Evaluation of a Regional Post-discharge Monitoring System for Suicide Attempters

VigilanS is an innovative healthcare program. Participants of this program are all patients leaving in the Nord-Pas de Calais region who survived a suicide attempt.

General goals of the post hospitalization monitoring system for suicidal attempters are:

* Standardize general healthcare's practices by offering alert networks and innovative response procedures in case of suicidal crisis.
* Coordinate the various health partners' actions around the patient (GP, psychiatrist, psychologist).
* Contribute to reducing mortality and morbidity by suicide (subsequent suicide) in determined territories.

The evaluation of VigilanS will be quantitative and qualitative.

Every patient who is discharged after a suicidal gesture will be proposed to enter the program. He will be handed a "green card" with a toll-free and unique phone number and an information letter which explains the program and his rights as a patient.

Phone calls Calling team is composed of 4 psychologists and 3 psychiatric nurses especially trained to detect and manage suicidal crises. Monday to Friday, from 9 AM until 6 PM, there is two callers located in the emergencies' calling center. They will give calls to patients after their entry in the program and they will also receive incoming calls at the number available on "green cards" handed to patients.

Calls 10 days after discharge

Subjects who did at least two suicidal attempts before entering the VigilanS program will be call 10 to 20 days after their discharge from the hospital.

After every call, a short report is sent to the patient psychiatrist or his GP. 6 months calls

For every suicide attempters included in the program, a call is planned at the end of the sixth month after discharge from the hospital. This call aims to make a clinical review of patient and propose the end of the monitoring. If needed, the monitoring program can be reset for a 6 months period. In order to structure the call and gather data on the program evaluation, the six months call includes a psychological assessment by Mini International Neuropsychiatric Interview / MINI DSM V (Sheehan et al. 1998) and by the Columbia Suicide Severity rating Scale C-SSRS (Posner et al. 2011) as well as a global satisfactory survey on the program. If a contacted subject represents a high suicide risk, callers can trigger various actions like in a 10 days call.

If patient is unreachable a unique postcard will be sent to remind him of VigilanS coordinates. After every call, a short report is sent to the patient psychiatrist or his GP.

Postcards After every contact, but mostly after a 10 days call, the caller can decide to send 4 personalized post cards to a patient. One postcard is sent by month on a period of four months. Cards are embodied by patient name, logo of the structure which included him and coordinates of including department.

Quantitative evaluation will assess:

* Profiles of patients with good respond to the program or not (who had or not attempted suicide within 6 months)
* Development of partnership within the program (number of facilities sharing the system, number of patients in the program compared to overall number of suicide attempters addressed to one centre...).
* Program efficiency "in real life" on reduction of suicidal conducts. Using four comparator tools :

  * Evolution of suicidal conducts since the implementation of VigilanS in a specific center (comparison "before / after").
  * Evolution of suicidal conducts between a region implementing VigilanS and a region which doesn't, upon the same period of time (comparison "here/there").
  * Comparison of subsequent suicide attempts rate between patients in VigilanS and patients benefiting of "treatment as usual", within a year.
  * Comparison of mortality by suicide rate.
* The impact of VigilanS on a patient's care pathway based on data from CNAMTS' database (National health insurance system).

Qualitative evaluation will assess the system acceptability by patients and professionals and also the variation of representations of suicide by different professionals which are in contact with suicidal patients.

Eligibility Criteria:
Inclusion Criteria:

* leaving in the Nord-Pas de Calais region
* entering in the VigilanS program after a suicide attempt

Exclusion Criteria:

* refusal to enter in the program