The number of doctors asking for guidance when a patient commits suicide has more than doubled over the last 10 years, despite a drop in UK suicide rates.
In 2013, 259 cases involving suicide were notified to the Medical Defence Union(MDU), an increase of 129% since 2004 when 113 cases arose.
The MDU published the figures following the sudden death of the actor Robin Williams which has highlighted the management of depression and suicide.
The medical indemnity provider has published advice on avoiding pitfalls when treating patients with depression. This includes:
- Be alert to the possibility of depression in patients with a history of mental illness, chronic health conditions and vulnerable groups such as the elderly or young.
- If it isn't possible to discuss all of a patient’s mental health concerns in one short appointment then ask the patient to come back for a longer appointment and book this straightaway.
- Document discussions with patients carefully. If they are seen by a colleague at the next appointment, it should be clear from the notes that the patient has had depressive symptoms or suicidal thoughts.
- If the patient fails to attend a follow-up appointment, it is advisable to try to contact them to find out why. The MDU is aware of cases where opportunities may have been missed to review a patient.
- Encourage the patient to allow you to involve close family members or friends who may be able to offer additional support. Bear in mind your duty of confidentiality although it is not a breach of confidentiality to listen to the concerns of a relative or friend.
- Have a system in place to audit or review all patients on long-term anti-depressants.
Dr Richenda Tisdale, MDU medico-legal adviser, said: "The increase we are seeing in MDU members wanting support and guidance in this area may be because doctors are coming under closer scrutiny when a patient commits suicide. Or it could be doctors are more aware of the possible ramifications involved in preparing a report for or giving evidence to a Coroner's inquest.
“Managing mental health conditions poses significant difficulties for doctors. Signs and symptoms can be subtle, and patients may be unwilling to disclose suicidal thoughts or symptoms of depression, out of embarrassment or fear of discrimination.
“GPs in particular are on the front line for the identification and management of mental illness. Of the 180 cases notified to the MDU so far in 2014, over half (56%) were from GPs. Around a third (29%) came from psychiatrists, and the remainder from other specialties.”