Suffolk & North East Essex Integrated Care System

Zero Suicide

Achieving this Higher Ambition will mean that:
People in Suffolk and North East Essex do not die by suicide.
As an Integrated Care System we will ensure that:
  • Children, adults and older adults are aware of the risks of suicide and how to take action
  • Access to the means of suicide is restricted where possible
  • Every person working in the health and care system sees suicide prevention as their business
  • People at risk suicide are supported
  • People bereaved by suicide receive the support they need
What’s the current picture?

Suicide is a significant cause of death in young adults, and is seen as an indicator of underlying rates of mental ill-health. Suicide is a major issue for society and a leading cause of years of life lost. Suicide is often the end point of a complex history of risk factors and distressing events, but there are many ways in which services, communities, individuals and society as a whole can help to prevent suicides.

The Mental Health Foundation highlights the following statistics:
  • Nearly 6,000 suicides occurred in the UK in 2017 – one every two hours.
  • Suicide rates in the United Kingdom have decreased in recent years, but it remains the leading cause of death in young people aged 20-34 years, and in men under 50.
  • Suicide rates are considerably higher in men, around three times higher than women.
  • Recent statistics show only 27% of people who died by suicide between 2005 and 2015 had been in contact with mental health services in the year before they died.
  • Talking about suicide is still highly stigmatised. Understanding it better is necessary to help prevent further suicides in the UK.

For further information see https://mentalhealth.org.uk/a-to-z/s/suicide

A more recent article published in the British Medical Journal in August 2019, reviewed the evidence for renewed national action around suicide prevention in the UK. This concluded that effort and resources should be focused not only on the prevention of deaths by suicide but also relieving suicidal distress and removing stigma. This confirms the approach by the Zero Suicide Alliance in the UK and the Zero Suicide in Healthcare model in the USA which both emphasise that with good screening and connection to care,far fewer people will fall through the cracks. It’s not “someone else’s” job.

Based on this evidence, we aim to make a bold, uncompromising mindset shift from “no one can do anything” to “everyone can do something” to achieve zero suicide.

Poor mental health and mental illness have huge human and economic costs. Developing a compassionate culture at work where colleagues are able to talk freely about mental health or ill-health reduces stigma and discrimination, encourages engagement in well-being and resilience activities, and improves early uptake of services when necessary. Early recognition of mental health problems and effective emotional first aid often makes a significant difference to the lives of people at risk.

Numerous workshops with similar themes exist nationally. This one day Mental Health Awareness and Emotional First Aid Workshop is different in delivery mode. Being experientially based, and through compassionate conversation in role play and active participant engagement, it enables attendees to gain appropriate mental health knowledge, skills and values to enhance their personal circumstances or to transfer to their workplace with ease. Themes include creating a workplace culture that promotes resilience and reduces stigma, recognising distress and early signs of mental health problems, and responding compassionately to emotional distress including suicidal thoughts and self-harm.

To date 23 workshops have been delivered to 242 attendees across Suffolk and North East Essex. Over 82% of attendees evaluated the workshops as excellent. They felt empowered and confident in listening to and sharing personal mental health issues with colleagues and in accessing help. From feedback, these workshops are helping to promote a positive mental health culture in the workplace.

The workshop’s success lies in attendees being fully engaged throughout. Sometimes individuals share personal mental health problems; these situations offer another opportunity to role model application of sensitivity, care and compassion in the group with good effect. The workshop facilitation draws from a wealth of expertise in working collaboratively with service users, in evidence based mental health practice, education and group work, and in change management.

Chris lost his wife Ursula in May 2008. In the weeks and months afterwards, not only did he struggle to find the right support to help him begin the healing process, but also battled isolation as people avoided talking about her death.

“People just don’t know what to say when it comes to suicide,” said Chris, who was married to Ursula for nine years. “They will talk around it, use euphemisms or just not talk at all. That can be very difficult – when you have lost someone who is very dear to you, you don’t want that person to be suddenly removed from your life as if they didn’t exist.

“After somebody dies by suicide, often people only remember them for that last act and many can be so cruel – branding them cowardly or selfish. Nobody would ever use that language if somebody lost a loved one to cancer or old age. That is so sad – but part of the stigma that many people who have been bereaved by suicide have to endure.”

Chris is now urging the community to help break down the stigma which still exists around suicide by speaking about it more openly.

“But there is life – and hope – after suicide. I still have bad days, but they are incomparable to what it was like in the hours and days straight afterwards. During those times it’s important to remember that it does get better – one day you will wake up in the morning and it won’t be the first thought that crosses your mind.

Some people believe that aiming to reach zero suicide is over-ambitious. However if the target is not zero, what is an acceptable number for deaths by suicide? As an Integrated Care System we believe that no death by suicide should be regarded as either acceptable or inevitable. Each and every one of them has an incalculable impact on those who know the deceased and has huge impact on society in general, the local community and its resources. Every single suicide is a tragedy because it is another person who either felt unable to ask for help or did not know how to access it.

The concept of zero suicide was inspired by the Henry Ford system in Detroit, which began a programme of screening every patient for risk of suicide, not just those with mental health issues, in 2001 and enjoyed significant results. The suicide rate among its patient population fell by 75% within four years and by 2008, they eliminated all suicides among people in their care. Another study in the USA looked at help-seeking data of people who have died of suicide. Only 45% of had a mental health diagnosis the year before their death by suicide; only 1/3 of people had a mental health visit before their death, and only 5-10% of people were in inpatient care before their death. However, 85% of people had contact with broader health or care services before suicide.

Beginning in 2103, four CCGs in the East of England took part in a whole system Zero Suicide programme supported by the East of England Strategic Clinical Network.  The programme was subject to external evaluation by the Centre for Mental Health who concluded that they were very impressed by the work carried out.  In term of cost analysis the report concluded that:

”While any attempt to put a value on the benefit of suicide reduction in monetary terms is clearly problematic, estimates of the value of a prevented fatality are used in other public sector contexts such as the appraisal of transport safety measures.  These estimates suggest a figure of around £1.5 million per case.  Set against the relatively low cost of the measures discussed in this report, the obvious implication is that even a modest degree of success, e.g. preventing one suicide a year, would be sufficient to demonstrate that the measures in question are highly cost-effective.”

Source: https://centreformentalhealth.org.uk/sites/default/fiels/2018-09/zerosuicides.pdf

Last Friday, I was in the hospital with my son and partner and there was a lady in a lot of distress there. I waited a while to see if anyone was with her but no one sat with her. She was sobbing her heart out. I went over, introduced myself, said I was concerned about her, and if she minded me coming over and if she wanted to talk. She opened up and said she just wasn’t coping and didn’t know what to do. We chatted for quite some time and I even heard myself saying the words about being ‘safe for now’... It was really emotional but I hope I did OK. I didn’t think I’d be putting the training into practice quite so soon and outside work. Just wanted to let you know how the zero suicide training has helped.

HOW we plan to make a difference

    1.1 People will be aware of suicide as a health problem and what can be done to prevent it.

  • We will promote national awareness campaigns such as World Suicide Prevention Day, using a range of media.
  • We will develop local suicide awareness programmes targeting groups and communities with higher incidence, identified using population health data. These programmes will help people recognise the signs that someone may be contemplating suicide, have confidence in speaking about suicide to them, and signpost to sources of support.
  • Leaders, including elected members, community representatives and employers, will be encouraged to promote suicide awareness and talking about suicide.

    1.2 People will have a range of ways to seek support if they are contemplating suicide.

  • We will provide a range of resources and services that will help people to access support when they need it, and publicise these in health and care buildings, and community, work and leisure settings.
  • We will provide a range of ways in which people can seek support with suicidal ideations, including face-to-face, online and helplines, maximising opportunities to divert them from suicide.

    2.1 People can talk about their thoughts of suicide without fear of stigma or discrimination.

  • Suicide awareness training programmes will challenge stigma around suicide to create an environment where people contemplating suicide, and those bereaved by suicide, are able to talk openly without fear of judgement or discrimination.
  • Suicide awareness training programmes will incorporate ways to help people to be confident in talking to someone they are worried about.

    2.2 People know how to identify and listen to someone who is thinking about suicide.

  • We will train all staff in the public sector in suicide awareness, and offer training to employers and communities. This will help people both in their work roles and as members of their communities to be able to support each other.
  • Health and care staff will be trained to actively listen to people who have thoughts of suicide, through open and therapeutic interpersonal relationships. Listening to people who are at risk of suicide helps them to share their situation and fears, as the first step to obtaining support.

    2.3 Health and care organisations learn from experience.

  • People who have used suicide-related services or who have been bereaved by suicide co-produce services and systems of support. In this way process improvement and strategy design will cultivate empathy, decrease fear and improve the patient experience.
  • We will develop and promote a learning environment where system failures provide opportunities for improvement, rather than blame.

      3.1 Health and care settings will remove the means for suicide.

    • All urgent and emergency care settings and hospital wards will risk assess and take measures to prevent people having access to the means to attempt suicide. CQC recommends that “services that may deal with mentally disordered patients (such as emergency departments) should be aware of the risks and have management plans to meet them”.
    • We will implement the new Mental Health Safety Improvement programme for inpatients in mental health services, by December 2019. This programme focuses on prevention and reduction; the ambition for inpatients should be zero suicides.
    • All social care settings such as drop-ins, day services and residential homes will risk assess and take measures to prevent people having access to the means to attempt suicide.

      3.2 Access to the means of suicide is restricted wherever possible.

    • All public bodies and employers will be encouraged to risk assess and take measures to prevent people having access to the means of suicide within their work. This will include community-based settings, environmental and building planning, transport and roads.1,

      4.1 People at risk of suicide will have access to a range of mental health services. We will enable this by:

    • Extending coverage of the suicide reduction programme, by March 2024. This evidence-based programme supports organisations and systems to deliver the best quality care to those people at higher risk of suicide.
    • Integrated local health and care systems identifying and supporting people with the wider causes of their thoughts of suicide. Supporting people with the determinants of suicide and self-harm prevents harm and helps recovery.
    • Reviewing prescribing practice in primary care, secondary care and across the local system. This will ensure people receive the right support for their mental health needs, drawing on evidence based effective pharmacological and psychological treatments for depression, and enable the local system to ensure there is sufficient capacity of treatments to meet demand.

      4.2 People in more vulnerable groups and communities are supported to minimise the risk of suicide. We will enable this by:

    • Mental health intermediate care, crisis response and recovery services identifying those at highest risk and providing intensive targeted support. This includes for example people recently discharged from inpatient services or whose mental health is deteriorating.
    • Targeted support for children and vulnerable adults who have suffered trauma or exploitation have targeted support to prevent suicide. Support should be provided through integrated health and social care services, and align with the violence and vulnerability work of Police, Fire and Crime Commissioners.
    • Identifying people in minority ethnic groups at higher risk of suicide and giving culturally appropriate support. Some groups are at higher risk, such as young Asian and African women, young Black African men, asylum seekers suffering trauma and social exclusion, and immigrants separated from family networks who lack knowledge about the support available. • Prison services identifying those at risk of selfharm and suicide and provide targeted support. People in prison are at heightened risk. In 2018, there were 92 apparent self-inflicted deaths in prison nationally, up 31% from the previous year.
    • Using population health management techniques to support delivery of personalised care, and to help predict future behaviour including risk of suicide. Population health management can help identify high risk groups such as working age men and adolescents so that action can be targeted to try to minimise harms.

      4.3 Carers and families are supported.

    • Families and carers will be helped to understand suicide and how best to support the person. Improved knowledge and skills will help carers minimise harm and support recovery, and support their own wellbeing.

    5.1 Those directly affected by crisis receive high quality support in their bereavement.

  • We will provide bereavement support for families and mental health crisis staff building on the Cambridge and Peterborough model. Post-crisis support will enable people directly affected by suicide to feel supported in their bereavement.
  • The risks of suicide by people who have already been bereaved by suicide will be assessed. People who have been bereaved by suicide are statistically at higher risk of crisis and suicide themselves, so high quality support prevents the risk of further harm

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