Local Suicide Trends and
Update 2014
Carolyn Smith
Divisional Manager, South Somerset Division
Presentation Content
• National Policy Context
• Suicide Trends
• Findings and recommendations from the
National Confidential Inquiry (2014)
• Suicide Prevention in Somerset
• Somerset Suicide Prevention Advisory
• Somerset Partnership Suicide Prevention
• NHS England Zero Suicide Project
National policy
• Preventing Suicide in England: A crossgovernment outcomes strategy to save lives
• Suicide prevention is not the sole responsibility of any one
• One quarter of people who die from suicide have been in
contact with specialist mental health services in the
previous year
• More can be achieved by collaborative working across
government, local agencies and services
• Local responsibility for coordinating and implementing work
on suicide prevention (Healthy Lives, Healthy People, Our
Strategy for Public Health in England, 2010)
Policy Objectives
• A reduction in the suicide rate in the general population in
• Better support for those bereaved or affected by suicide
Six key areas for action
• Reduce the risk of suicide in key high-risk groups
• Tailor approaches to improve mental health in specific
• Reduce access to the means of suicide
• Provide better information and support to those bereaved or
affected by suicide
• Support the media in delivering sensitive approaches to
suicide and suicidal behaviour
• Support research, data collection and monitoring.
High risk groups identified
in the strategy
• Young and middle-aged men
• People in the care of mental health services, including
• People with a history of self-harm
• People in contact with the criminal justice system
• Specific occupational groups, such as doctors, nurses,
veterinary workers, farmers and agricultural workers.
Tailored approach
• Children and young people, including those who are
vulnerable such as looked after children, care leavers and
children and young people in the youth justice system;
• Survivors of abuse or violence, including sexual abuse;
• Veterans;
• People living with long-term physical health conditions;
• People with untreated depression;
• People who are especially vulnerable due to social and
economic circumstances;
• People who misuse drugs or alcohol;
• Lesbian, gay, bisexual and transgender people; and
• Black, Asian and minority ethnic groups and asylum
Suicide Trends
A note about suicide
• Different figures from different sources;
– Different parameters used, for example population and
– Coding differences and changes;
– Narrative verdicts;
– Some NCI data about patients who have had contact
with mental health services in the previous 12 months is
produced from questionnaires sent to mental health
– Different ways of reporting in NHS Trusts;
• Some report suspected suicides as ‘suicide’ and
others report these deaths as ‘unexpected deaths’.
Suicide Rates: England
• 78,170 suicides in England from 1996 to 2012;
• 20,300 (26%) of which were patient suicides;
• Patients defined as people who had been in contact with
mental health services in the 12 months prior to their death;
• Small reduction in the suicide rate from 2002 apart from
slight increase in 2008;
• 10.6 deaths per 100,000 general population in 2002;
• 9.4 deaths per 100,000 general population in 2012;
• Higher suicide rate per 100,00 of the general population in
the rest of the UK:
– 17.4 in Scotland
– 15.4 in Northern Ireland
– 12.4 in Wales
• (NCI, 2014)
Suicide rates per 100,000 by
area 2010-2012, NCI (2014)
• Ranges from 7.2 to 11.4 per 100,000
Birmingham and the Black Country 7.2;
London 7.7 – 8.3
Bristol, Somerset and South Gloucestershire 9.7;
Bath, Gloucestershire, Swindon and Wiltshire 9.9;
Merseyside 10.1;
North Yorkshire and the Humber 10.7;
Devon, Cornwall and Isles of Scilly 11.1;
Greater Manchester 11.1
Lancashire 11.4
Somerset suicide rate:
Public Health Outcomes Framework
HSCIC 2010-12
Number of suicides or
deaths following injury
of undetermined intent
Directly standardised
rate (15+)
South West
HSCIC 2012
Number of suicides or
deaths following injury
of undetermined intent
Directly standardised
rate (15+)
South West
National Confidential Inquiry
Findings (2014)
Young people under 25 accounted for 10% of all suicides;
Suicide rate for men is just over double the rate for women;
Increase in male suicide rates for ages 45 to 64;
37% of those who died from suicide had not seen their GP
in the previous year;
• More likely to be male and younger than those who did
seek GP support;
• Rate of suicide for patients under Community Treatment
Orders was 2.2 per 1,000 in 2009-2012, higher than the
rate for all patients;
– Patients are usually selected for CTOs on the basis of
• 54% of people had a history of drug and/or alcohol misuse.
Findings: Patient Suicide,
(NCI, 2014)
• Little variation in the overall number of patient
suicides over the past 10 years;
• Significant reduction in deaths of people who are inpatients;
• After the introduction of Crisis/Home Treatment
Teams in 2004-6, deaths in the community increased;
– 11% of suicides in Crisis Teams;
• A downward trend appears to be emerging from 2009
for suicides in Crisis Teams;
• Living alone is associated with suicide for patients
under the care of Crisis Teams;
– 47% of people who died lived alone;
– 49% experienced adverse life events.
Patient Suicide Numbers
1250 1123 1242 1307 1272
Findings: Inpatient
Discharge, NCI (2014)
• Increased risk of suicide for patients in first 3
months after discharge from in-patient
–18% of all patient suicides;
• Highest period of risk is first week after
• Greatest risk is on day 2 following discharge;
–20% of people who died within 7 days;
• Short admissions under 7 days and adverse
life events also linked to suicide in first 2
weeks after in-patient discharge;
Findings: non-adherence and
missed contacts, NCI (2014)
• 14% patients had not adhered to their drug
treatment in the month before their death;
• 26% patients missed their final mental health
service appointment before their death;
• Non-adherence and missed contact are
often linked;
• 39% of patients were not receiving their
planned treatment before their death;
• Care Programme Approach (CPA) is
protective (NCI, 2013).
Findings: Suicide Method,
NCI, (2014)
General Population
Patient Population
Hanging &
Self strangulation
Jumping &
Most common drugs in selfpoisonings
•Tricyclic anti-depressants
NCI Recommendations
• Patient suicides
– Address economic issues with patients.
• Post-discharge suicide (from in-patient care)
– Effective care planning addressing life events;
– Early follow up;
– Caution with short admissions;
– Suicide within 3 days as a Never Event.
• Crisis/Home Treatment Teams
– Priority for suicide prevention;
– Review suitability for certain patients.
• Hanging
– Media portrayals to be examined;
What are we doing in
Somerset Suicide Prevention Advisory Group
• Somerset Suicide Prevention Strategy
• Coordinates and monitors suicide prevention activities
• Multi-agency group
Somerset Partnership Suicide Prevention Group
• Strategic Plan
• Mental health and community health services
NHS England Zero Suicide in the South West
Advisory Group work
• Systems in development for local suicide audit;
– Aim to identify issues and provide focus for
local action;
• ASIST - suicide prevention skills training offered
to frontline staff;
– 2 new trainers;
– 6 courses a year;
• Samaritans sessions in the ED at Yeovil District
Hospital once a week. Working to develop
sessions at Musgrove Park Hospital;
• 5000 copies of the Help At Hand leaflet distributed
in the community including to street pastors;
Work streams cont…
• Suicide Bereavement Support Service;
– Successful peer support group with 10 new joiners;
– 30 people accessed support from Cruse Bereavement
– New leaflet of bereavement services produced;
• Men’s health group established;
– Planning a men’s health event and promoting the ‘Is
your mate off his game’ leaflet;
• New mental health toolkit developed with educational
psychologists for schools;
– Refreshing schools critical incident guidance to include
more specific protocols around suicide;
• Work with the Local Authority in relation to car parks,
bridges, roads and high buildings;
– Continue to monitor for suicide hotspots – a car park in
Taunton was fenced off.
Somerset Partnership Suicide Prevention Group
Work Streams
• Strategic Plan and Action Plan;
• Recommendations from NCI and other learning being fed
into Integration Phase 2, a whole service redesign project;
• Assessment of policies, processes and practices against
Safer Mental Health Services Toolkit;
• Review of how learning from serious incidents is
disseminated and embedded at all levels of the
• Advanced risk training for professionally registered mental
health staff is now a mandatory training requirement;
• Suicide prevention awareness training for community health
• Front line operational group being established;
– First project focuses on implementation of follow-up
within 72 hours (NCI recommendation);
• Service user and carer representatives joining the strategic
Zero Suicide in the South West by
• Henry Ford programme in Detroit
• Provides mental health and substance misuse programmes;
• Continuum of integrated services with 2 hospitals, 10 clinics
and over 500 staff.
• “Depression care program eliminates suicide”
• Rate of suicide in patient population decreased by 75% in
first four years of the programme;
• 89 suicides per 100,000 to 22 per 100,000;
• No suicides for two and a half years followed by very low
• Video conference with Edward Coffey;
• Questions asked about validity of the data!
Consumer advisory panel helped design the program;
Whole systems approach;
Removal of barriers to access services;
Education for families and carers;
Protocols for three levels of risk for suicide, each with
different interventions;
• Different levels of access: drop-in, medication
appointments, same day access, e-mail support, website;
• Protocol for removing weapons from the home. Potential
use for other means in Somerset;
• Questionnaires at every contact to check well-being,
understanding of treatment and satisfaction. Staff don’t
proceed with any treatment/intervention until scores of 9 or
above are achieved – ‘Perfect Care’.
The National Confidential Inquiry into
Suicide and Homicide by People with
Mental Illness
Annual Report 2014
University of Manchester
[email protected]
Free Stay Alive App.
Helpful advice and information for
people at risk of suicide and people
supporting them.

Somerset Suicide Prevention Update 2014