Therapeutic engagement between people experiencing suicidal crisis and mental health nurses

People are encouraged to seek, and are sometimes legally compelled to receive, mental health service around experiences of suicidal crisis. Nurses typically constitute the largest discipline group with the greatest consumer contact in settings providing such service. Nursing care in this context is positioned as a key element in the process of recovery from suicidal crisis. However, the nature and role of such nursing care is not adequately understood and there is indication that its therapeutic potential may be under‐developed and under‐realised. There is, therefore, a need to examine experiences of service with a view to extending the limited evidence base and promoting positive reform. This thesis contributes to the existing evidence base by generating and exploring survey and first‐person interview data concerned with mental health care consumer suicidal crisis and related mental health nursing care. An interpretive, multi‐method approach embracing critical intent gives voice to nurses and consumers and helps contextualise their accounts. This extends the predominantly qualitative nursing research in this area and helps to redress the broader quantitative bias in suicidology. The methodology also gives insight into how ‘reductive’ bias in clinical contexts may be better understood and ameliorated. The findings highlight the relevance of a multidimensional understanding of suicide, within which intrapersonal and interpersonal factors are of central importance. Therapeutic interpersonal engagement is indicated to be particularly important as it may enable consumers’ intrapersonal experiences to be understood and positively affected. Benefits are suggested to potentially occur in this respect as engagement itself is experienced therapeutically, and as engagement can enhance the various other interventions available (such as observation, risk assessment, medication and broader management within secure hospital units). Concerningly, however, the findings also indicate that the desired quality and extent of therapeutic engagement experienced between nurses and consumers may be experienced as minimal. This, in turn, infers that issues of isolation, distress, loss of control, and objectification, may be potentially compounded. The thesis highlights the pertinent theme of how, within a time of reform, promotion and development of the nurse‐consumer relationship may help realise aspirational principles of care such as ‘holism’ and ‘recovery’. In this regard the thesis has implications for how nurses are educated and supported to therapeutically engage with people at risk of suicide. The thesis establishes that, both in clinical and research contexts, movement beyond over‐reliance on medicalisation and objectification of consumers is required in order to better understand and respond to people at risk of suicide. It is argued that this necessarily entails clarifying and evolving the greater paradigm changes inherent in human/social research and suicidology, mental health nursing, and the broader mental health care ‘recovery’ movement. In particular, it is highlighted that suicidal consumers must be engaged in ways other than, or additional to, the ‘reductive’ and dichotomous practices which in the past have created an unnecessary ‘distance’ between nurses and consumers. It is argued that therapeutic relationships enabling this give people voice, harness the expertise of lived experience, appreciate people’s individuality and complexity, work to preserve people’s essential rights, and promote the potential to learn from and help one another