1. Support for those Bereaved and Affected by Suicide Gina Perigo, Public Health Practitioner Liverpool City Council

2. Impact of Suicide It is an individual tragedy, life altering for those bereaved and a traumatic event for the community and local services involved. The impacts are immediately and profoundly distressing for all those affected and may lead to: Long term psychological trauma Destruction of social bonds Reduced quality of life and increased ill health Suicidal behaviour It’s estimated that a further 6 people on average suffer a severe emotional impact as a result of the death..

3. The need for better information and support for those bereaved or affected by suicide as been identified as a key area for action. Preventing suicide in England - A cross-government outcomes strategy to save lives, 2012 The Future of Local Suicide Prevention Plans in England, All Party Parliamentary Group on Suicide and Self-Harm, 2013. Preventing suicide in England: one year on First annual report on the cross-government outcomes strategy to save lives, 2014. Policy Context

4. Local Suicide Prevention Partnerships and the Cheshire and Merseyside Suicide Reduction network (CMSRN) highlighted the following areas as a key priority for development: Providing effective and timely support for families bereaved or affected by suicide Having an effective local response to the aftermath of a suicide In response, a task and finish group was established to explore the development of a postvention approach. Local Context

5. POSTVENTION Postvention is a term used to describe an intervention conducted after a suicide, largely taking the form of support for those bereaved or affected by suicide. The aim is to support and debrief those affected; and reduce the possibility of suicide clusters by;  alleviating the distress of suicidal bereaved individuals,  reducing the risk of imitative suicidal behaviour,  promoting the healthy recovery of the affected community.

6. Cost Effectiveness An Economic evaluation of the Australia the StandBy Response Service found: provides a direct cost saving to society of approx $800 (£512) per person per including improved quality of life, improved physical and mental health, increased community capacity and awareness a potential reduction in the number of future suicides Potential cost saving of £1.8M over a 3 year period

7. Task and Finish Group Sept 2013 – May 2014 Secured commitment from both Merseyside and Cheshire Police to collect and share information in real time so that a postvention response can be activated. A scoping exercise was undertaken to identify what support services are currently available. Explored a range of different options of provision which included: 1. Distribution of the ‘the help is at hand’ booklet a resource for bereaved families 2. Telephone Support Service e.g. Samaritans 3. Cornwall’s Suicide Liaison Service 4. Community Response e.g. Northern Ireland and Australia’s Models Developed a business case

8. Cheshire and Merseyside Proposal It is proposed that Northern Ireland’s postvention model is adopted and piloted over an 18 month Period: Phase 1. Formal Reporting and Surveillance of Suspected Suicides Phase 2. Suicide Liaison Service Phase 3. Community Response Plan Expected Benefits/Outcomes Reduction in number of deaths by suicide and attempted suicides Alleviate the distress of those bereaved or affected by suicide Reduce the risk of imitative suicidal behaviour and suicide clusters Promote the healthy recovery of the affected community Reduce the economic costs of suicide

9. Phase 1. Formal Reporting and Surveillance of Suspected Suicides: To develop data sharing protocols for the exchange of information between agencies to ensure formal reporting mechanisms are in place for suspected suicides and the monitoring of patterns and trends of suicide in real time. Allowing agencies to share information so those bereaved can by referred to a service for support.

10. Phase 2: Liaison Service Suspected Suicide Police Gain Consent from family to contact Liaison Service (LS) via the form 97 Inform Coroner & Liaison Service Telephone contact with family to arrange initial visit Bereavement Support/emotional and practical support by LS Referral to Secondary services eg. CMHT Referral to Primary Care and Non- Statutory Support Services Referral to Bereaved By Suicide Support Groups e.g. SOBS Follow up visit within 1 week of death Assessment carried out of needs of clients LS to inform local public health team

11. Phase 3. Purpose of Community Response Plan To prevent the development of clusters of suicides occurring in a local council areas To facilitate early detection of such clusters To provide a timely response by all sectors of the community to address the problem and prevent further deaths occurring To provide a template for action that can be implemented in any council experiencing this problem.

12. Community Response Plan Pathway WHSCT / PHA monitor suicides (SD1) Apply criteria Convene Local Co-ordinating Committee to decide if plan should be implemented Provide support for family/friends Liaise with media Identify and support those at risk Stand down Committee Debrief and support of Committee PH/LS to monitor suicides Apply criteria Convene Local Co-ordinating Committee to decide if plan should be implemented Provide support for family/friends Liaise with media Identify and support those at risk Stand down Committee Debrief and support of Committee

13. Criteria to Activate plan 1.How individual perceived within the community 2.Potential for media interest 3.Unusual circumstances surrounding the death 4.Perception of rise in suicide within the community 5.Statistics indicate a cluster may be developing

14. Next Steps Contact Details: Email gina.perigo@liverpool.gov.ukgina.perigo@liverpool.gov.uk Tel: 0151 2331360