Title: Identifying the impact of a colleague’s suicide on NHS staff, and their support needs, to inform postvention guidance.
Funder: Department of Health and Social Care

Abstract: Aim_x000D_ To understand the impact on, and support needs of NHS staff following a colleague’s suicide._x000D_ _x000D_ _x000D_ Background_x000D_ There is a high rate of suicides among staff who work in the NHS which is above the national average, particularly among female nurses, female doctors and male paramedics. We know that NHS staff often suffer from poor emotional and psychological health but little is known about how NHS staff suicides affect their colleagues. _x000D_ _x000D_ Past research shows that if people affected by suicide receive support early on, it can help them come to terms with their loss and reduce the risk of further mental health problems and suicide. It is therefore important that NHS staff receive the best support at the right time. _x000D_ _x000D_ Alongside the Samaritans, this study group will try to understand how suicide affects staff, and how NHS employers and managers can best support those likely to be affected. We will use this information to write guidance about how the NHS and other relevant workplaces can support staff after a suicide. _x000D_ _x000D_ Design and methods_x000D_ This is a 22 month study, involving face-to-face interviews with NHS staff affected by the suicide of a colleague. We will speak to staff working in different work places, such as the ambulance service, GP practices and hospitals. We will also speak to staff/managers who support staff affected by suicide. The interviews will explore the effects of suicide on individuals and teams and how they come to terms with their loss. The study will also identify what helps and hinders staff during the bereavement process. We will hold a stakeholder event at the end of the study and share our research findings with them. Stakeholders will include people affected by suicide, employers and other organisations who specialise in suicide and mental health such as the Samaritans and CRUSE bereavement services. Our findings and conclusions will be written up to provide appropriate advice to managers and organisations to help them to give the best support to staff following a suicide of a colleague._x000D_ _x000D_ Patient and Public Involvement and Engagement_x000D_ Discussions with members of the public and NHS staff who have been affected by the suicide of a colleague, have informed the need for this study and identified gaps in knowledge and support currently given to staff. We will continue to involve members of the public, nurses, paramedics and doctors who have been affected by suicide throughout the study.

Lay abstract: Background_x000D_ There were 18,998 deaths attributed to suicide in England between 2011 and 2015 in the general population, constituting 12 deaths for every 100,000 people per year. Amongst health professionals, the suicide rate is 24% higher than the national average, largely explained by the increased risk of suicide in female nurses (four times the national average), male paramedics and female doctors. Those affected by suicide are at greater risk of mental ill health and suicide. The impact on staff is unknown and there is currently no postvention guidance to assist NHS organisations or managers to support staff; this research will fill this gap._x000D_ Aim_x000D_ To understand the impact of a colleague’s suicide on NHS staff and their support needs, in order to inform postvention guidance._x000D_ Objectives_x000D_ 1. To undertake a rapid review of suicide impact and postvention interventions in other settings_x000D_ 2. To explore the impact of colleague suicide on staff wellbeing and grief reactions to such an event_x000D_ 3. To explore staff views about risk factors, relevant contextual factors, and warning signs, which may have contributed to the likelihood of suicide in their NHS colleagues_x000D_ 4. To identify what helps and hinders bereaved colleagues to seek support, to characterise supportive work cultures, and to identify staff preferences for future support _x000D_ 5. To explore how managers respond to and support their employees and colleagues following a death by suicide, and to identify current postvention activity_x000D_ 6. To use the findings to: _x000D_ a) develop evidence based postvention guidance for NHS organisations and managers on how to support and respond appropriately and effectively to bereaved or affected employees_x000D_ b) apply for further funding, to develop, and evaluate the appropriateness and effectiveness of, an empirically informed postvention support package for use across the NHS._x000D_ Methods_x000D_ WP 1 A rapid review of primary research to explore evidence of the impact of suicide in the workplace, including postvention policies and evaluations in other settings._x000D_ WP2 A qualitative study using a case-study approach: In-depth interviews will explore the experiences of staff bereaved by suicide (n=50) and the views of managers / staff who provided support (n=20). 6-8 cases will be identified through existing information on cases reported in the media, those identified by the research team, stakeholders and through snowballing. An inductive, iterative approach to analysis will be undertaken._x000D_ WP3 Co-design workshop. Findings of WP1 and WP2 will be analysed and triangulated by the research team with PPIE support, and presented to an expert consensus group to identify key components of the postvention guidance._x000D_ WP4 Co-production of postvention guidance with the Samaritans_x000D_ Timelines_x000D_ Four work packages over 22 months. Ethics and HRA will be sought before the start of the study._x000D_ Anticipated impact and dissemination_x000D_ The guidance will enable NHS employers and managers to provide support and respond appropriately and effectively to employees bereaved or impacted by colleagues’ suicide. The Samaritans hosts and co-chairs National Suicide Prevention Alliance (NSPA) with over 300 members, and is well-placed to support dissemination. Co-applicants will disseminate across their networks: Appleby (National Confidential Inquiry into Suicide); Chew-Graham (RCGP); Grayling (HEE). Stakeholders: Mortimer, Chief Executive, NHS Employers, Pace, Association of Ambulance Chief Executives

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH