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
Group
• Somerset Partnership Suicide Prevention
Group
• NHS England Zero Suicide Project
National policy
• Preventing Suicide in England: A crossgovernment outcomes strategy to save lives
(2012)
• Suicide prevention is not the sole responsibility of any one
sector
• 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
England
• 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
groups
• 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
inpatients
• 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
seekers.
Suicide Trends
A note about suicide
rates…
• Different figures from different sources;
– Different parameters used, for example population and
age;
– 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
services;
– 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
(2014)
HSCIC 2010-12
Number of suicides or
deaths following injury
of undetermined intent
(15+)
Directly standardised
rate (15+)
Somerset
138
10.43
South West
1,529
11.62
England
13,209
10.09
HSCIC 2012
Number of suicides or
deaths following injury
of undetermined intent
(15+)
Directly standardised
rate (15+)
Somerset
38
8.5
South West
519
11.7
England
4,507
10.2
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
risk;
• 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
Patient
suicides
1250 1123 1242 1307 1272
Inpatient
suicides
165
Crisis
(CRHT)
team
suicides
59
Year
2002
142
103
83
50
Estimate
156
223
185
149
Estimate
2006
2009
2011
2012
Findings: Inpatient
Discharge, NCI (2014)
• Increased risk of suicide for patients in first 3
months after discharge from in-patient
services;
–18% of all patient suicides;
• Highest period of risk is first week after
discharge;
• 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)
2500
2000
1500
General Population
Patient Population
1000
500
0
Hanging &
Self-poisoning
Self strangulation
Jumping &
multiple
injuries
Most common drugs in selfpoisonings
•Opiates
•Tricyclic anti-depressants
•Paracetamol/opiate
compounds
NCI Recommendations
(2014)
• 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?
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
project
Advisory Group work
streams
• 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
Support;
– 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
organisation;
• Advanced risk training for professionally registered mental
health staff is now a mandatory training requirement;
• Suicide prevention awareness training for community health
staff;
• 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
group;
Zero Suicide in the South West by
2018
• 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
rate.
• Video conference with Edward Coffey;
• Questions asked about validity of the data!
How?
•
•
•
•
•
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’.
Reference:
The National Confidential Inquiry into
Suicide and Homicide by People with
Mental Illness
Annual Report 2014
University of Manchester
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Somerset Suicide Prevention Update 2014