1. East Sussex Suicide Data Analysis Jenny Broome-Smith Public Health Intelligence Team ESCC

2. Underlying cause of death codes Verdict ICD-10 codesDescription SuicideX60-X84Intentional self-harm For example: X82 Intentional self-harm by crashing of motor vehicle OpenY10-Y34Injury/poisoning of undetermined intent For example: Y32 Crashing of motor vehicle undetermined intent ONS suicide statistics are based on both suicide and open verdicts (underlying cause of death codes X60-X84 and Y10-Y34). It is assumed that almost all deaths due to injury/poisoning of undetermined intent were due to intentional self-harm, but the evidence to prove intent was simply not available.

3. Suicide rate, all persons, 2011-2013 Directly age-standardised suicide rate Areas shaded green, amber and red have significantly lower, similar and significantly higher rates of suicide, respectively, than England. Areas shaded grey have too few deaths for rates to be robustly determined. DSR England 8.8/100,000 DSR East Sussex 11/100,000 Source: PHOF, May 2015

4. Beachy Head

5. PCMD Deaths registered 2006-2014 inclusive Deaths occurring 2006-2013 inclusive East Sussex residents “Residents” Non- East Sussex residents “Non-residents” Underlying cause of death codes X60-X4, Y10-Y34 “Residents” “Residents” “Non-residents” “Non-residents” suicide all other causes suicide all other causes Average 50 per year Average 25 per year 92% occur in East Sussex (All occur in East Sussex) 8% occur outside county

6. Why Suicide Audits don’t capture all records In general coroners investigate deaths due to suicide occurring in their local area. Exceptions: The local area coroner may be too busy For “non-residents” the coroner for the person’s area of residence may have better information Narrative verdicts that are “hard-to-code” must be coded as accidental deaths: For example, “X was found with a ligature around his neck” according to international rules must be coded as an accidental death because it does not indicate whether the person intended to kill themselves

7. Causes of suicide UK 2013 death registrations CauseMale % deaths Female % deaths Hanging, strangulation and suffocation 5640 Self-poisoning2038 Drowning46 Falling from a height34 Other1611 Total100 -- indicates data suppressed East Sussex residents died in 2006-2013 Male % deaths Female % deaths 4531 2234 38 1318 179 100 Non-residents died in East Sussex 2006-2013 Male % deaths Female % deaths 89 6-- 7276 -- 100

8. Suicides at Beachy Head There are on average 25 deaths per year –Suicide at Beachy Head accounts for about one third of all suicides occurring in East Sussex “Non-residents” account for about 4 in every 5 suicides at Beachy Head Overall 40% of suicides occurring in East Sussex are at Beachy Head or other coastal cliffs

9. When do suicides occur at Beachy Head?

10. Area deprivation and suicide

11. Is ONS mortality data error-free? Occasionally the “place of residence text” and “place of residence postcode” do not match. Occasionally the “place of death text” and “place of death postcode” do not match. This seems to be a particular problem with sparsely populated areas. For example, deaths occurring at Beachy Head deaths (place of death text) have been assigned more than 20 different postcodes (place of death postcode). In more than fifth of Beachy Head deaths the place of death postcodes do not correspond to the Beachy Head area.

12. What data for the Suicide Audit in East Sussex? Collect information on how people travel to Beachy Head (car, bus taxi, on foot). Partnership working on IT/data issues with the faith organisation, “The Chaplaincy”, who actively patrol and intervene at Beachy Head, and with Fire and Rescue services. Both collect valuable incident data.

13. References ONS statistical bulletin on suicide in the UK 2013 http://www.ons.gov.uk/ons/rel/vsob1/mortality-statistics--deaths-registered-in-england-and-wales--series- dr-/2013/index.html PCMD factsheet http://www.hscic.gov.uk/pcmdatabase Guide to coroner services https://www.gov.uk/government/publications/guide-to-coroner-services-and-coroner-investigations-a-short- guide Narrative verdicts and their impact on mortality statistics in England and Wales. Health Statistics Quarterly 49 (2011) Chris Hill and Lois Cook http://www.ons.gov.uk/ons/rel/hsq/health-statistics-quarterly/spring-2011/narrative-verdicts-and-their- impact-on-mortality-statistics-in-england-and-wales.pdf Suicide in East Sussex. Analysis of ONS mortality data, 2006-2013 http://www.eastsussexjsna.org.uk/briefings http://www.eastsussexjsna.org.uk/briefings (appearing soon)