Local Suicide Trends and Update 2014 - PowerPoint PPT Presentation


Title: Local Suicide Trends and Update 2014


1
Local Suicide Trends and Update 2014
  • Carolyn Smith
  • Divisional Manager, South Somerset Division

2
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

3
National policy
  • Preventing Suicide in England A cross-government
    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)

4
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.

5
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.

6
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.

7
Suicide Trends
8
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.

9
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)

10
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

11
Somerset suicide ratePublic 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
12
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.

13
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
    in-patients
  • 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.

14
Patient Suicide Numbers
Patient suicides 1250 1123 1242 1307 1272
Inpatient suicides 165 142 103 83 50 Estimate
Crisis (CRHT) team suicides 59 156 223 185 149 Estimate
Year 2002 2006 2009 2011 2012
15
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

16
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).

17
Findings Suicide Method, NCI, (2014)
Hanging Self-poisoning Jumping
Self strangulation multiple
injuries
18
Most common drugs in self-poisonings
  • Opiates
  • Tricyclic anti-depressants
  • Paracetamol/opiate compounds

19
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

20
  • What are we doing in Somerset?

21
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

22
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

23
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
  • Mens health group established
  • Planning a mens 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.

24
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

25
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!

26
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 dont proceed with any
    treatment/intervention until scores of 9 or above
    are achieved Perfect Care.

27
  • Reference
  • The National Confidential Inquiry into Suicide
    and Homicide by People with Mental Illness
  • Annual Report 2014
  • University of Manchester
  • nci_at_manchester.ac.uk

28
Free Stay Alive App.Helpful advice and
information for people at risk of suicide and
people supporting them.
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Title: Local Suicide Trends and Update 2014


1
Local Suicide Trends and Update 2014
  • Carolyn Smith
  • Divisional Manager, South Somerset Division

2
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

3
National policy
  • Preventing Suicide in England A cross-government
    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)

4
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.

5
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.

6
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.

7
Suicide Trends
8
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.

9
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)

10
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

11
Somerset suicide ratePublic 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
12
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.

13
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
    in-patients
  • 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.

14
Patient Suicide Numbers
Patient suicides 1250 1123 1242 1307 1272
Inpatient suicides 165 142 103 83 50 Estimate
Crisis (CRHT) team suicides 59 156 223 185 149 Estimate
Year 2002 2006 2009 2011 2012
15
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

16
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).

17
Findings Suicide Method, NCI, (2014)
Hanging Self-poisoning Jumping
Self strangulation multiple
injuries
18
Most common drugs in self-poisonings
  • Opiates
  • Tricyclic anti-depressants
  • Paracetamol/opiate compounds

19
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

20
  • What are we doing in Somerset?

21
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

22
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

23
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
  • Mens health group established
  • Planning a mens 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.

24
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

25
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!

26
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 dont proceed with any
    treatment/intervention until scores of 9 or above
    are achieved Perfect Care.

27
  • Reference
  • The National Confidential Inquiry into Suicide
    and Homicide by People with Mental Illness
  • Annual Report 2014
  • University of Manchester
  • nci_at_manchester.ac.uk

28
Free Stay Alive App.Helpful advice and
information for people at risk of suicide and
people supporting them.
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