Development of a strategy for the prevention of
suicide and self-harm: Project Brief
EXECUTIVE SUMMARY
This paper sets out the project brief for the development of a Richmond joint strategy
for the prevention of suicide and self-harm (between Richmond Borough Council and
CCG) (2014-2017).
The project timeline is March to December 2014. Outputs will include needs
assessment, service mapping, draft strategy document for consultation in September
(including commissioning implications) and final strategy.
This project is included within the Richmond Joint Mental Health Strategy
Implementation Plan. It builds on work on self-harm by the LSCB, and also links to
the JSNA broader work on mental wellbeing.
While numbers of suicides in Richmond are small, the issue of self-harm and risk of
suicides, particularly among young people and people with mental health problems,
has been identified as a significant concern in consultation on the Strategy
Implementation Plan. Recent national research has highlighted the impact of the
economic downturn, debt and financial distress on increasing risks of suicide and
self-harm.
The project is also linked to the Richmond Health and Wellbeing Strategy, Strategy
for Prevention of Substance Misuse, and Children and Young People’s Health
Strategy and Commissioning Plan.
The strategy development is led by the Richmond Public Health team, and will
involve collaborative work with the coroner’s office, police and community safety,
commissioners (health and local authority), AfC, mental health services, GP
practices, Health Watch and other stakeholders including voluntary and community
groups.
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PROJECT BRIEF
1 Definitions of suicide and self-harm
In the UK, suicide is defined as deaths given an underlying cause of intentional selfharm or injury/poisoning of undetermined intent.
Self- harm is defined by NICE as “any act of self-poisoning or self-injury carried out
by a person, irrespective of their motivation.” Self-harm is a significant risk factor for
suicide: there is a 50- to 100-fold increased risk of death by suicide in the twelve
month period after an episode of self-harm compared to the general population.
A wide range of mental health problems are associated with self-harm, including
borderline personality disorder, depression, bipolar disorder, schizophrenia, and drug
and alcohol-use disorders.
This project will cover both adults and young people1.
Services have an important role in helping families, parents, teachers and others deal
with both the threat and consequences of self-harm and suicide.
2 Scale of suicide and self-harm
Suicide and self-harm are not inevitable, and there is substantial evidence-based
guidance on how the risks of suicide and self-harm can be reduced as the basis for
prevention strategies.
In Richmond the number of suicides in a year are small–ranging from 7 to 19
individuals annually 2008 to 2012.
Richmond had an age standardised mortality rate for suicide and undetermined injury
for 2010/12 of 8.3 per 100,000. This is not significantly different to the figure for
England of 8.5 per 100,000.
Rates of hospital admission for self-harm in 2011/12 were significantly lower in
Richmond compared to England- at 109 per 100,000 and 207 per 100,000
respectively. The rates for London were 112 per 100,000. Clearly there are a
proportion of cases that are not admitted to hospital.
3 The strategic context
The development of this suicide and self-harm prevention strategy is a project within
the Richmond Joint Mental Health Strategy Implementation Plan.
Suicide and self-harm indicators are included in the National Public Health Outcomes
Framework.
The Government published in 2012 a new national cross-government strategy for
suicide prevention (Preventing Suicide in England: 2012). This strategy sets out six
goals:
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Suicides in those aged 15 years and over in Richmond, and episodes of self-harm among people aged
8 years and over. This is in keeping with national definitions and data availability.
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1.
2.
3.
4.
To 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
5. Support the media in delivering sensitive approaches to suicide and suicidal
behaviour
6. Support research, data collection and monitoring
The recent national strategy update (January 2014) reports that around half of people
who die by suicide have a history of self-harm. It stresses the importance of mental
health promotion, prevention and early intervention to reduce self-harm in the
community, and of effective assessment and on-going management when an
individual who has self-harmed presents to health services.
The new NICE Quality Standard for self-harm (2013) is intended to inform the
planning and delivery of services for those who self-harm. It focuses on treatment
with compassion and respect, the importance of comprehensive assessment,
monitoring and risk reduction in the clinical environment. There is also a focus on
continuing support with a risk management plan and psychological interventions to
reduce recurrence.
4 Project aims
 To assess the pattern of suicide and self-harm in Richmond
 To map services currently available and options to intervene
 To produce a joint strategy for Richmond 2014-2017 as a framework for a
coordinated and effective approach to improved services for the prevention of
suicide and self-harm.
 To define implications for commissioning and service development 2015/16.
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Objectives
 To conduct a needs assessment for suicide and self-harm (including
audit work) to determine the pattern of suicide and self-harm and related risk
factors, (and including equality considerations)
 To identify and engage key local stakeholders with a responsibility or
interest in self-harm and suicide
 To review and identify the evidence for effective strategies/practice to
reduce the rates of suicide and support the needs of those who have selfharmed
 To identify and map current services concerned with the prevention of
suicide and support those who have self-harmed in terms of medical,
psychological and social needs
 To identify and map current services which support those who are made
bereft by the suicide of a partner, friend or relative
 To identify key priorities for Richmond and make recommendations for a
multi-agency approach to prevention of suicide and self-harm
 To ensure performance management arrangements are in place to enable
monitoring of the impact of the strategy over time.
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Project Plan
The analysis of patterns of suicide and self-harm will be based on both quantitative
and qualitative data and information, including engagement with service users and
families.
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The needs analysis will provide an overview on the current situation in Richmond:
available data will help benchmark the borough against wider trends and factors
which correlate with higher rates of suicide and self-harm. The potential use of data
(Mental Health Trust, Coroner, GP data, A&E) for audit work of cases will be
examined in order to understand more fully the circumstances and factors causing
suicide and self-harm. The analysis will identify high risk groups as the focus for
prevention measures.
The potential use of risk stratification for self-harm and the effectiveness of different
approaches to subsequent management will be examined.
The mapping of local services relevant to prevention of suicide and management and
prevention of self-harm against an evidence-based framework will identify gaps and
options for service development and quality improvement.
A multi-agency stakeholder workshop will be organised to consider the findings of the
needs analysis and service mapping work.
A draft strategy will be produced taking account of the workshop discussion with
proposed actions informing commissioning intentions.
7 Management and Governance
The project will report to the Joint Adult Mental Health Strategy Group, and Strategic
Partnership Group (and Health and Wellbeing Board) and Community Safety
Partnership
Public health team:
Principal and
Ben Bouquet (Specialist Registrar), Amanda Killoran (PH
Key stakeholders:
Coroner’s office
Mental health services
Substance misuse services
Social services
Commissioners
GPs
Secondary care clinicians involved in the self-harm pathway
Children’s services
Health Watch
Local interest groups – specifically suicide/self-harm campaign; patient
groups; relatives
Local interest groups – high-risk categories e.g. LBGT, BME, men’s health
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Summary Timetable
Phase 1: March-May 2014 Needs assessment and service mapping (including
equality impact audit)
Phase 2: March-May 2014 Suicide and self-harm audit
Phase 3: April-June 2014 Review evidence for effective interventions & mapping
current services
Phase 4: July-December 2014 Draft suicide and self-harm prevention strategy
including commissioning implications (September) and consultation; final strategy
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