1. Promoting improvement in the quality of health and social care Local action planning in mental health: Using NCISH recommendations to help improve care Dr. Kirsten Windfuhr Senior Project Manager Professor Nav Kapur Professor of Psychiatry and Population Health & Head of Suicide Research www.hqip.org.uk

2. Outline What do we do? What works?

3. Collecting the data All potential cases nationally (suicide and open verdicts from ONS, GRO) Contact with mental health services Data collection via questionnaire

4. Annual Report

5. Scope UKEnglandWalesScotlandN. Ireland General population 100,32978,1705,47513,2353,449 In contact 26,216 (26%) 20,300 (26%) 1,260 (23%) 3,705 (28%) 951 (28%)

6. Timing of last contact with mental health services

7. What works 1) Focussing on safety in particular settings: o In-patient Smaller in-patient bed base More morbid in-patient population Falling general suicide rates Safety focus: o the environment o absconding

8. In-patient suicide rates

9. In-patient suicide: England 1997/8 – 2007/8

10. In-patient suicide rates

11. In-patient and post-discharge suicide rates

12. Patient suicide: weeks following discharge

13. In-patient suicide and suicide under crisis resolution/home treatment teams (CRHTs) (Hunt et al Lancet Psychiatry 2014)

14. What works (or doesn’t) 2) Risk assessment prior to suicide

15. Assessment of risk prior to suicide

18. Risk assessment and management Over 80% were rated as at low or no risk at last contact In over 1/3 the process of risk assessment was unsatisfactory Risk formulation and management plans were the domains most commonly judged to be unsatisfactory

19. What works 3) National policies and recommendations Safety First (2001) 12 Steps to a Safer Service o Removal of ligature points o Assertive outreach o 24 hour crisis team o 7 day follow-up o Non-compliance o Dual diagnosis o Criminal justice information sharing o Multi-disciplinary review o Training in suicide risk management

20. Questions Do mental health services implement policies? Do they make a difference?

21. Do they make a difference * Suicide rate per 100,000 While et al., 2012; Lancet * = significant difference p<0.05

22. Do policies make a difference While et al., 2012; Lancet

23. What works A new study o UK wide o A longer time period o A wider range of services

24. Recommendations associated with the largest falls in suicide rates

25. Outline What do we do? What works?

26. What works locally? How have NCISH findings or key recommendations impacted on your local services? Do you have examples of good practice? What has not worked? What local mechanisms could be developed to help implement NCISH findings and other relevant work?