Suicide Prevention –
a partnership approach
Mark Smith
Head of Suicide Prevention and Mental Health
Fundamental Issues
• Mental Health and Vulnerability
• Vulnerability and Risk
• Risk and Consequence
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Victimisation
Criminality & criminalisation
Danger to others
Danger to self
Impact on families & communities
Impact on resources
Economic impact
Liability issues
The Rail Network
• A draw for the vulnerable
• Transient population
• Equality Issues
(access to services)
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Immigration status
Homelessness
Learning difficulties
Alcohol & substance misuse
Race and culture
BTP National Analysis
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350 fatalities a year
84% believed to be suicides
41% of deceased had a mental health
history
1700 incidents a month which involve
mental health issues
2700 incidents of suicidal behaviour per
year
680 suicide prevention plans opened in
one year
Evidence of vulnerable people travelling
great distances to attempt suicide and
importing demand for services
In a 3 month period only 5 out of 11
people involved in suicidal incidents in
Camden lived in the Borough
London North hotspot area with 30% of
suicides & 37% of all related incidents
Suicidal Incidents
01/04/12 - 31/03/13
2738 incidents
• 296 suspected suicides
• 89 injurious attempts
• 313 non injury attempts or life
saving interventions
• 44 reconnoitring
• 796 threats with no attempt
• 630 third party reports
• 570 Para-suicide events
BTP Approach
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2010 new Suicide Prevention Policy and SOP
Vulnerability assessment tool & structured suicide prevention plans
Public Protection Units & Mental Health Liaison Officers
Close working with Rail Industry Partners and the Voluntary sector
• However barriers to effective working identified –
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Unfamiliarity with local Health & Social Care services and structures
Reluctance of many agencies to share information
Lack of medical oversight of police decision making
Differences in local Health and Social Care service provision
Inconsistency in clinical judgements
Detention under S136 often ineffective in reducing risk
• Need for a new approach to overcome these barriers
• Need to secure appropriate diversions & free up police officer time
2013 - New Partnerships
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January - BTP & Network Rail (NR) agree a 3 year project to better
coordinate activity in relation to Mental Health and Suicide Prevention which
includes closer working with Samaritans
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February - BTP, NR and NHS London agree 3 month funding to provide a
pilot joint health and police intervention capability – ‘Operation Partner’
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April - NHS England (London) agree further 6 month funding for Operation
Partner
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April - BTP and London Underground agree a 12 month project to join and
enhance Operation Partner
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September - BTP join ‘Street Triage’ programme funded by Department of
Health and will seek to re-create Operation Partner outside London
Operation Partner
• Combined Public Protection Unit
• BTP operational & analytical
resources
• Supported by Mental Health
Professionals
• Key elements;
– Medical operational review of BTP
interventions and PIER plans
– Support to BTP custody
– Outreach interventions & assessments
– Fast access to data
– Transition from Crisis to Care
689 people reviewed in 2013 – Only 1 later completed
suicide on the railway and 1 away from the railway
A New Model
Joint Intervention Team
Providing Care
•Care Plan
•Family support
•Information sharing
•Escalation process
Identifying Vulnerability
•Assessment tool
•Custody Screening
•Analysis – people & places
Managing Risk
•Intervention
•Diversion
•Situational solutions
A life saved – Op Partner
Suicide Prevented at Twyford Railway Stn 15/03/13
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09/03/13 - Male seen acting strangely at station
by rail staff
13/03/13 - Male returns – rail staff report to BTP
who attend, gain CCTV images & circulate to rail
staff
14/03/13 – PPU circulate Image to all local GPs
and local police. MHP circulate to all local Mental
Health Units
15/03/13 - Male returns - rail staff call BTP who
detain him under S136. Suicide note found in
subject’s pocket and he tells officers he was going
to do it ‘today or tomorrow’
MHP liaised with hospital and after assessment he
is further detained
MHP have maintained contact with hospital re
ongoing treatment and status
One life saved – one railway fatality prevented
Key Benefits
• Early access to relevant information
• More informed and robust decision making
• Support to frontline officers assisting them to access
places of safety/services
• Better outcomes for vulnerable people
• Savings in police officer/staff time within the PPU
• Savings in Officer/PCSO time on the front line
• Defined progression from Crisis to Care
• Up-skilling of PPU staff
• Many examples of MHP intervention being invaluable in
breaking down organisational boundaries
Life Saving Interventions
Interventions, Suicides and Injurious Attempts 2013
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Incidents
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Lif e Saving Interventions
40
Supspected Suicides
Injurious Attempts
30
20
10
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April
May
June
July
Month
August
Sept
Key Issues
• Funding challenges
• Transport Health Needs Assessment – transient
demand
• Most people presenting in mental health crisis
or with suicidal behaviour are not offenders
• Commissioning – strategic fit
• Care Bill requirements for vulnerable adults
• Concordat commitments
• S136 improvement plan for London