Parliament has held a one-off evidence update session on suicide prevention.
Please see notes on this session below.
There will be a Prevention Green Paper during 2019.
Office of National Statistics has been in touch about improving the quality of death registrations, and with specific reference to suicide
The revised standard of proof from the High Court in Maughan is expected to be considered by the Court of Appeal during the first half of 2019 [In September there was talk of Parliament simply changing this standard by legislation without an appeal – https://hansard.parliament.uk/Commons/2018-09-05/debates/B8A2C436-64BE-4694-B4AA-F6535E49E31E/SuicideCoroners%E2%80%99Courts ]
Association of Directors of Public Health
Local suicide prevention plans are not required by law but we started voluntary self-assessment with local authorities in September 2018
There will be a thematic review in spring 2019 by our expert advisory group (led by Jim McManus and Louis Appleby)
Local authorities’ suicide prevention priority needs to shift to upstream prevention and including wider mental health and social determinants of health (poverty, housing, employment) – which means better policy and funding
Royal College of Psychiatrists
National suicide rate target should be a 20% reduction between 2021/22 and 2028/29
NHS England should endorse and promote the Mortality Review Tool
Three new self-harm and suicide prevention competence frameworks by NHS England need to be implemented and resourced
Training and curriculum for staff working in education, police and housing need to include these competences (or appropriate versions of them)
Ditto mental health support teams in schools
Inappropriate out of area mental health placements need to stop – the Confidential Inquiry shows they are linked to increased risk of suicide
King’s Fund says spending per person on public health will fall by nearly a quarter between 2015/16 and 2019/20
Non-NHS parts of the Department of Health & Social Care budget will be cut by £1billion per year in the budget (Red Book)
Cuts in addictions services will be a major factor: [the RCPsych has been saying for years that suicide will not be tackled unless we look harder at the needs of older people as well as younger people, and at alcohol and drugs]
Zero Suicide Alliance
We need more and better research in mental health and suicide prevention
NICE guidelines are largely ignored by frontline primary and secondary care
GPs and primary care are the most important component for most service users in the mental health care continuum – yet most prevention is in schools, workplaces, secondary NHS and public health
Consent, confidentiality and lessons from reviews need to be more independently and rapidly addressed [RCPsych also touched on this]
There is still more to do for the at risk and hard to reach groups
There is no clear vision on how 10% reduction will be achieved by 2020/21
Rising incidence among females 15-19 years does not make them highest risk, but their risk is increasing and we don’t know why
Suicide is an inequality issue: males in the lowest social class, unemployment and recession and debt.
Suicide can also be an occupational issue: low skilled male labourers, especially in construction, three times likelier to die by suicide
We need improved data, research and real-time surveillance
Wider public health funding may be limiting impact and local duplication is limiting impact and effectiveness (money going to NHS England and STPs with highest suicide rates)
That said, further national evaluation is needed and with a public health focus
Samaritans media guidelines are not always followed, local areas need national support and resources, Ofcom and editors’ code need strengthening
Government and social media need to work together on harmful content
Ruth Sutherland (Samaritans):
Of the £25 million, we are pleased that it is going to the STPs, which is a good compromise in a way, but it is a finite, small amount of money, and when you have a small amount of money, you need to make sure that it is making the most difference. There is a scarcity of evidence about what works, but I still think that we are spending on things when we do not know whether they are going to work or not, so there is the evidence thing.
There is also duplication. There are high‑frequency locations all over the country. The only body that has a national view of that is in the rail estate—the rail industry. If high‑frequency locations are not in the rail industry, nobody can tell you about the national picture of what is happening in each of those. Public Health England provides good guidance on high‑frequency locations, so there is an evidence base to use, but nobody knows what works where. If you are a local authority and you have one of those in your area, you have nowhere to go to find out what works, so you could be spending money on things that you think might be a good idea. We are wasting money in that way.
Most of the original money—the first tranche of money—is being spent on training and campaigning. Most local authorities are having to work out which is the best solution for them. Public Health England and the Department of Health are working on a national mental health literacy campaign that is being piloted at the moment in the West Midlands, yet a local authority has to invent its own.
Are we not confusing the public? Are we not wasting money on individual market research of audiences in each location rather than providing a kit that would enable a local authority to say, “This is the campaign kit, and this is the training I am going to use, because here is the evidence base”? Why are we not making it easier for local authorities to spend their money wisely?
Dr Peter Aitken (RCPsych & Devon Partnership Trust):
For example, being safe around the railway would have saved two lives in my county this weekend. Being safe around the coast would save a lot of lives. The RNLI and the national drowning prevention strategy take that very seriously, and it is not impossible that within the next two or three years 256 lifeboat stations will all know where there are bits of coast that are particularly at risk in and around their area.
I know some work is beginning with Highways England to look at difficult points on the bridge infrastructure. We need to think about targeted, focused interventions around big infrastructure like that and then, to the point made, we would know where other areas of vulnerability might be. I know where they are in my county. I am not going to say them in a public forum because I do not want people to know where they are; nevertheless it is known and things could be done.
What we are missing is the strategic leadership, the vision and the commitment to do it, and to know that it is done and then to be able to share the learning. I absolutely accept the point that we are a series of islands of excellence with some gaps, and it is very difficult to share learning across them for a whole host of reasons. I welcome the approach in the cross‑Government document to do something about the information‑sharing problem….
The best example I can think of locally to me is the Lions Barber Collective and Tom Chapman’s work, simply identifying that men sitting in a barber’s chair are liable to have a conversation with the person cutting their hair and, based on personal experience of suicide in their friendship group, thinking it would be a good idea if the barber knew what to listen for and what to do, and then coming to a strategy agency like ourselves and saying, “We have come up with this good idea. Could you have a look at what we are doing and help us improve it or tell us that it is okay?” Statutory mental health services can use their expertise more creatively to help developing third sector initiatives find a way to the most effective interventions for the particular people who want to come to speak to them.
There are a number of examples of that beyond hair. I find them in some of the Men’s Sheds environments in and around Devon that are springing up, where again the right expertise is lent to a shared space, helping ordinary people have ordinary conversations with people in difficulty. It is all about improving access, because we know in my county that we have to enable 100 people in 1 million to have the right momentary conversation at the point it most matters to them. That is an extremely difficult thing to cope with.
The full oral evidence is here and well worth reading: Full report