Nursing lecturer, Penelope Sweeting, never thought she’d end up an academic, let alone a PhD candidate exploring inpatient suicide prevention – an area of research she says requires more awareness in order to address current system failures.

“I started my career as an enrolled nurse working in an orthopaedic ward,” says Ms Sweeting.

“It was a great place to work and learn while I studied to become a registered nurse. I then moved to emergency nursing and that is where my clinical passions are.”

With plans to move into management, she threw her hat in the ring for a nursing lecturer position with Charles Darwin University and got the job – that was five years ago.

“I love education and research and I am very happy that I decided to give something different ago.”

Not one to do things by halves, Ms Sweeting is now researching the complex and fraught issue of preventable suicides in hospitals, with a focus on system and process failures.

“To be honest as a clinical nurse we can see the gaps in the system, such as not enough staff not enough beds etc, but it's always just anecdotal,” she says.

“Having a study that shows the relationship between system failures and the actions of the individual on the frontline and patient care is exciting, because it means we have solid evidence to inform patient safety strategies.”

Ms Sweeting believes there is an overall underestimation of the extent of the problem, and this only further complicates the issue. 

“I realised this was a really big problem and no one was talking about it,” she says.

“I started reading stories of people who had tried to take their own lives but had survived and how they were grateful they had a second chance at life.

“This made me realise that more needed to be done to prevent these tragic deaths.”

While she had always been passionate about patient safety, the more Ms Sweeting learned about inpatient suicide, the more she realised something could be done about it.

“Now, there are some people who will disagree with me and say suicides are unpredictable and therefore unpreventable, but I argue we at least need to try.

“By washing our hands of the issue, it feels like we are giving up, and I think we need to start focusing on what we can do rather than what we can't do.

“Hospitals should be a safe place for patients, especially when they are admitted against their own choice. No one should die in a place that should be affording them safety and care.”

Inpatient suicide prevention is a critical area of research, says Psychotherapist, Dr Karen Phillip, who believes a lack of qualified mental health staff within hospitals is a primary factor.

“Many inpatients, including those who are in a mental health ward are treated for the symptoms presented, such as an eating disorder, depression, suicide ideation and so on.

“Every symptom is based on a reason. In therapy we note the symptom but treat the reason.

“Unfortunately, many inpatient services need to treat the symptom without enough time or staff to treat the reason.”

Dr Phillip says any patient in hospital could be at risk of suicide, which is what makes the situation so complex.

“It may have little to do with a condition or diagnosis. Many people struggle silently within, and it is challenging to know what is in their thoughts.

“It could be patients with terminal conditions, those suffering long term illness or disability where they feel there is no recovery or improvement.

“Other factors include the recent loss of a loved one and those who feel alone and unloved or uncared for.  They may feel insignificant and invisible believing no one will care or miss them.

“Others may feel their burden is unfair on their family, so they consider suicide to spare the family of the challenge.”

While Dr Phillip says not all suicides can be prevented, the number could be reduced if hospital staff had more time and expertise to properly manage at-risk patients.

“Nurses are so very busy it is difficult to have conversations with each patient.

“Nurses will often pick up the nuances of patients and while they are very caring people, all medical staff should be trained in basic psychological counselling skills to understand what may be going on.

“They could learn the questions to ask and those to avoid, and when to call for additional support for the patient.”

As far as Dr Phillip is concerned, the community has been largely kept in the dark about such issues, which is why it remains unresolved.

“There is deliberately not enough awareness. We know if stories of suicide are leaked, there is a flow on effect within the community, hence why this issue remains silent.”

Which is why Ms Sweeting plans to continue her research in this area, even after her PhD has been completed.

“This study has really opened my eyes to the extent of the problem, and I hope to team up with other researchers to continue to develop this area of study.

“Essentially my study is designed to identify individual and system failures that contribute to patients' ability to take their own life while they are receiving treatment in a hospital.

“Based on preliminary findings, close to forty people take their own life while receiving inpatient hospital treatment every year in Australian public and private hospitals.

“These preventable deaths represent a failure in the healthcare system to keep patients safe. 

“Inpatient suicide is a healthcare challenge that is poorly understood and understudied.

“I am using a unique method to analyse coroners' cases of inpatient suicides to identify areas where improvements can be made and hopefully contribute to the prevention of inpatient suicides.”