Interview with Professor Nav Kapur on the development of NICE guidelines and the year ahead

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Nav Kapur is Professor of Psychiatry and Population Health at the University of Manchester and an Honorary Consultant Psychiatrist at the Greater Manchester Mental Health Trust. 

 He has worked in suicide prevention for 25 years, published books and many academic articles, and leads the suicide programme at the National Confidential Inquiry into Suicide and Safety in Mental Health as well as sitting on a number of advisory groups and NICE guidelines.

Professor Nav Kapur

Thank you for talking to us Nav! Your work is so relevant to our community, and we’re very excited to chat with you about it. Many people will be aware of your experience in the field, but we’d love to know how it all began. Can you tell us how you first became involved in suicide and self-harm research?

I do get asked a lot about how I ended up where I am, and the answer is there was no plan! It almost happened by itself. I trained to be a doctor, then decided that I was going to specialise in psychiatry. I took a research job in Leeds just for 12 months and found I enjoyed the process of academic work and was quite good at it. That always helps. I was offered a job in Manchester, a major centre for psychiatry, and I’ve been here ever since. I’m a clinical academic, with most of my time now spent on research and policy work.

I lead the suicide work of the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH). For about 25 years, we’ve been focused on how we improve safety – and particularly how we prevent suicide– in mental health services. We do that through collecting comprehensive data from clinicians and people on the ground from all services in the country. By building up a detailed picture of people who sadly die by suicide we can investigate how we might best improve services and patient safety.

In one of our biggest studies, we found that involving families in care, the availability of crisis support, and tackling drug and alcohol misuse can help improve safety and reduce suicide rates. On these issues and many more, we’ve been able to generate recommendations for services. Every year we hold a conference and publish a report looking at the latest trends and focussing in on specific topics. I also work on the Manchester Self-harm Project which collects information on everyone who self-harms in Manchester and presents to hospital, and the Multicentre study of Self-harm in England which is one of the best sources of information we have about self-harm.

I’ve worked a lot with The National Institute for Health and Care Excellence (NICE) over the years, most recently on the revised self-harm guidelines. I also work with the Department of Health and Social Care to advise on the national suicide prevention strategy. These days I spend a lot of time giving talks on self-harm and suicide. One of the reasons I love research is that it gives you an opportunity to have an impact on clinical care as a whole and not just the patient in front of you (although of course that’s absolutely vital too).

A hot topic over the past few months has been the new NICE guidelines for self-harm. A lot of our community will have been working through what the guidelines mean for them. Can you tell us about the development process for the new guidelines and the key message people should take away from them?

Guideline development is a long and complicated process. NICE develop guidelines with the help of specialist committees which have a wide range of members – some people are experts by experience (both service users and carers), some people are clinicians, and others are researchers or come from other professional disciplines. We get round a table – either physical or these days virtual! We review the research evidence and ask how should we best help people after self-harm?

Sometimes there isn’t much evidence, so we have to come to a consensus-based decision. It is quite an involved process; in this case, I was involved for over two years.

The guideline is full of lots of detail about assessment, aftercare and treatments which we hope will be helpful but there are a couple of big things that are new.

First, the two previous guidelines (short-term and long-term management of self-harm) have been combined so that all the evidence and advice is now in one place.

Second, the guideline takes the view that self-harm isn’t something that only mental health professionals should know about. Self-harm can present anywhere. We have suggestions and recommendations in the new guidelines for Emergency Departments, GPs, paramedics, teachers, and people working in the criminal justice system – a wide variety of settings.

I think that’s the main message from the guideline: everyone has a role to play in how we help people after self-harm. We aren’t asking everyone to be a mental health professional, but everyone should have a bit of basic knowledge around self-harm – that it isn’t a diagnosis but a behaviour, that every person is different, and how to signpost people for help.

In fact, perhaps the single most important skill has nothing to do with being a psychiatrist or mental health nurse. It is just about being able to listen in a kind and sympathetic way. I think we can all do that.

Everyone working in mental health, self-harm and suicide prevention at the moment will likely have encountered some challenges due to the pandemic and the cost of living crisis. What do you think are the most important things to focus on this year? Where are the biggest pressures and what can our community do to best help and support people?

A major focus for us in the last couple of years has been looking at the impact of the pandemic (thankfully we didn’t see the rise in suicide that many people were worried about) and now, of course, we need to keep an eye on any impacts from the cost of living crisis and the economy.

It’s going to be challenging, but in the end – almost regardless of what the statistics on suicide are doing – the important thing for me is action. Some of the response is always in the hands of governments and their policies on welfare and support, but there is a lot we can do on the ground as well. We are working on the revised National Suicide Prevention Strategy for England, which will hopefully be published later this year. Some of the priorities may well be focussed on children and young people, domestic violence, and gambling – important issues which have come to the fore recently. But others have featured in our strategy since 2002, for example, the role of mental health care and high quality services for self-harm.

One of the crucial things that we’re really beginning to realise is the essential role of the voluntary sector in supporting suicide prevention. They are in touch with people and listen to them every day. Others advise on debt or signpost to help. They understand the pressures people are under and how to navigate systems locally. The staff who work in financial advice settings are also on the frontline for people in crisis, so one of the challenges might be how can we equip them with a working knowledge of mental health?

There is also an enormous demand on our health and social care services. We all have work to do to ensure that patients and service users get the care they need and deserve, but also that we look after health and social care staff as well.

Despite all the challenges, though, the basics haven’t changed. The evidence is still the evidence. High quality care is still high quality care. Yes, the context is more difficult, but how we talk to people in distress and hopefully get them the care they need remains the same. I think it’s really helpful to remember that.

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