current suicide picture across lancs and sc stp - … · current suicide picture across lancs and...

Current suicide picture across Lancs and SC STP - Overview

Chris Lee & Farha Abbas

September 2017

Overview

Presentation will focus on:

➢Suicide rates in and across Lancashire &

South Cumbria STP

➢Main findings of suicide audits across the

STP

12.2 per 100,000 - 522 people - 392 M|130 F

18.6 per 100,000

5.9 per 100,000

Age band

Lancashire &

South

Cumbria STP

Rank Highest Lowest

10-29 11th highest

Durham, Darlington,

Tees, Hambleton,

Richmondshire and

Whitby The Black Country

30–44 5th highest

Durham, Darlington,

Tees, Hambleton,

Richmondshire and

Whitby South West London

45–59 8th highest

Cornwall and the

Isles of Scilly

Milton Keynes,

Bedfordshire and Luton

60–74 9th highest

Cornwall and the

Isles of Scilly

West, North and East

Cumbria

75 and over 18th highest

Cornwall and the

Isles of Scilly

Leicester,

Leicestershire and

Rutland

Suicide rate rank in England STPs

Source: ONS

Highest in Preston

& Blackpool

58 people-Preston

59 people-Blackpool

22% of STP suicides

England - top 10% districts & UAs

Preston 4th

highest &

Blackpool 5th

highest (Out

of the 326

Upper tier

and district

authorities)

Main findings of the suicide auditsLancashire Blackburn with Darwen Blackpool Cumbria

Period April 2013-March 2015 2012-2013 2011-13 2012-2013

% males 71% 90% 74% 77%

Age group with highest proportion of suicides 40-49 followed by 50-59 years 45+ years 25-44 years

Common ethnic group White British White British White British

Deprivation/employment 26% residing in deprived areas (Q1)

21% semi-routine/routine

occupation

highest number of suicides

in categories L49

(disconnected youth), O63

(streetwise single), L52

(midlife stopgap), K46 (self-

supporters) and L50 (renting

a room).

The highest rate of suicide

was among those in

‘Process, Plant and Machine

Operative’ occupations,

including jobs such as drivers

and machinists

Common method Hanging/strangulation (58%)

Hanging/strangulation

(38%) Hanging/strangulation (52%) Hanging/strangulation

2nd common method Self-poisoning (19%) Self-poisoning (34%) Self-poisoning Self-poisoning

Common place of suicide completion Home (71%) Home (38%) Home (64%)

Depression diagnosis 47% (45% males|54% females) 41% 54% males, 41% females 42%

History of alcohol/drug misuse 25% (alcohol) 18%(drug misuse) 22% 17%

Contact with primary care in last month before suicide 24% 46% 22% (in the week prior)

Contact with specialist mental health services in their lifetime 46% 28% 63%

History of self harm 41% 35% males, 38% females 42%

Dignosis of a physical health condition 48% 58%

Contact with CJS in 12 months preceding death

16% (date of custodial contact

recorded) 36%

Contributory risk factors present

Mental illness (including history of self-

harm) Depression Depression

Proprtion of retired

individuals increased

Depression Relationship breakdown Mental illness Mental illness

Financial difficulties Substance misuse

History of drug and alcohol

abuse Alcohol/substance misuse

Relationship breakdown/difficulties Self-harm Self-harm

Alcohol/substance misuse Having a long term condition Welfare reforms

Bereavement Alcohol use

Chronic pain and long term

condition

Ongoing criminal investigation or

recent police contact

Unemployed, single, living

alone, having financial and

relationship difficulties Contact with CJS

Where there was a recent police

history/ongoing investigation, the

highest proportion related to child

sexual offences.

Separated, recent

relationship/marital problems

Abuse

Single, divorced, separated or

widowed and living alone

Key cross cutting contributory risk

factors identified

• Depression

• Mental illness

• Alcohol and substance misuse

• Self-harm

• Relationship breakdown

• Financial difficulty

National Policy Context

Suicide Prevention

Annie Murray

Public Health Mental Health

2 National context suicide prevention 13.9.17 Lans & Sth Cumbria

National Policy Context: Mental Health • 10% reduction in suicide by

2020/21

• Lancs & South Cumbria

approx18

• 18 less suicides equates to

£28.8 million

• To have multi-agency suicide

prevention plans in place by

2017

• To develop a local “Prevention

Concordat” by 2017


National Policy Context: Mental Health• Designed to complement, not replace, related

resources such as suicide prevention resources and the Mental Health Crisis Care Concordat

• Suicide prevention is seen in the context of wider work promoting positive mental health and preventing mental ill-health

• There is a number of linked resources • ROI tool includes SP and delivery of

psychosocial assessment in A&Ehttps://www.gov.uk/government/publications/mental-health-services-cost-effective-commissioning

• Prevention Concordat Consensus statement which is commitment to action

• Infographic public health mental health• MH JSNA and guide • Psychosocial pathways and health equity

report

https://www.gov.uk/government/collections/prevention-concordat-for-better-mental-health


https://www.gov.uk/government/publications/mental-health-services-cost-effective-commissioning

National Policy Context: C&YP Mental health Key Themes • Promoting resilience, prevention

and early intervention

• Improving access to effective support – a system without tiers

• Care for the most vulnerable

• Accountability and transparency

• Developing the workforce

All will impact on self-harm and suicide


National Policy Context: Suicide Prevention • Update of 2012 strategy (2017)

• Reducing the risk of suicide in high risk

groups

• Tailoring approaches to improve mental

health in specific groups

• Reducing access to means of suicide

• Providing better information and

support to those bereaved or affected

by suicide

• Supporting the media in delivering

sensitive approaches to suicide and

suicidal behaviour

• Supporting research, data collection

and monitoring

• Reducing rates of self-harm as a key

indicator of suicide risk.


National Policy Context: Suicide Prevention:- HMPs

Key Stats

• Self-inflicted deaths increased by 13% (Sept

15-Sept 16) and 75% increase on 2012

figures

• Self-harm increased by just over a quarter

(June 2015-June 2016)

• Women are more likely to self-harm than men,

and to do so more frequently – although the

seriousness of self-harm is greater among

men

• Addressing self-harm and self-inflicted deaths

is critical to address the causes of re-

offending

Reducing self-inflicted deaths in the 5

prisons will contribute to overall 10%

reduction by 2020


National Policy Context: Alcohol/drug use and Mental Health

• 54% of all suicides in people experiencing mental health problems have a history of alcohol or drug use

• Prisoners with addiction have an increased risk of self-harm and suicide

• The National Confidential Inquiry calls for specialist alcohol and drug services with the ability to manage clinical risk, working closely with mental health services, with agreed arrangements for "dual diagnosis" patients

• Local understanding the needs and increased risk of suicide for people with co-occurring conditions and local suicide prevention plans include a strong focus on alcohol and drug use

•


Twitter @MindFacingUP

• Facing Up is a Lottery funded mental health /wellbeing project run by Lancashire Mind

• Aimed at all men in BwD (Blackburn withDarwen)

• We are now in Year 4 of 5

• Volunteer led

• Just over three out of four suicides (76%) are by men and suicide is the biggest cause of death for men under 35 (Reference: ONS)

• Men are less likely to access psychological therapies than women. Only 36% of referrals to IAPT (Increasing Access to Psychological Therapies) are men.

• Men have measurably lower access to the social support of friends, relatives and community (References: R. Boreham and D. Pevalin).

• 3 pronged attack

– 1. Instilling Mental Wellbeing & Resilience

– 2. Support for Mental Health Conditions

– 3. Campaigning & Changing Attitudes

• 5 Ways to Wellbeing (NEF) as the main structure

• Early intervention / prevention • Deliver at source as much as

possible i.e. Job centre’s, college’s, hostels, car meets

– Workshops (5 Ways, anger)– Peer Support Groups– One to One’s (MOT’s)– Social Media campaigns– Mainstream media– Talks

“You can look after your ownmental wellbeing and that

regardless of your situationyou can do things that willhelp to keep you stronger

and happier in the toughestof times”

• Take it to the man

– Workplace, Job Centre’s, Community venues, pubs, tenants bases, barbers, butty vans etc

• Be non clinical in appearance

– Colour schemes

– Professional chameleon

• Champions

– Upskill relevant people who can make a difference i.e barbers, supermarket cashiers, workplace champions – early signs

• Partnerships

– Increase impact & reach: Age UK BwD, Healthwatch BwD, Blackburn College

• Be relevant!

– Know your audience

– Recruit from within

“The main thingabout this project is that it is

delivered and attended bypeople from the same

background, sharing tipsand experiences with

each other”

• We have reached over 2500 men

– 99% feel more supported

– 98% have increased awareness of coping strategies

– 94% report reduced mental health distress

– 83% report increased confidence to engage with personal development opportunities

– 48% engaged in personal development opportunities

“Helping to supportother men has been

enormously beneficial to me interms of experience

and also my ownmental health”

• Sustainability

– Peer support (Side by Side)

– Shared learning

– Embedding our tools in partner organisations

– Blokes now on panels i.e dad’s at children’s centre’s

– Successful campaigning messages to continue

– Autonomous volunteers and champions

– Exploring wider reach i.e wider pan Lancs partnerships

“It is the best thing I have ever done, I just love how

you can get thingsoff your chest with no

agenda”

Twitter @MindFacingUp

[email protected]

07964 083 340

//21-Sep-17 1

The Rail Industry Suicide

Prevention Programme

Richard Godwin - Route Crime Manager and Suicide

Prevention Route Lead / Suicide Prevention Plan

Co-ordinator - London North Western Route

/21-Sep-17 2

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/21-Sep-17 5

The larger brown blobs represent the locations that will see some focus in the 9 point

plan delivery. Locations such as Preston, Leyland, Morecambe, and Burnley Central

/21-Sep-17 6

Given the size of the Network we identify high risk locations which are called National

Priority Locations - these are identified from the number of incidents that occur on the

network including pre-suicidal incidents, suspected suicides and injurious attempts

and the associated delay times.

We deliver key activities through working in partnership with Samaritans and BTP

including a Community Outreach Project which consists of a range of deliverables that

focus on these 23 locations Nationally. It’s important to stress that these are the

railways highest risk locations. Many others exist where we look to employ some sort

of mitigation measure and on LNW route this is around 50 locations

Escalation Process

Purpose

The key aims of the escalation process are to target specific additional activity at

locations where repeated suicide incidents or pre-suicidal incidents are recorded to

mitigate against the risk of further incidents. Part of the activity involves contacting

Public Health Leads and local MP’s to inform them of the incidents and to work

together. We currently have 20 locations of which 2 are in Scotland.

/21-Sep-17 7

Samaritans carry out a

range of projects

including campaign

material targeting men

between the ages of 35-

55. There has been a new

campaign launch of new

material highlighting the

main message is that

Samaritans don’t just hear

you, we listen and

therefore can support

people with all types of

issues including

relationship breakdown,

financial issues etc.

Media Guidelines

Developed to promote the sensitive and appropriate reporting of suicide and to respond quickly to

journalists enquiries about how to portray these deaths.

Community Outreach and Awareness Training

Samaritans attend a range of events and will visit a rail station where there has been an incidence

between 24-72 hours to offer support to passengers, rail staff etc. They will also visit a train station

straight after an incident to provide support if required depending on volunteers being available.

/ 8

Over 15,000 Rail Staff and

BTP Officers trained

1593 Life saving

Interventions made in

2016/17 on the UK Rail

Network

/

The Suicide Prevention and Support on the Railway: Learning Tool aims to

empower rail personnel with the knowledge and understanding required to prevent

a suicide.

The video modules cover suicide prevention on the railway, and they:

Improve your understanding of the issue of rail suicides and the myths and

barriers around it.

Provide you with guidance for identifying someone who may be suicidal and

how to talk to them.

Provide you with guidance for getting help for that person and resolving the

situation safely.

To date a further 17,000 have

been trained using this tool

10

Other Industry Training

/21-Sep-17 11

Network Rail part fund a dedicated Suicide Prevention and Mental Health

Unit

BTP collate data on pre-suicidal behaviour, interventions and suspected

suicide. This data is becoming more widely available through our partnerships.

Intervention data is now being shared in a restricted way because we feel this

will provide the true picture of what is happening in an area or location for

example the incidents may be low, but the number of interventions might be

higher.

Suicide Prevention Plans

BTP Suicide Prevention and Mental Health Unit provide bespoke policing

arrangements to identify and support vulnerable individuals who have

attempted or expressed an intention to attempt suicide on the rail network. Joint

Health and Police ‘Suicide Prevention Plans’ are developed to support at risk

individual's to reduce the risk that they will return to the railway to take their own

life or take their own lives by other means.

In 14/15 less than 1% of people who tried to take their own life on the railway

and were subsequently supported via a SPP ended up taking their own lives on

the railway or elsewhere.

/21-Sep-17 12

Anthropology - We are aware that we have issues with certain stations and we want to

identify why clusters of people take their lives at specific locations particularly where

existing mitigation measures should, it is believed, act as a significant deterrent. A number

of additional studies will be commissioned this year at some of our National Priority

Locations

Middlesex University Research - Focus on Why do people choose to take their lives on the

railways in Great Britain? In-depth qualitative interviews with individuals who have survived

or contemplated a suicide attempt on the railways with the addition of CCTV footage

analysis

Analysis of news and online content that may influence people’s decisions to use the

railways as a method of suicide.

The Middlesex university research showed a number of key reasons that suicidal people

choose the railway – these include the belief that attempting suicide on the railway will be

100% lethal – in fact about 20% of suicide attempts on the railway end in life-changing

injuries. People also believe the railway to be impersonal, easy to access and private.

Media portrayal of rail suicide emphasises the means as highly lethal. Factors that reduce

the likelihood of people choosing the railway as a means of suicide include the belief that

someone will intervene, the presence of barriers can also prevent suicides occurring.

Using Research

/21-Sep-17 13

Using Research

The Middlesex University and University of Westminster research (Why do people take

their lives on the Railways in Great Britain?) published in November 2016

recommended that a bystander campaign be progressed so that members of the

general public could play their part in “identifying individuals in distress and

intervening in a safe and effective way.”

The Suicide Prevention Duty Holders Group (SPDHG) have sought to deliver the

recommendations of the research and in relation to the bystander campaign requested

that the senior media relations manager – Network Rail and the central suicide

prevention team progress it on behalf of the Rail Industry.

A campaign agency – Pegasus – was enlisted to develop appropriate material working

closely with Samaritans and the BTP. It is now being tested with focus groups and

commuters via an online survey.

The ‘campaign platform’ has become known as Small Talk Saves Lives.

The nature of the campaign through the direct link it makes between suicide and the

railway, breaks away from the traditional thinking that the two should not be referred

to together. The industry’s respected advisors in this area, Samaritans however fully

support the approach being taken and have been involved in the campaign since its

conception. We hope to launch this later this year.

/21-Sep-17 14

/21-Sep-17 15

The Rail Industry cannot control the suicide risk in this country but it can influence it.

Much has been done at route levels to achieve this whilst external stakeholders at

government and local authority level have been lobbied by the industry’s central suicide

prevention team to do more to support our programme.

At its heart is Network Rail’s role to bring stakeholders together and coordinate suicide

prevention activity. This activity is not new to the company but for the first time through

the Plan there will be transparency across the industry about who has responsibility for

what.

The nine points that comprise the guidance are not an exhaustive list of measures that

can be taken to prevent suicide. They do however represent in the view of the industry’s

Suicide Prevention Duty Holders Group (SPDHG) - based on six years of experience the

most effective measures to address suicide on the railway and the trauma they cause

staff, customers, families, friends and others.

On 8 November 2017, the SPDHG will be supporting the industry’s fourth suicide

prevention conference which will be held in central London.

In contrast to previous years it will be focused around one key aspect of suicide

prevention – delivery by the industry of its “9 Point Suicide Prevention Plan”. It will look

to explore the:

• background of the Plan

• support available to deliver it

• progress being made towards its delivery

• sharing of good practice between those with responsibility for suicide prevention

/21-Sep-17 16

1. Leadership and resources

A Suicide Prevention Plan is unlikely to succeed unless appropriate resources are

allocated to oversee its delivery and to provide direction to employees and escalate issues

as the need arises.

What is recommended?

the appointment of a Suicide Prevention Champion

the appointment of a Suicide Prevention Plan Coordinator

2. Identifying ‘at risk/priority locations’

It is essential that each organisation cooperates with other industry stakeholders to agree

which locations are particularly vulnerable to suicide or delay following a suicidal event so

that appropriate action can be taken to mitigate against those risks.

3. Mitigation measures

Having identified and agreed at risk/priority locations with other industry stakeholders

consideration should be given to deploying mitigation measures at them using a priority or

risk based model.

4. Promoting life-saving interventions in suicide attempts

Rail Industry staff can play a key role in preventing suicides by directly intervening in

them. A comprehensive package of industry material exists to promote and support such

interventions.

5. Training staff to intervene in suicide events

Intervening in a suicide attempt is one of the most direct and effective ways of preventing

suicides on the railway. Training can provide staff with the added confidence and incentive

to intervene.

/21-Sep-17 17

6. Promoting help seeking behaviour through campaign material – ‘Samaritans

posters’

The industry has funded recognisable and academically/focus group researched campaign

material to prompt those in crisis (or with issues that may lead them to be in crisis) to turn

to Samaritans for support. Posters and supporting material promote help seeking

behaviour amongst those vulnerable to suicide and as such are integral to the overall

success of the programme.

7. Trauma management support and resilience training

The impact of a suicide can be traumatic on those members of staff who are directly (and

in some instances indirectly) involved in them. It is important that support mechanisms are

in place for them to:

• detect emerging consequential mental health problems amongst them

• support those that have been involved in or witnessed potentially traumatic events.

8. Trauma support training

The Industry should consider training those who manage or supervise staff that may be

exposed to traumatic events to allow them to offer the most appropriate level of support to

them and ‘at risk’ staff themselves to increase their resilience to traumatic events.

9. Emotional Support

Emotional support for staff and/or customers following a traumatic event. Samaritans offer

ESOB (Emotional Support Outside Branch) arrangements where volunteers can provide a

station presence to support those that may have witnessed an event or have been made

vulnerable to suicide as a result of one.

/

Thank you for your time

21-Sep-17 18

Serving the people of Cumbria

Cumbria Suicide Prevention

Leadership Group

Active & Engaged Partnership


Partners

County Council Cumbria Police Coroners Office

Probation Service Service User Rep CCG

CPFT SOBS MIND

Samaritans Lay Rep UNITY

Cumbria Newspapers NCUHT UHMBT

NWAS General Practice Haverigg Prison


Connectivity

Cumbria Suicide

Prevention

Leadership Group

Cumbria Health

and Wellbeing

Board

Cumbria Suicide Prevention Reference Group

Mental Health

Providers Forum

Mental Health

Commissioners Group

Media

sub-group

Public Health AllianceLocal Health

and Wellbeing

Fora (x6)

Safeguarding Boards

(Children & Adults)

Mental Health Crisis

Care Concordat

Emotional Wellbeing and

Mental Health of Children

and Young People Board


Core Business

To provide leadership for the

implementation of the National Strategy,

the Multi-Agency Suicide Prevention

Strategy for Cumbria and associated

action plans


Functions

• To monitor the implementation and impact of

the Cumbria Suicide Prevention Strategy and

Action Plan

• To review and update the Action Plan

annually

• To convene an annual meeting of the Cumbria

Suicide Prevention Reference Group

• To report to the Cumbria Health and Wellbeing

Board via the Cumbria Public Health Alliance


Functions cont.

• To connect with, and share learning and

collaborate with, the Cumbria Local Safeguarding

Children Board, Cumbria Safeguarding Adults

Board, Cumbria Mental Health Partnership Group,

Cumbria Mental Health Crisis Care Concordat,

Cumbria Emotional Wellbeing and Mental Health of

Children and Young People Board, and other

multi-agency and single agency governance

bodies as appropriate Board via the Cumbria

Public Health Alliance


Functions cont.

• To receive and interpret intelligence, audit and

performance data

• To highlight and share local, national and

international intelligence, good practice and

research related to suicide and its prevention,

and in relation to people impacted by suicide

• To seek resources for implementation of the

strategy and action plan as appropriate


Effective Partnership Working

• Participation

• Relationships and trust

• Co-ordination, facilitation and leadership

• Communication

• Structural balance

• Diversity and dynamism

• Decentralisation and democracy

• Time and resources

• Monitoring and evaluation(Kerr et al 2003)


Common Barriers to Effective

Partnership Working(Adapted from Scottish Government, Joint Improvement Team 2009)

RESOURCES

• Different Funding Cycles

• Cost shunting

• Lack of integration of

information

• Reluctance to share data

• Balance between operational

• and change management

• No Time

STRUCTURES

• Wrong Partners

• Blurred Accountabilities

• Poor engagement of local people

and service users

• Partnership Fatigue

• Constant change

• Different Boundaries



Partnership Working cont.

PEOPLE

SKILLS

• No training in

partnership skills

• Lack of knowledge of

other professions

ROLES

• Different employment

conditions

• Loss of autonomy

• Power and Hierarchy

• Unclear roles

BEHAVIOUR

• Poor morale from

past failures

• Revert to type

• Professional identity

and interprofessional

mistrust

• Threatened



Partnership Working cont.

ENVIRONMENT

• Poor alignment of national

targets and standards

between different sectors

• Short term political

timescales and funding

• Competing policy agendas

and maze of initiatives

• Government departments

remain entirely separate

• ‘good news’ imperatives

PROCESS

• Flawed decision-making

mechanisms

• Lack of common goal

• Poor communication

• No integration of

partnership and partner

agencies’ activities

• Not planning for when

things go wrong

• Lack of focus on action

CULTURE

• Power differences

• History of

unproductive

partnership

• Allegiance to

uni-professional

culture

• Different ways of

working


Future of the Cumbria Suicide

Prevention Leadership TeamWorking with Sustainability and Transformation

Partnerships

Lancashire and

South Cumbria

STP

Pop (1.75m)

North Cumbria STP

Pop (320k)

Cumbria

Pop 520k

South Cumbria Pop (2000k)

11·7% of STP population




Partnerships

South Cumbria

area 1,600sq km

35·7% of STP area

Lancashire

and South

Cumbria

STP

Area

4,700sq km

Cumbria

Area

6,800sq km




Partnerships

CHALLENGES

Limited Resources New Structures

People (roles and behaviour) New Environment

Changed Processes Culture (power & authority)




Partnerships

OPPORTUNITIES

Sharing Resources New Partners

People (sharing knowledge) New Environment

New & Refreshed Processes Culture (experience of a

productive partnership)

Taking Camerados to the Streets

A series of conversations with…

Dr Nina BrowneClinical and Community Psychologist

Our vision is a world where anything is possible through collaboration and where communities

are listened to and listened to for solutions

[email protected]

http://www.owls.org.uk

Sarah MortimerDevelopment Manager

Association of Camerados

The answer to all our problems is each otherwww.camerados.org

[email protected]

http://www.camerados.org

Jacqui Lane

Trainer and Coach

[email protected]

Love is the cause and love is the cure

http://www.jacquilane.com

S U I C I D E

I C U S D I E

current suicide picture across lancs and sc stp - … · current suicide picture across lancs and...

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