Introduction

It is widely recognised that suicide is a serious public health concern, with more than one in every hundred deaths attributed to suicide in 2019 [1]. In Ireland, suicide is reported to be the cause of approximately 500 deaths each year. However, this number is likely to be underestimated as a result of misclassification and overly high burdens of proof required to register a suicide death [2]. Importantly, there is now an increased understanding of suicidal behaviour based upon the "iceberg” model of self-harm [3, 4]. In this model, the incidence of suicide is represented at the tip of the iceberg, followed by higher incidences hospital-treated self-harm, and at its very base, the more common, yet hidden cases of self-harm that have not been observed/treated [3, 4].

This provides a unique opportunity to incorporate suicide prevention strategies in healthcare settings. These strategies can focus on providing mental health support, screening for suicidal risk, early intervention, and creating an environment that encourages help-seeking behaviour. However, evidence shows that many existing clinical training programmes do not adequately prepare healthcare professionals to engage in suicide prevention [5, 6].

A population-based cohort study conducted in Sweden between 2004 and 2015 found that 86% of individuals who died by suicide received healthcare in the year preceding their death [7]. It was also estimated that in the month before their death, 53% of those who died by suicide had received some form of healthcare consultation. This is compared with 20% in the general population [7]. Health professionals, such as nurses, pharmacists, primary care providers and social workers, are well-positioned to detect signs and symptoms of suicidal ideation and behaviours and provide those at risk with the appropriate referrals to support [8–11]. Training of healthcare staff has been highlighted as an important element of suicide intervention and prevention [12]. However, healthcare staff often do not receive appropriate training or lack knowledge and awareness of suicide and self-harm that allows for an appropriate response to suicide risk, primarily due to a lack of resources for healthcare professionals to gain access to appropriate information and training [13–15]. This is reflected in the fact that both professional practitioners and students rate their own interpersonal suicide prevention skills as poor [16]. Healthcare professionals also report a lack of confidence in their own competence in risk screening and intervention and this may serve as a barrier to effective suicide prevention in the healthcare setting [17, 18].

A suicide prevention programme targeted at healthcare and social care students provides an ideal opportunity to ensure a universal approach to suicide prevention in the healthcare system, as all graduates will begin their careers with similar knowledge, attitudes, and skills. In addition, a growing body of international evidence indicates that healthcare students may be at higher risk for poor mental health outcomes, suicidal ideation and behaviour [19–21]. For example, one cross-sectional study examining mental wellbeing and its associated factors among undergraduate pharmacy students from 14 countries (n = 2,665) found that more than one third of participants had poor mental wellbeing [21]. Thus, incorporating suicide prevention training in the curriculum of health and social care students may have a positive impact on help-seeking behaviours among this cohort through improved mental health literacy [22, 23].

To the best of the authors’ knowledge, the extent of the evidence regarding a suicide curriculum for health and social care students has not been reported on to date. The aim of this article is to describe the protocol for a scoping review to identify literature that describes the design, development, implementation and/or evaluation of suicide prevention training for healthcare and/or social care students in higher education settings. This question was prompted by the recognised need for a national standardised undergraduate suicide prevention curriculum in the Republic of Ireland as stated in Action 5.4.4 of Connecting for Life: Ireland’s National Strategy to Reduce Suicide [24]. It is intended that this scoping review will help inform the development of a suicide prevention curriculum for undergraduate health and social care students in the Irish higher education setting.

Methods

The reporting items in this protocol comply with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines which are presented [25] (see S1 File). We chose to adopt a scoping review approach for this research as the evidence on suicide prevention curricula is still emerging, particularly for health and social care students. A scoping review is an appropriate method for this research given that the main aim of this review is to identify studies that encompasses any aspects of the design, development, implementation and/or evaluation of suicide prevention training for healthcare and/or social care students in higher education settings. To identify potential similarities and differences between suicide prevention programmes, we intend to review the available evidence regarding the content and delivery of these programmes and, where applicable, their impact on student learning. We used the framework of Arksey and O’Malley to design the scoping review protocol [26] and utilised five primary stages to inform the study design: (i) identifying the research question; (ii) identifying relevant studies; (iii) study selection; (iv) charting data; (v) collating, summarizing, and reporting the results.

Limitations

The authors recognise that this study will have limitations. As we are constrained by resources, only studies published in the English language will be included. We have also noted a limitation with respect to the search of grey literature; even if grey literature is reviewed systematically, some sources may be overlooked. We will attempt to overcome this by searching as many sources as possible in the time we have allocated to complete the review.

Discussion

The interaction between patients and their healthcare professional provides an opportunity to screen and assess for patient suicide risk given the evidence that the majority of people who die by suicide have been in contact with a health professional in the year preceding their death [29]. The provision of suicide prevention training for students of the healthcare and social care professions presents an ideal opportunity to equip healthcare and social care professionals with relevant suicide prevention skills, knowledge, and confidence. The purpose of the proposed review is to give an overview of the design, development, implementation and/or evaluation of suicide prevention training for healthcare and/or social care students in higher education settings. The information gathered will be presented in a published scoping review.

The findings will be used by the authors in National Suicide Research Foundation with the Health Service Executive National Office for Suicide Prevention to inform the development of a national suicide prevention curriculum for all health and social care undergraduate students in Ireland. As a basis for designing the curriculum, the authors intend to develop a core-competency framework for suicide prevention. Through this framework, it is the authors desire to impart the necessary skills, knowledge and attitudes needed to develop an appropriate response to those in need. Moreover, it is hoped that a competency-based framework will help students understand the complexities of suicide prevention and reduce stigma surrounding this sensitive topic. Specifically, the results of this study are expected to support the development of a framework that includes intended learning outcomes, teaching methods, and supporting learning activities and assessments. For instance, results gained from this study may provide insight into the most appropriate strategies to teach the subject matter. These strategies may include using lectures, tutorials, and simulations/role plays, as well as the use of technology to help learners develop these fundamental skills.

Supporting information