Suicide Prevention National priorities and evidence for action Chris Nield FFPH Based on a presentation by Professor Louis Appleby Chair of the National Suicide Prevention Advisory Group

Children with mental health problems will be given more support, Theresa May announcement  Laura Hughes, Political Correspondent 6 January 2017 • 4:12pm Children who are victims of sexting and cyber-bullying will be given more support by schools, Theresa May will announce next as she vows to fight the "burning injustices" in modern Britain.  In a major domestic policy speech the Prime Minster will vow to do more to tackle inequalities and outline a series of measures improve mental health.

Age-standardised suicide rates UK 1981- 2015

Percentage of population who report self - harm Source: NatCen 2016

FACTS & FABLES OF SUICIDE § You have to be mentally ill to even think about suicide? • If a person is serious about killing themselves then there is nothing you can do? Talking about suicide is a bad idea as it may give someone the idea to try it? People who are suicidal want to die? FACTS & FABLES OF SUICIDE

National study of teenage suicide Linked to suicide bereavement, isolation Suicide-related internet use in 23% No service contact in 43%

Contact with Services % of cases saw their GP within a month of 44.6 their death Many of these visits were for a physical health problem – % 42 12.20 44.60 60.60 76.60 90.20 10 20 30 40 50 60 70 80 90 100 Within previous week within 1 month within 3 months within a year More than a year ago Chart shows cumulative percentages of people attending primary care

Leeds Suicide Prevention Strategy - Personal Circumstances 147 59 20 40 60 80 100 120 140 160 Single, Divorced or Seperated Married, Cohabitating or Civil Partnership Most common marital status was single – % 50 Majority of cases were single, divorced or separated Most common living situation was ‘living alone’ 53 % experienced relationship/ family problems 38 % experienced divorce/ separation Theme of social isolation emerges Chart showing the number of single, divorced or seperated cases versus married, cohabitating or civil partnership

Risk Factors

National Suicide Prevention Strategy 2012: Six Actions 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

Romanticising suicide suicide UK_SUICIDE © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be repro duc ed in whole or part without the permission of the copyright holder. Sensationalising and Romanticising suicide suicide

PHE Guidance Suicide Prevention Plan in Every area Multi-agency Leadership Interventions Work with local press

Suicide prevention at hotspots • Barriers Helplines Intervention/patrols Local media Source: h ttps://www.gov.uk/government/publications/suicid e - preventio n suicide s i publi c place

Real Time Surveillance “Real-time suicide surveillance is a system that enables consideration of interventions required after a death has occurred where the circumstances suggest suicide in advance of the coroners conclusion.” (PHE 2016) .

Real Time Surveillance Why ? 1 in 6 adults have had a mental problem in the last week 1 in 5 people have considered suicide at some time in their life It is estimated that for every suicide, up to 60 people will be affected, 6 of them severely Coroners reports can be longer than a year after the suicide.

Real Time Surveillance Purpose & Process On December 1st 2016 North Lincolnshire Council and partners launched a Real Time Surveillance (RTS) pilot in order to: - share information in a timely manner - implement an early alert system - be responsive to a potential suicide or contagion - enable those affected and bereaved by suicide to receive support in a timely manner RTS Process Police triage sudden deaths to determine if the cause is potential suicide and notify Public Health and also the Adult Protection (AP) Team within the Council.

Emerging Findings from evaluation of the pilot No evidence of cluster or contagion High level multi-agency commitment and effective partnership work including work with Humber Bridge partnership Universal services have increased understanding about the effects and aftermath of suicide Early identification and removal of inappropriate reporting of means /method of suicide on social media Local media coverage has improved and is currently more appropriate Key agencies Samaritans and Educational Psychology have provided additional support and training including in workplaces. Proposed changes to the model Initial support offered to bereaved family and friends to be reviewed & further developed Mapping of wider current support is required. Consider revising the initial pathway from Police to Adult Safeguarding and develop an information sharing protocol

Support after Suicide: A guide to providing local services - Postvention Those exposed to or bereaved by suicide are up to 300 % more at risk of completing suicide Local Suicide Prevention Planning : Describes importance of timely identification & referral ( real time surveillance) for postvention support Promotes specific opportunities for this known group to be targeted for follow up Considers how to develop & evaluate support services Local postvention programmes rely on strong partnership work Help is at Hand - provides support for people who may be bereaved by suicide