Post on 19-Jul-2020
Welcome
A suicide prevention event in Cheshire & Merseyside
10th September 2015, World Suicide Prevention Day
#wspd15 #zerosuicide @CMPHN @Mersey_Care
CALM 0800 58 58 58
SAMARITANS 08457 909 090
Professor Louis Appleby
Director, National Confidential
Inquiry
Chair, National Suicide Prevention
Strategy (England)
World Mental Health Day 2015
• 800,000 suicides per
year worldwide
• 16 million self-harm
episodes per year
• Second leading cause of
death in 15-29 year olds
Suicide rate, England 1995-2013
Source: ONS ICD 10 codes X60-X84 (for 10 year olds and over), Y10-Y34 (for 15 year olds and over), excluding Y33.9 -
where the coroner's verdict was pending up to 2006. ICD 9 codes E950-E959 (for 10 year olds and over) and E980-
E989 (for 15 year olds and over), excluding E988.8.
• Record low in
2006-7
• Rise from 2008,
linked to
recession
Suicide rates in NHS areas 2011-13
Colour-coded, highest rates = darkest
National Suicide Prevention Strategy 2012:
• Reduce risk in high risk groups
• Tailor approaches to improve mental health in
specific groups
• Reduce access to the means of suicide
• Support for those bereaved by suicide
• Support media in delivering sensitive approaches
to suicide
• Support research, data collection and monitoring
Six actions
Suicide rates in England, by age and gender
0
5
10
15
20
25
10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+
Age Group
Age specific death rate per 100,000 population
male
female
Source: ONS ICD10 X60-X84 (for 10 year olds and over) and Y10-Y34 (for 15 year olds and over)
• Rates in men 3
x higher
• Highest rates in
men 40-54
years
• Higher in over
75s
Suicides per week following discharge
• Peak of risk in
first 1-2 weeks
after hospital
discharge
• 14% deaths
occur before
first follow-up
• Linked to lack
of care plans
Suicide under crisis resolution/home treatment,
England
71
108
153
156
177187
207
179193 195
226
183
162 155
142 122104 100
9099
71 67
0
50
100
150
200
250
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Nu
mb
er o
f p
atie
nts
Year
CR/HT In-patient
• Suicide
under CRHT
now 3 x in-
patient care
• 37% within a
week
• 43% living
alone
Suicide risk & number of GP consultations in
previous 12 months
12.3
7.8
1.67
• Suicide linked
to frequent GP
consultation
• 12-fold increase
with attendance
x 2 per month
• Risk also high
in non-attenders
Bergen et al 2012, Lancet
Life expectancy in men who
self-harm vs the general
population
• 50%+ of those who
die by suicide have
a history of self-
harm
• Risk of suicide
increased 30-50 fold
in the year after self-
harm
Self-harm and suicide
0
100
200
300
400
500
600
700
800
<18 years <20 years <25 years <=25
Num
ber
of
suic
ide d
eath
s
Age groups
UK
70
160
500
700
Suicide in children and young people:
deaths per year (England; UK)
Suicide in children and young people
In care or
custody
History of
abuse
Copycat
clusters
Social media
Alcohol/drugs
Bullying
Self-inflicted deaths in prison custody,
England & Wales
0
20
40
60
80
100
120
140
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Rates per 100,000 prisoners
• Currently 80
deaths/year
• Rates fell
post-2004
• Recent rise
Suicide after prison release
0
10
20
30
40
50
60
70
80
90
1 2 3 4 5 6 7 8 9 10 11 12 13
Time from release (28 day periods)
Source: Pratt et al, Lancet 2006
No.
suicides
• Risk remains high
on release
• Highest risk in first
month
• Importance of
“through the gate”
services
Patient suicide method, England
456
515487
456473
538
453
564 575
636 654
345379
339
273 281 283 306 313
380 354 351
210182 192 206 200 195 203 179 173 188
226
0
100
200
300
400
500
600
700
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Nu
mb
er o
f p
atie
nts
Year
Hanging/strangulation Self-poisoning Jumping/multiple injuries• Around 50% of
suicides are by
hanging
• Commonest
method in men &
women
• Seen as quick
and painless
Helium poisoning, England
Source: ONS
UK_SUICIDE
© National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright
holder.
Sensationalising and romanticising suicide
Support for bereaved families
• Support and practical
advice
• Where to find help
• Services that men will access
• Plan to reduce heavy drinking
• Prevent suicide clusters, eliminate “hotspots”
• “Zero Suicide”
National support for local action
“It is time to change the widespread view that
individual deaths are inevitable – such a view is
bound to discourage staff from taking steps to
improve safety.”
National Confidential Inquiry 2006
“….. if mental health staff are to give up the
culture of inevitability, it is up to commentators
outside clinical practice to give up the culture of
blame.”
From Avoidable Deaths, 2006
Website:
http://www.manchester.ac.uk/nci
Like us on Facebook
https://www.facebook.com/pages/Centre-for-Mental-Health-and-Risk
Follow us on Twitter
https://twitter.com/NCISH_UK
#wspd15 #zerosuicide @CMPHN @Mersey_Care
CALM 0800 58 58 58
SAMARITANS 0845 7 909 090
Dr Rita Robertson Chair of Partnership Board
Champs Mental Wellbeing Programme • Mental Wellbeing is a priority for the Directors
of Public Health, underpinning work to improve health and wellbeing across their communities
• Champs Public Health Collaborative has been leading collective action on mental wellbeing since 2010
• Five Ways to Wellbeing- making the messages real
• Children & Young People’s Mental Health & Wellbeing; 2015-16 priority for the collaborative, building on to value activity
• Suicide Prevention – NO MORE Zero Suicide Strategy
Zero Suicide
The vision Cheshire and Merseyside is a region where suicides are eliminated, where people do not consider suicide as a solution to the difficulties they face. A region that supports people at a time of personal crisis and builds individual and community resilience for improved lives.
Key drivers for action
Locally, men account for eight out of every ten suicides, therefore our actions must particularly engage with and positively influence men.
Increase in pressures and negative circumstances on local populations including deprivation, vulnerability, debt, unemployment.
Local audit data suggests a) over a third of people who complete suicide in our region had been in contact with their GP in the month before their death and b) half had been in contact with mental health services.
We also know many suicides occur out of the blue – with the individual not having a diagnosed mental health problem and many close to them with no idea that they were considering suicide.
Data on Cheshire Merseyside Suicides Number of deaths by suicide and undetermined injury, Cheshire
and Merseyside
How can we reach zero? Suicides are not inevitable. There are many effective ways in which
services, communities, individuals and society as a whole can help to
improve mental health and prevent suicides. The aims of the NO MORE
Zero Suicide strategy are underpinned by key objectives:
A Cheshire and Merseyside becomes a Suicide Safe Community
B The Health Care System transforms care to eliminate suicide for patients
C Support is accessible for those who are exposed to suicide
D A strong, integrated Suicide Reduction Network provides oversight and governance
Suicide Reduction Network
http://www.no-more.co.uk
CALM 0800 58 58 58
SAMARITANS 0845 7 909 090
David Fearnley
Striving for zero suicide
No medication-
led or physical restraint
No suicides for those in
our care 100% compliance
with the Lester Tool
1 2 3
Culture of low aspirations and low confidence in mental health sector– people often lack belief that they can really improve things
Through our Centre for Perfect Care and Wellbeing we have spent a long time challenging lower aspirations in mental health than in physical health services.
Why can’t suicidal thinking be seen in the same terms as central chest pain, breathlessness, loss of consciousness, paralysis, urinary retention?
Pursuing ‘zero’ or 100% in mental health has been contentious, but if not zero what is acceptable to us?
Why aim for zero?
Why Perfect Care?
If not Perfect Care, are we really proposing that we should aspire to imperfect care and the acceptance of inbuilt error? Why would we view amenable, avoidable deaths by suicide differently from avoidable death in other healthcare settings?
If zero is not the right number, what is it?
We feel it is time for a much more ambitious approach
• Our aim is to eliminate suicide, in the first instance, of patients in our care;
• We believe that this can be done because suicide in our care is avoidable
amenable to interventions that we can optimize using specific approaches and strategies, and is therefore avoidable;
• It is therefore both a concept and a set of practices;
• It is the ultimate expression of Mersey Care Trust’s commitment to patient safety;
• Its essence is an integrated approach in that it requires multi-agency involvement;
• However, it is about an organisational commitment to being the fulcrum point for change to demonstrate that ‘where there is a will, there is a way’;
• For Mersey Care Trust, if this approach had been successfully adopted over the last decade, 200 people would be alive today.
Aiming for zero suicides in our care
Driver Diagram: Zero Suicide
Secondary Aim: To identify and measure four priority areas that when consistently implemented across Mersey Care Trust will reduce suicide
Engagement with all
stakeholders / partners
Competent workforce
Continuous analysis of data,
research and innovation
Service user and carer engagement 1
Co-production with MCT service user s and carers 2
Staff engagement in all stages of design and implementation3
Collaborative / integrated care pathways across services 4
Stakeholder training and guidance to support early identification and post-discharge support 5
Wider stakeholder engagement and partnerships6
Leadership and governance 7
Integrated community services - Standardised care pathways for specific conditions / services / transitions 8
Intensive care: post discharge and in times of crisis9
Evidenced based interventions stringently applied across the pathways 10
psychologically informed safety planning intervention 11
environmental risks and reduction of access to means 12
medication safety 13
Timely Post incident reviews , learning and sharing 20
Actions based upon emerging evidence from internal, national and international analysis and recommendations 21
Mersey Care led research and innovation priorities 22
Safe and effective care and treatment
Development of a learning strategy 14
Connect with OE strategy 15
Competency based suicide prevention training for all staff 16
Skilled workforce in evidence based interventions 17
Confidence in use of appropriate assessment tools 18
Ensure appropriate staffing skill-mix 19
Projects / PDSA cycles
Secondary drivers Primary drivers
Primary Aim Zero suicide: to eliminate deaths from suicide by service users under the care of Mersey Care Trust by 2020
Psychosocial Interventions - Safety planning - Formulation based care - Self management - Recovery
Standardised care pathways - Stepped up care - Safer discharge planning - Medication
- Environment / removal of means
Innovate Depression
Measures a. Number of suicides (completed) b. Number of near-fatal self harm c. Number of repeated self-harm d. Adherence to standardised care
pathways e. Number of staff undertaking
training f. Number of safety plans
implemented g. 4 week post incident reviews h. Patient experience
i.
Research and Innovation
RM: Rebecca Martinez CK: Cecil Kullu LW: Lisa Woods SB: Steve Bradbury CI: Claire Iveson PR: Paul Roberts JB: Jane Boland SG: Simon Graham LK: Lee Knowles PL: Peter Lynes LE: Louise Edwards AS: Andrew Sedgwick
No. of suicides
Competency based training - Learning Strategy implementation
- External stakeholder training
Post Incidence reviews
- Predictive analysis
Self Harm clinics in A&E Frequent attenders in A&E
CI, PL LE,LW
JB,
JB, LW
RM
SB, JB
RM, AS LK
CK, PR
LW, LE
CK RM RMLW
Personality Disorder Hub SG
Primary Drivers
Engagement with Stakeholders and Partners
Safe and Effective Care and Treatment
Competent and Skilled Workforce
Analysis of Data, Research and Innovation
Our change journey
Create Urgency
Create a Coalition
Develop a Vision
Communicate the Vision
Empower Action
Quick Wins
Drive Change
Embed in Culture
Our change journey
Create Urgency
Create a Coalition
Develop a Vision
Communicate the Vision
Empower Action
Quick Wins
Drive Change
Embed in Culture
Today !
OUR change journey
Create Urgency
Create a Coalition
Develop a Vision
Communicate the Vision
Empower Action
Quick Wins
Drive Change
Embed in Culture
Today ! Moving Forward
Why do we think that this is possible?
• There is evidence, albeit in a limited number of systems, that a focus both on the leadership of prevention as well as on the means of suicide can have a dramatic effect;
o The effective elimination of in inpatient setting suicides is a practical example of success
• Systematic approaches to quality improvement have been shown to be effective in impacting on other problems with these features;
• No Force First is a practical example of success
• Suicidal people often fall through the cracks in the existing, fragmented and busy system healthcare system;
• There is some predictability associated with what happens.
Staff sickness and absence: Gladstone Ward – Acute
Male Admissions Unit:
In the 23 months ( 1/11/2012 – 30/9/2014) since the issue of restraint
reduction was first explored on Gladstone Ward there have been a
total of 25 days lost in work related absence. In the same 23
month period prior to this (1/12/2010 – 31/10/2012) the figure was
888 days lost.
Early signs from some of our quality improvement work suggest that people become more engaged in work if we unleash their intrinsic motivation to improve patient care
This has been achieved by doing the right things first time, which systematizes evidence based practice.
“To improve is to change: to be perfect is to change often” Winston Churchill
CALM 0800 58 58 58
SAMARITANS 0845 7 909 090
CALM 0800 58 58 58
SAMARITANS 0845 7 909 090
Richard Brown, CEO
0151 488 1614
07850 476 360
Richard.brown@listening-ear.co.uk
Headstart – cognitive behavioural coaching
About Listening Ear
• Operational since 1992
• Established open age counselling and support agency
• 1st BACP accredited adult counselling agency on Merseyside
• Specialist in bereavement support across all ages
• Based in Halewood, operational in Merseyside and Cheshire
Headstart – cognitive behavioural coaching
SLS procurement process
• Tender opportunity advertised 1st December 2014
• Submission deadline 17th December 2014
• Appointed as delivery agent 5th January 2015
• First planning meeting 26th January 2015
• Service operational 1st April 2015
Headstart – cognitive behavioural coaching
Significant milestones to become operational
• Recruit staff
• Develop referral pathway and process map
• Cultivate 3rd party relationships
• Create the brand and marketing material
• Apply for Ministry of Justice secure email address
Headstart – cognitive behavioural coaching
Developmental lessons
• 3rd party relationships
• Regular meetings with commissioners
• Remote working and service footprint
• Internal communication
• Signposting
Headstart – cognitive behavioural coaching
Service Impact quarter 1
• 22 suicides leading to 37 beneficiaries
• 90% initial contact commenced within 24 hours of referral
• 92% offered first appointment within 7 days of initial contact
• 100% completed full needs assessment
• 100% have a safety plan in place following risk assessment
Headstart – cognitive behavioural coaching
Stakeholder feedback
• ‘You don’t know how much this has helped’ - client A
• ‘I feel much better knowing someone who gets it’ – client B
• ‘AMPARO have been there to support individuals and communities at a time of great tragedy and they have done so in a sensitive and professional way.’ Dr. Rita Robertson - Director of Public Health Warrington MBC
• ‘AMPARO provide timely and empathetic support and I’m confident in recommending this service’ Pat Nicholl - CHAMPS
Headstart – cognitive behavioural coaching
CALM 0800 58 58 58
SAMARITANS 0845 7 909 090
A Zero Suicide Strategy for Cheshire & Merseyside 2015-2020
Paul White – Mental Health Lead, Liverpool Community Health
Suicide Safer Community
What is a Suicide Safer Community
• A “Suicide Safer Community” is one that will demonstrate a commitment to suicide prevention, providing compassionate care and support to those bereaved by suicide and promoting the mental health and wellness of its citizens.
• Suicide Safer Communities are passionate in their belief that suicides are preventable and that prevention is a shared responsibility where every person has the potential to make a difference and save a life.
• It is a community that believes that everyone has a fundamental right to have a future filled with hope and possibility.
http://suicideprevention.ca/engagement/building-suicide-safer-communities/
Objective A Canadian Suicide Safer Community Model:
1. Establish a Suicide-Safer Community committee
2. Establish the population size of your community
3. Identify organisations representing your committee
4. Create and agree an action plan or strategy with identified priorities
5. Support and commission accessible suicide intervention services
6. Support and commission accessible suicide bereavement support
7. Support and commission promotion of mental health and wellness activities
8. Support and commission proactive suicide prevention activities
9. Establish a pool of formally trained gatekeepers
10. Participate in World Suicide Prevention Day
What are we doing locally?
7) Support and commission promotion of mental health and wellness activities Champs Public Health Collaborative and local teams implement a full range of programmes that build resilience in communities and individuals Connect 5 – a successful shared programme For people in non-mental health roles who have contact with clients, service users and patients on a daily basis. Helping to support everyone’s emotional health and wellbeing.
Three levels of training
Session 1 Brief Mental Wellbeing Advice
Session 2 Brief Mental Wellbeing Intervention
Session 3 Extended Mental Wellbeing Intervention
Numbers trained in one of the nine local areas
2014-15: 368 individuals attended all three sessions
8) Support and commission proactive suicide prevention activities
CALM – Man Dictionary & Man Down (local) State of Mind (Rugby) Opening up Cricket
MIND/Sport England - Get Set Go
Time to Change Hub Liverpool
• Time to Talk
• Everton in the Community Football Club Foundation (LFCF)
• Brew Monday – Mersey Care NHS Trust
National Campaigns
Local Campaigns
9) Establish a pool of formally trained gatekeepers
Gatekeepers - individuals who have attended commissioned
training, which is ongoing, for example Suicide Potential
Training for communities:
• Suicide recognised as a hidden problem
• If suicide rates were applied to different health scenarios then there would
probably be national outrage
• Mental health GP leads in Liverpool identified suicide awareness as a training
need
• Brief Suicide Awareness for Primary Care,
by Dr Reeves (Chair BACP) approved by Liverpool CCG
• Designed to be 30 minutes long so they can be incorporated into practice
meetings
9) Establish a pool of formally trained gatekeepers
• Review commissioned of Suicide Awareness Training by Champs in 2014
• Recommendations were to roll-out the Brief Suicide Primary Care Training and the wider community suicide prevention training
Local suicide awareness
Papyrus Assist/ SafeTalk Suicide Potential Training
STORM
10) Participate in World Suicide Prevention Day
What does the future hold?
• Links with national & local MIND (Get, Set, to Go)
• Sport England
• Liverpool Time to Change Hub
• Development with Homotopia and National MIND of a play touring schools across the area
• Roll out Brief Primary Care and Community Suicide Prevention Training
• Call to Action for each Local Authority to become a Suicide Safer Community
Contact Details
Paul White – Mental Health/Suicide Awareness Lead
Public Health Promotion Team
Liverpool Community Health
Mob: 07887657128
Twitter:@MentalHealthPW
E-mail: paul.white@liverpoolch.nhs.uk
THANK YOU
Group work
Thank you for attending
#wspd15 #zerosuicide @CMPHN @Mersey_Care
CALM 0800 58 58 58 SAMARITANS 08457 909 090
Presentations will be available via the Champs website
www.champspublichealth.com
Full zero suicide strategy available via www.no-more.co.uk