusts will have some impact on this problem, perhaps not.
Risk assessments: nothing in the psychiatric field is an exact science, least of all the assessment of risk, but this is frequently not well done. In how many cases is the carer taken seriously in the matter of assessing risk? Not often. I hope never again to hear a psychiatrist, told of a patient talking of suicide, respond with: 'I can live with that'.
Professor Appleby is to be congratulated on this move towards standard 7, but there is much more to be done.
Rev Frank Crowther Group co-ordinator for North Nottinghamshire NSF
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