Mental Health and Specialist Services, Gold Coast Hospital and Health Services, Southport, QLD, Australia.
Faculty of Health Sciences & Medicine, Bond University, Robina, QLD, Australia.
Aust N Z J Psychiatry. 2020 Jun;54(6):571-581. doi: 10.1177/0004867420918659. Epub 2020 May 8.
The prevailing paradigm in suicide prevention continues to contribute to the nihilism regarding the ability to prevent suicides in healthcare settings and a sense of blame following adverse incidents. In this paper, these issues are discussed through the lens of clinicians' experiences as second victims following a loss of a consumer to suicide, and the lens of health care organisations.
We discuss challenges related to the fallacy of risk prediction (erroneous belief that risk screening can be used to predict risk or allocate resources), and incident reviews that maintain a retrospective linear focus on errors and are highly influenced by hindsight and outcome biases.
An argument that a Restorative Just Culture should be implemented alongside a Zero Suicide Framework is developed.
The current use of algorithms to determine culpability following adverse incidents, and a linear approach to learning ignores the complexity of the healthcare settings and can have devastating effects on staff and the broader healthcare community. These issues represent 'inconvenient truths' that must be identified, reconciled and integrated into our future pathways towards reducing suicides in health care. The introduction of Zero Suicide Framework can support the much-needed transition from relying on a retrospective focus on errors (Safety I) to a more prospective focus which acknowledges the complexities of healthcare (Safety II), when based on the Restorative Just Culture principles. Restorative Just Culture replaces backward-looking accountability with a focus on the hurts, needs and obligations of all who are affected by the event. In this paper, we argue that the implementation of Zero Suicide Framework may be compromised if not supported by a substantial workplace cultural change. The process of responding to critical incidents implemented at the Gold Coast Mental Health and Specialist Services is provided as an example of a successful implementation of Restorative Just Culture-based principles that has achieved a culture change required to support learning, improving and healing for our consumers, their families, our staff and broader communities.
预防自杀的主流范式继续导致一种虚无主义，即认为在医疗保健环境中预防自杀的能力有限，并且在发生不良事件后会感到自责。本文通过临床医生在失去患者自杀后的二次伤害经历，以及医疗机构的角度来讨论这些问题。
我们讨论了与风险预测谬误相关的挑战（错误地认为风险筛查可用于预测风险或分配资源），以及事件回顾，后者保持对错误的回顾性线性关注，并且受到后见之明和结果偏差的高度影响。
提出了应在零自杀框架下实施恢复性公正文化的观点。
目前在发生不良事件后使用算法来确定责任，以及采用线性方法来学习，这忽视了医疗保健环境的复杂性，可能对员工和更广泛的医疗保健社区产生破坏性影响。这些问题代表着“不便的事实”，必须加以识别、协调并纳入我们未来减少医疗保健中的自杀率的途径。引入零自杀框架可以支持从依赖对错误的回顾性关注（安全 I）到更前瞻性的关注（安全 II）的急需转变，这种关注承认医疗保健的复杂性，同时基于恢复性公正文化原则。恢复性公正文化用关注所有受事件影响的人的伤害、需求和义务取代了向后看的责任追究。在本文中，我们认为，如果没有实质性的工作场所文化变革的支持，零自杀框架的实施可能会受到影响。我们提供了黄金海岸心理健康和专科服务机构实施的关键性事件应对流程作为成功实施基于恢复性公正文化原则的示例，这些原则实现了支持学习、改进和康复的文化变革，为我们的消费者、他们的家庭、我们的员工和更广泛的社区提供了帮助。
