Implications and recommendations

Staff experience and perception	Implications for staff, patients and clinical practice	Recommendations
Repeated exposure to suicidality	Normalisation of suicidality (acclimatisation, blunting of empathic capacity) Emotional toll on staff (burnout and reduced morale, sickness absence, high staff turnover, reduced stability of ward teams, increased National Health Service recruitment costs)	Structured peer support to create culture of support Mandatory clinical supervision to allow staff time to reflect and receive support in developing personal resilience and self-care strategies Support for staff at all levels of seniority following serious incidents (for example patient death/serious attempt)
Organisational blame	Staff fear negative impact on career/livelihood Increased risk-aversive practices Training limited to mandatory organisational risk assessment/management procedures	Organisational strategy/culture shift towards a genuine ‘no blame’/learning organisation Active encouragement of staff to uptake support resources (training and supervision) Involvement of staff in investigations Protocols for ensuring that staff are supporting following an event
Conceptualising suicide as inevitable and untreatable	Management options viewed as limited Learned helplessness by staff	Training in (a) broader holistic models of suicidality and (b) formulation-based psychosocial assessment Wards to have access to effective psychological interventions for in-patients who are suicidal