Healthcare Professional Suicide Risk
High suicide rate among health service professionals, particularly GPs, indicating a need for greater awareness and preventative action.
Strongest theme matches
Mixed across source types and ranked by classifier confidence plus text match strength.
PFD report
85match
Susan Carling
The coroner noted approximately 100 suicides occur annually within the health service profession. The report highlights the need for this issue to be addressed to prevent future deaths in this vulnerable professional group.
Matched on
terms: professional, suicide
Inquiry recommendation
77match
COVID-M3.10 - Healthcare Worker Support
The UK government, Scottish Government, Welsh Government and Northern Ireland Executive, working with healthcare employers and professional bodies, should put in place plans to deliver effective support for healthcare workers at scale from the outset of a pandemic. Plans should cover the nature and level of support that will be provided during and after a pandemic. All four...
Matched on
terms: healthcare, professional
PFD report
69match
Shaun Dewey
The coroner raises concerns that the elevated risk of self-harm and suicide among remand prisoners is not adequately incorporated into staff training, highlighted to care teams, or reflected in national guidance and risk assessment documents.
Matched on
terms: suicide
PFD report
65match
Steven Davidson
Healthcare staff at HMP Chelmsford experienced difficulties navigating System One records to find previous self-harm incidents, potentially due to insufficient awareness of the importance of searching these records and inadequate training.
Matched on
terms: healthcare
IMB annual report
64match
Isle of Wight (2023)
HMP Isle of Wight's population rose to 1,089 in 2023, operating at near capacity. The prison experienced a rise in deaths in custody (13) and violent incidents (191), although self-harm decreased. Key challenges included aging infrastructure, high staffing vacancies in OMU and healthcare, and inconsistent regime delivery for older prisoners, while positive developments were noted in education and...
Matched on
terms: healthcare
Committee recommendation
62match
#7 - Create clear objectives and actions for agricultural and veterinary workers in national suicide prevention strategy
We are very concerned by the evidence indicating that agricultural and veterinary workers have a higher-than-average suicide rate compared to the rest of the population. Although more accurate information is needed, a clear enough picture Rural Mental Health 77 was already established for the Government’s national suicide prevention strategy (published over ten years ago) to identify both as...
Matched on
terms: suicide
PFD report
61match
James Forryan
The coroner raised concerns about the easy accessibility of websites and forums that openly promote suicide methods, noting insufficient regulation and enforcement action against such platforms.
Matched on
terms: suicide
PFD report
61match
Robert Stevenson
The coroner raises concerns that current guidelines for Ciprofloxacin and Quinolone antibiotics do not sufficiently emphasise a potential rare link to suicide behaviour, noting that prescribing doctors may lack full awareness of this side effect.
Matched on
terms: suicide
IMB annual report
60match
Foston Hall (2023)
HMP/YOI Foston Hall has shown positive developments in regime provision and some safety initiatives, yet it continues to grapple with persistently high self-harm rates and increased use of force. Staffing shortages have impacted key work and overall experience levels, while healthcare faces challenges with recruitment, missed appointments, and inadequate facilities. The Board highlights significant concerns regarding accommodation decency,...
Matched on
terms: healthcare
Committee recommendation
60match
#6 - Joined-up public health approach essential for preventing suicide among agricultural and veterinary workers
Adopting a more joined-up approach to public health focused on early intervention could make a positive contribution to preventing suicide amongst agricultural and veterinary workers. It would need to ‘wrap-around’ people at potential risk, incorporating the NHS, other key public services and the regular contacts that people have in their local community or economy, and be under-pinned by...
Matched on
terms: suicide
IMB recommendation
59match
Scotland and Northern Ireland short-term holding facilities (STHF) (2025)
Ministers should also mandate that immigration detention procedures at least meet the same standards expected of the police. A particular area in need of improvement is healthcare: Policies and practices: A senior clinician should oversee healthcare policies and practices, approving any departure from standards applied in police custody. This would ensure that practices such as the failure to...
Matched on
terms: healthcare, professional
PFD report
57match
Lee Gaunt
The coroner identified ineffective Occupational Health support and delays in accessing a doctor. Concerns were also raised about the Fire and Rescue Service requiring the deceased to take on extra duties despite knowing he was suffering, indicating insufficient support for staff in stressful situations.
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classifier match
PFD report
57match
Benjamin Websdale
The coroner noted the absence of local or national data on police officers who died by or attempted suicide during misconduct investigations. There were also concerns about inconsistent implementation of the "STEP" campaign for officers exposed to trauma.
Matched on
terms: suicide
Inquiry recommendation
57match
5 - Consider urgent professional counselling
In devising a Serious Incident Procedure the Chief Executive and Trust Board shall consider the need for urgent professional counselling: – A proportion of individuals within any group is always likely to require psychological support in the aftermath of disaster. – An individual within the serious incident team shall be nominated to take responsibility for the arrangements and...
Matched on
terms: professional
Inquiry recommendation
57match
COVID-M3.8 - Recording Healthcare Worker Deaths
The UK government, Scottish Government, Welsh Government and Northern Ireland Executive should work with their respective public health agencies and healthcare employers to develop nation-specific mechanisms to collect, analyse and publish data systematically on the deaths of healthcare workers in the event of a pandemic outbreak. The UK Statistics Authority should work with data providers to ensure that...
Matched on
terms: healthcare
Committee recommendation
56match
#5 - Require DEFRA to establish a clear and active role in national suicide prevention strategy
DEFRA should be an active stakeholder in any national suicide prevention strategy, as the Department is responsible for populations and occupational groups arguably at higher-than-average risk of poor mental health and death by suicide. However, DEFRA does not appear to have carved out a clear role in the last two initiatives— the national strategy and cross-government workplan—and its...
Matched on
terms: suicide
PFD report
53match
Neil McDougall
The coroner raised concerns about post-tour debriefing for serving personnel, which lacks 1-to-1 sessions. There is also no mandatory mental health assessment during the Army resettlement process for those leaving service.
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classifier match
Committee recommendation
53match
#26 - Eighteenth Report - NHS nursing workforce
The Royal College of Nursing noted that, to retain nurses who worked during the pandemic, it will be essential to provide access to specialised mental health support, carry out risk assessments for staff and ensure people are able to take rest breaks and annual leave.66 NHSE&I told us that it has made a free mental health helpline available...
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Committee recommendation
52match
#25 - Eighteenth Report - NHS nursing workforce
NHSE&I acknowledged that there are worrying signs of stress and burnout amongst NHS staff since the COVID-19 outbreak. It cited figures from a Nursing Times survey, 56 C&AG’s Report, para 2.6. Based on England-domiciled applicants, UK universities, and includes midwifery degrees. The withdrawal of the NHS bursary applied to students on courses in England. NHS bursary schemes continued...
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classifier match
IMB annual report
52match
Lewes (2023)
HMP Lewes continues to face severe challenges, primarily driven by staff shortages that restrict the regime, leaving many prisoners out of cell for only an hour a day. This has contributed to significant increases in self-harm and assaults on staff, while issues with healthcare provision, mental health support, and the decency of accommodation persist. The Board highlights the...
Matched on
terms: healthcare
Inquiry recommendation
52match
SP35 - Balancing vulnerability with professional curiosity
Counter Terrorism Policing Headquarters should review and where necessary strengthen the training that Counter Terrorism officers involved in Prevent already receive to ensure that they understand the importance of balancing concern for an individual’s vulnerability with appropriate professional curiosity and awareness of disguised compliance. The training should: 1. Address cases involving children or individuals with mental health conditions...
Matched on
terms: professional
IMB annual report
51match
Chelmsford (2021)
HMP/YOI Chelmsford, a Category B local prison, faced significant challenges during a reporting year heavily impacted by COVID-19 restrictions, leading to a restricted regime with limited purposeful activity and prolonged cell confinement. Key concerns included persistent overcrowding, a severe rat infestation, and substantial delays in handling prisoner complaints and property issues. The prison also struggled with staffing shortages,...
Matched on
terms: healthcare
PFD report
49match
Carl Sargeant
The coroner noted that high-profile individuals removed from government roles, especially those attracting significant media interest, may not receive appropriate support channels, irrespective of their mental vulnerabilities.
Matched on
classifier match
PFD report
49match
Jaden Francois-Espirit
The coroner noted that Jaden's deteriorating mental well-being was not recognised, preventing access to available support. The report highlights the importance of recognising subtle signs of distress and exploring a request for help that is subsequently not utilised.
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classifier match
PFD report
49match
Kelly Hewitt
The coroner identified a lack of mental health support available to prison officers and recommended a review of its provision.
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classifier match
PFD report
49match
Barry Lall
The coroner raises concerns about the level of detail published on the GDC website regarding allegations against dental practitioners before proceedings are concluded, noting a potential detrimental effect on individuals' mental health.
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classifier match
PFD report
49match
Benjamin Sulzbacher
The coroner noted a lack of understanding by Priory staff regarding available NHS community discharge services and a general lack of clarity across all services on whether private-paying patients could be referred to NHS discharge packages.
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classifier match
PFD report
49match
Anugrah Abraham
The coroner identified a lack of specialist mental health nurses in West Yorkshire Police's Occupational Health Unit and no post-death investigation into care quality. Concerns also relate to unclear procedures for officers disclosing suicidal thoughts and the impact of the Police Constable Degree Apprenticeship.
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PFD report
49match
John McLoughlin
The coroner identified that the Peer Support system for pilots is insufficient for those with severe mental health difficulties, noting a lack of adequate support within the aviation industry for escalating mental health problems.
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classifier match
IMB annual report
48match
Leeds (2023)
HMP Leeds, a Category B local prison, faced significant challenges in 2023, particularly regarding overcrowding, which impacted shared cell conditions, and a concerning number of deaths in custody. The Board highlighted persistent issues with mental health provision, including transfer delays and a lack of secure beds, alongside ongoing concerns for IPP prisoners' progress and wellbeing. Staffing shortages and...
Matched on
classifier match
IMB annual report
48match
Heathrow immigration removal centre (2023)
The IMB report for Heathrow IRC (2023) highlights increasing safety concerns, including a rise in self-harm (180 incidents), assaults (131 detainee-on-detainee, 54 on staff), and drug finds (104). The Board expresses significant concerns over the detention of mentally unfit individuals, the dilapidated infrastructure, and the misuse of segregation units. While health needs are generally met, staffing shortages and...
Matched on
classifier match
Committee recommendation
48match
#6 - Eighteenth Report - NHS nursing workforce
The COVID-19 outbreak presents new challenges, as well as opportunities, for improving the recruitment and retention of nurses in the NHS. In particular, it is vital that the NHS protects the mental health and well-being of nurses who have contributed so much during the COVID-19 outbreak. NHSE&I told us it had put measures in place to support staff,...
Matched on
classifier match
IMB annual report
48match
Lancaster Farms (2023)
HMP Lancaster Farms, a category C resettlement prison, has largely provided a safe environment, though some pandemic regime restrictions were slow to lift. While primary healthcare is reasonable, mental health provision faces significant challenges due to staffing and a lack of specialist transfer capacity. Key worker contact and prisoner property management remain ongoing concerns for the Board, alongside...
Matched on
terms: healthcare
PPO recommendation
48match
The Head of Healthcare at HMP Berwyn
The Head of Healthcare should ensure that: appropriate measures are put in place to offer support to healthcare staff following their involvement in significant incidents.
Matched on
terms: healthcare
PPO recommendation
48match
The Governor and Head of Healthcare
The Governor and Head of Healthcare should ensure that all staff involved in a death in custody, and those that are identified as significant to the deceased, should be offered support in line with Postvention procedures.
Matched on
terms: healthcare
Committee recommendation
47match
#21 - 8th Report - Historical Forced Adoption
The Government must introduce a dedicated, trauma-informed health pathway for all those affected by historical forced adoption. This should include improved access to specialist psychological support for birth mothers and adult adoptees, national clinical guidance recognising the heightened prevalence of complex PTSD and suicide risk in these groups, and consistent provision across England through a single national service...
Matched on
terms: suicide
Committee recommendation
47match
#17 - Existing data underscores the urgent need to improve support for terminally ill individuals.
We are pleased that the ONS in now attempting to monitor the rates of suicide for people with a terminal diagnosis, as this will facilitate scrutiny in the future. The existing data already serves as a sobering reminder that the support and care around people who are managing a terminal diagnosis must be improved.
Matched on
terms: suicide
PFD report
45match
John Davies
The coroner noted that doctors undergoing General Medical Council investigations may experience adverse psychological effects that are unrecognised and unsupported. The report suggests considering communication tone, providing information on support agencies, and assessing for suicidal or self-harming behaviour.
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classifier match
PFD report
45match
Joshua Blackham
The coroner noted a lack of written policies defining the role of Welfare Officers and their training. Concerns also included improving communication channels regarding officer welfare and establishing a policy for the location of a serving officer's arrest.
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classifier match
PFD report
45match
Helen Spicer
The coroner noted the absence of restrictions on the import, export, possession, or administration of oral morphine, and that safe custody requirements and signing for collection from pharmacies do not apply.
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classifier match
PFD report
45match
Sarah-Louise Doyle
The coroner noted that five-minute observations were recorded at precise, predictable intervals, which could allow individuals to anticipate timings and plan self-harm attempts. There were also concerns regarding a single signature covering multiple observations.
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classifier match
PFD report
45match
Lee Winslow
The coroner raised concerns that the Trust did not formally refer a doctor, who admitted taking medicines to end his life, to the Police or GMC. There was also a lack of meaningful external or multi-disciplinary review of the incident.
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classifier match
PFD report
45match
Ruth Perry
The coroner raised concerns about the impact of the Ofsted inspection system on school leader welfare, identifying a lack of Ofsted training and clear policies for addressing distress during inspections. The report also noted the absence of defined processes for raising concerns and conducting learning reviews after inspections.
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classifier match
PFD report
45match
Wayne Brown
The coroner identified a lack of policy at WMFS for investigating work-related deaths to learn about welfare support, and noted that existing wellbeing policies do not provide sufficient support for senior staff facing stressors or disciplinary investigations.
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classifier match
Inquiry recommendation
45match
5 - Support systems for child protection staff
Consideration should be given in all agencies where the need is recognised to the provision of an appropriate support system for those engaged in child protection work including those at managerial levels. Senior staff in Social Work Departments and Police Forces should within a set period work out what support is needed and programme its provision (15.19).
Matched on
classifier match
IMB annual report
44match
Garth (2023)
HMP Garth, a Category B training prison, generally provides a safe environment, though self-harm and violence incidents increased. The Board's key concerns include persistent staff shortages impacting regime stability, key worker schemes, and offender management. The prison's physical estate is in poor condition, and delays in mental health transfers for complex cases remain critical. The IMB highlights the...
Matched on
classifier match
IMB annual report
44match
Gatwick IRC (2023)
The Gatwick IRC experienced a deterioration in safety during 2023, marked by increased violence, assaults on staff, and a rise in use of force incidents, partly attributed to a changing detainee population. Key safeguards for vulnerable individuals, such as Rule 34 and Rule 35 assessments, were found to be insufficient or subject to unacceptable delays. The report highlighted...
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classifier match
IMB annual report
44match
Liverpool (2023)
HMP Liverpool has shown positive progress in some areas, including education and the key worker scheme, but faces significant challenges. The Board is concerned by increases in self-harm, violence, and deaths in custody, compounded by high staff absence leading to regime closures. Major issues include inhumane delays in mental health transfers for segregated prisoners and a critical lack...
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classifier match
Committee recommendation
44match
#17 - Second Report - Workforce burnout and resilience in the NHS and social care
Covid-19 has exacerbated existing problems with staff welfare, but also brought some benefits, including higher levels of recognition and different ways of working. While enhanced recognition of the work of health and care staff is welcome, adequate and holistic support for their mental health and wellbeing is of primary importance. That support was not just needed during the...
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classifier match
HMICFRS recommendation
44match
FRS 2018-19 CoC Recommendations: Avon Fire and Rescue Service
Cause of concern: Avon FRS isn’t looking after the wellbeing and mental health of its staff effectively. It hasn’t clearly communicated to staff the new values and how to demonstrate these values in the workplace. Recommendation: By 30 June 2019, the service should assure itself that its policy, procedures and support for mental health and wellbeing are well-understood...
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