Addressing Inconvenient Truths in Suicide Prevention: A Call for a Restorative Just Culture

In a pivotal study by Turner et al. (2020), published in the Australian & New Zealand Journal of Psychiatry, Inconvenient truths in suicide prevention: Why a Restorative Just Culture should be implemented alongside a Zero Suicide Framework, the authors challenge existing paradigms in suicide prevention within healthcare settings. They argue for a significant shift towards a Restorative Just Culture (RJC) alongside the implementation of a Zero Suicide Framework (ZSF), suggesting that current approaches inadequately address the complexities and cultural barriers inherent in healthcare systems.

The paper begins by critiquing the prevailing nihilism about suicide prevention capabilities within healthcare and the prevalent blame culture that follows adverse incidents. It discusses the psychological impact on clinicians as 'second victims', who often suffer in silence due to the existing punitive environment. This distress is exacerbated by a retrospective focus emphasising errors over systemic improvements.

The authors propose integrating RJC principles, which shift focus from blaming individuals for errors to understanding and rectifying systemic issues that lead to such outcomes. They suggest that this cultural shift is essential for the effective adoption of the ZSF, which aims for zero suicides within healthcare settings. The ZSF and RJC together promote a proactive approach to patient safety and clinician support, recognizing the multifaceted challenges clinicians face and the systemic changes needed to foster a supportive and blame-free environment.

The study highlights several 'inconvenient truths', such as the fallacies of risk prediction and the limitations of traditional incident reviews that focus on linear causality and often neglect the complex interdependencies in healthcare settings. Turner et al. advocate for a model that understands clinical incidents through a broader, more holistic lens, which acknowledges human factors and system complexities.

This approach not only aims to prevent suicides but also supports the mental health and resilience of healthcare providers by fostering an organisational culture that values transparency, continuous learning, and compassionate accountability.

In summary, Turner et al. call for a paradigm shift in how healthcare settings approach suicide prevention, urging the adoption of frameworks that emphasise systemic resilience and restorative practices. Their research underscores the necessity of transforming organisational cultures to better support both healthcare providers and patients in a more humane and effective manner.

Read the complete study here for a comprehensive understanding of these proposed changes and their implications for suicide prevention within healthcare systems.