Suicide prevention and postvention in hospitals in Japan: Current status and perspectives

Inpatient suicide has been listed as a common severe incident in hospitals in the USA since the 1990s.1 In Japan, the Patient Safety Promotion (PSP) Committee of the Japan Council for Quality Health Care (JCQHC) first conducted a survey to reveal the situation regarding inpatient suicides in Japan in 2005.2 Thirty percent (170/575) of the participating hospitals reported a total of 347 inpatient suicides within the previous 3 years. Almost half of these cases had exhibited several risk factors of suicide just before their suicides. Care for medical staff who had been in charge of the patients died by suicide and who had been close to them was rarely provided. In addition, the survey revealed that learning opportunities for suicide prevention were lacking. The survey was conducted again in 2015 and it again revealed the current status and issues of inpatients' suicides. In particular, cancer patients accounted for 48.6% of suicides in hospitals without psychiatric wards, which gained significant attention.3 In 2009, based on the first survey, the PSP Committee assigned a special committee to develop educational tools (a textbook and several short movies) and a 2-day training program, including prevention and postvention for inpatient suicide. The program consisted of five lectures, six role-playing activities, and group workshops developed for participants to learn the basic knowledge of suicidology, mental disorders, communication skills, risk assessment, and intervention by a multidisciplinary approach, as well as occupational mental health (mental care/postvention for medical staff), planning for suicide prevention measures, and so on. The program officially commenced in 2011 and by 2019, 546 medical personnel from 261 hospitals had participated in the program. Few detailed investigations into inpatient suicide in general hospitals had been conducted previously, and no training programs involving such an extensive scale of education had been conducted worldwide. Therefore, this knowledge and these countermeasures have been reported in domestic and international conferences many times. To assess the effectiveness of the training program, we conducted a questionnaire survey among participants of the program between 2011 and 2016. The questionnaire consisted of multiple-choice questions. This study was approved by the Ethics Committee of Yokohama City University School of Medicine. During the study period, 400 participants attended the program, and a total of 393 individuals (male: 91; female: 302) completed the questionnaire (response rate: 98.3%). The most common occupation was nurse (n = 223, 56.9%), followed by medical safety officer (n = 68, 17.3%), psychiatrist (n = 31, 7.9%), and psychologist (n = 28, 7.1%). Table 1 shows the questionnaire responses. Before participation, about 90% of participants had felt that their knowledge about suicide and their suicide intervention skills were insufficient. They had been stressed when coming across suicidal patients, probably because of a lack of learning opportunities for suicide prevention. After participation, about 90% of participants felt that their knowledge about suicide had improved, and about 80% of participants felt that their intervention skills had improved. On the other hand, the rate of participants who answered that they now experienced reduced stress when dealing with suicidal patients was as low as 60%. A more comprehensive training program may be necessary to effectively alleviate the stress of medical staff dealing with suicidal patients. Nonetheless, the participants might again recognize resolving these issues would be difficult. In October 2016, the Japanese Society of Psychiatry and Neurology, the Japanese Society of General Hospital Psychiatry, the Japanese Association for Suicide Prevention, the Japan Psycho-Oncology Society, and the Japanese Society of Mood Disorders submitted a request form to the JCQHC in order to promote suicide prevention measures. It requested that the JCQHC establish an evaluation item on suicide prevention in hospitals to create countermeasures for prevention of inpatient suicide and support medical staff concerned with inpatient suicides. The JCQHC created the item of risk assessment for inpatient suicides in the new ‘Hospital Accreditation Standards,’ which was revised in 2017 (3rdG: Ver. 2.0). In the demanding report, it was shown that ‘the program for prevention and postvention of inpatient suicide will be offered to many hospitals in Japan.’ In 2018, a new measure of suicide prevention for cancer patients was inserted into the third version of the ‘National Cancer Control Promotion Basic Plan.’4 The designated intervention method for preventing suicide and related behaviors in cancer patients was developed by the authors and its feasibility has been tested (in file). Professor Kawanishi acknowledges grants from Japan Society for the Promotion of Science (09K08051). Dr Inoue reports personal fees from Yoshitomi Pharmaceutical Industries and grants from Grant-in-Aid for Scientific Research outside the submitted work. Professor Kawanishi reports grants from Fujifilm, grants from Novartis Japan, grants from Nihon Medi-Physics, grants and personal fees from Otsuka Pharmaceutical, grants from Nihon MSD, grants from Daiichi Sankyo, grants and personal fees from Takeda Pharmaceutical, grants from Shionogi, grants from Tsumura, grants and personal fees from Sumitomo Dainippon Pharma, grants from Eisai, grants and personal fees from Mochida Pharmaceutical, grants and personal fees from Pfizer Japan, personal fees from Meiji Seika Pharma, and personal fees from Janssen Japan outside the submitted work. Professor Cho reports personal fees from Shionogi, personal fees from Eli Lilly Japan, personal fees from Kyowa Kirin, personal fees from Pfizer Japan, grants and personal fees from Otsuka Pharmaceutical, personal fees from Meiji Seika Pharma, personal fees from Mitsubishi Tanabe Pharma, personal fees from Sumitomo Dainippon Pharma, personal fees from Astellas Pharma, and personal fees from MSD outside the submitted work. Professor Otsuka reports grants and personal fees from Otsuka Pharmaceutical, grants and personal fees from Sumitomo Dainippon Pharma, grants and personal fees from Mochida Pharmaceutical, grants from Takeda Pharmaceutical, personal fees from Meiji Seika Pharma, personal fees from Nihon MSD, and personal fees from Eisai outside the submitted work.

Topic: Suicide and Self-Harm Studies
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences