Contents
1 Forward
The death of a loved one has a devastating impact on the family and friends of those who have died. However death from suicide has a ripple effect and impacts wider on witnesses, bystanders, staff and communities.
The five year forward view for mental health set out an ambition to reduce the number of suicides in England by 10 per cent by 2020. The NHS long-term plan reaffirms the NHS’s commitment to make suicide prevention a priority over the next decade. It commits to rolling out funding to further sustainability and transformation partnership (STP) areas, implementing a new mental health safety improvement programme, as well as rolling out suicide bereavement services across the country.
Alongside this to address suicide prevention in mental health settings, In 2018 the secretary of state for health and social care launched a zero-suicide ambition for mental health inpatients. In line with this, all mental health trusts were required to develop a zero-suicide ambition plan to be submitted to NHS England by April 2019.
This strategy provides us with a roadmap that will help us to meet the challenges that are faced by our patients and service users, carers and staff. Above all, we will keep safety and recovery at the forefront of these challenges.
Navjot Ahluwalia, Executive Medical Director.
Tracey Wrench, Executive Director of Nursing and Allied Health Professionals (AHP).
2 Introduction
National data shows that every day in England approximately 13 people take their own lives. In 2018, there were 6,507 suicides registered in the UK, 11.2 deaths per 100,000 population. There were 686 more deaths in 2018 than in 2017 and the rate has increased to the level seen when it previously peaked in 2013.
There were 5,821 registered suicides in the UK in 2017, more than one death every two hours, with the Yorkshire and Humber region having some of the highest suicide rates in England.
Men remain the highest risk group with three-quarters of the suicide deaths in 2018 among men which has been the case since the mid-1990s. National statistics state that the rate amongst women was not found to be statistically higher than in the previous year however local data shows an increase in deaths in women.
As seen in previous years, the most common method of suicide in the UK was hanging, accounting for 59.4% of all suicides among males and 45.0% of all suicides among females.
However one death by suicide is one death too many and there is a key need for organisations and services to work together across localities with the aim to reduce deaths from suicide.
3 What is the context for this strategy?
This strategy is set against a backdrop of national documents and guidance that set out the ambitions and goals about reducing the numbers of suicides in the UK. The national preventing suicide strategy sets a target of a 10% reduction in all suicides nationally in 2020 to 2021 and zero suicides within in patients across the NHS.
The five year forward view for mental health set out an ambition to reduce the number of suicides in England by 10 per cent by 2020 to 2021. The NHS long-term Plan reaffirms the NHS’s commitment to make suicide prevention a priority over the next decade. It commits to rolling out funding to further sustainability and transformation partnership (STP) areas, implementing a new mental health safety improvement programme, as well as rolling out suicide bereavement services across the country.
In 2018 the secretary of state for health and social care launched a zero-suicide ambition across the NHS with investment over the next three years and a national quality improvement programme being led by NHS England to improve suicide prevention and safety.
As part of the work all mental health trusts were required to develop zero suicide actions plans which were to be submitted to NHS England by April 2019.
4 Values, ambitions and aspirations
4.1 Our vision
“Leading the way with care”.
4.2 Our mission
Promoting health and quality of life in partnership with people and communities. Strategic ambitions How the suicide prevention strategy helps meet the strategic ambitions
4.2.1 Ambition one
Be a leading provider of co-ordinated mental and physical healthcare services for people of all ages.
To provide robust, quality safe care to all service users. Service users have accessible care at the right place and time.
4.2.2 Ambition two
Develop and deliver services which have a focus on prevention and early intervention, building resilience and promoting recovery.
To provide accessible care recognising stressors and risks and supporting resilience, recovery and safety To adopt the zero suicide ambition for all our services.
4.2.3 Ambition three
Take the lead with our partners to drive the development of accessible patient centred care services closer to peoples homes.
To ensure that service users and carers are at the heart of all care planning and delivery.
4.2.4 Ambition four
Develop a healthcare workforce who are equipped to provide the highest level of clinical care.
To ensure that staff have access to the right training and support around suicide prevention We have a culture of learning with staff as part of this process
4.2.5 Ambition five
Embrace technology to innovate and continually improve clinical services.
To use technology such as apps and the web to support patient safety planning and engagement.
4.2.6 Ambition six
Maximise benefits to patients through ensuring a strong and sustained financial position to underpin the delivery of high quality clinical services.
To ensure that key services are commissioned and coordinated between partners to ensure the most effective use of resources.
5 Suicide prevention strategy
The aim of the strategy is to reduce the suicide rate in the population of individuals that come into contact with Rotherham Doncaster and South Humber NHS Foundation Trust (RDASH) services. Working with our partners in our localities in the ambition to reduce suicides by 10% In 2018 the secretary of state for health and social care launched a zero-suicide ambition in mental health in patients.
Our aim by the end of 2021 to 2022:
- zero suicide in inpatient services, a mental health trust ambition
- 10% reduction in community suicides, a place based ambition
The trust is aware that In May 2019 however the burden of proof for suicide changed from the criminal standard of proof (beyond reasonable doubt) to the civil standard of proof (on the balance of probabilities). This may therefore impact on the number of conclusions of suicide being returned.
The trust will continue to work with other agencies to ensure that service users have access to services, receive the right care in the right place at the right time especially during times of crisis, and are supported to keep safe from preventable harm.
National evidence shows that on average only 30 to 40% of those who take their own lives are under mental health services, and the trust has a vital role to play in suicide prevention by working in partnership with other statutory organisations, third sector providers, and service users or carers and families in the wider aim of reducing suicide in our communities.
As leaders in the field of mental health care RDaSH operational and clinical staff will use this strategy to support their zero suicide ambition, with services having a particular role in reducing the risk of suicides in high-risk groups and those people presenting in distress or in crisis.
5.1 Key areas
National confidential Inquiry into suicide and safety in mental health at the University of Manchester have developed a list of 10 key elements that are essential for safer care for patients.
Within the trust we will work to the 10 key ways for patient safety We will ensure that the core principles underpin all our care and service delivery.
5.1.1 Safer wards
In patient safety with a focus on ligature points, safe leave from wards, and observation.
5.1.2 Early follow up on discharge
Follow up following discharge within 72 hours. Personalised discharge planning with plan in place.
5.1.3 No out of area admissions
Aiming to keep patients closer to home, allowing support from family and friends.
5.1.4 24 hours crisis services
24 hour access to crisis services, single phone numbers for services, and prompt and robust support in crisis.
5.1.5 Family involvement
Working with and involving families and carers. Ensure families know how to raise.
5.1.6 Guidance on depression
Providing service users and their families with information to help and support their.
5.1.7 Personalised risk assessments
Risk assessments identify individual risks with service users and carers being part of completion.
5.1.8 Outreach teams
Outreach and support to patients who are difficult to engage or who may lose contact.
5.1.9 Lower staff turnover
Staff support and training to ensure staff feel confident and remain in the trust.
5.1.10 Services for dual diagnosis
Joint working between mental health and drug and alcohol services
The trust are members of the South Yorkshire and Bassetlaw ICS Suicide prevention group and the Humber Coast and Vale suicide prevention group.
We will work alongside our partners in each of our localities with a single vision around suicide prevention across all organisations
Along with our partners we will work toward the following aims that tie in with the national strategy, as well as working on local issues that are specific to this region.
5.2 The seven national key aims
The seven national key aims are:
- reduce the risk of suicide in high-risk groups
- tailor approaches to improve mental health in specific groups
- reduce access to the means of suicide
- provide better information and support to those bereaved or affected by suicide risk assessments identify individual risks with service users and carers being part of completion. Outreach and support to patients who are difficult to engage or who may lose contact with services Staff support and training to ensure staff feel confident and remain in the trust Joint working between mental health and drug and alcohol services
- support the media in delivering sensitive approaches to suicide and suicidal behaviour
- support research, data collection and monitoring
- reducing the rates of self-harm as a key indicator of suicide risk
4.2.1 Reduce the risk of suicide in high-risk groups
- Young and middle-aged men.
- People in the care of mental health services, including inpatients.
- People with a history of self-harm.
- People in contact with the criminal justice system.
- People with long term physical health problems.
- People who have experienced relationship breakdown.
- Tailor approaches to improve mental health in specific groups.
4.2.2 Tailor approaches to improve mental health in specific groups
Specific groups may be:
- children and young people, including those who are vulnerable such as looked after children, care leavers and children and young people in the youth justice system
- survivors of abuse or violence, including sexual abuse
- veterans
- people living with long-term physical health conditions; ensuring parity of esteem
- people with a history of self harm
- People with a family history of suicide
- people who are especially vulnerable due to social and economic circumstances such as relationship breakdown
- people who misuse drugs or alcohol, measures that reduce alcohol and drug dependence are critical to reducing suicide
- lesbian, gay, bisexual and transgender people
- ethnic minorities
4.2.3 Reduce the access to means
According to the preventing suicide strategy, the suicide methods most amenable to intervention are:
- hanging and strangulation in psychiatric inpatient and criminal justice settings
- self-poisoning, for example, medication overdose focusing on safer prescribing
- those in high-risk locations such as bridges
4.2.4 Providing better information and support to those bereaved or affected by suicide
Families and friends bereaved by a suicide are at increased risk of mental and emotional problems and may be at higher risk of suicide themselves.
We will along with our partners ensure that families, friends and carers are signposted to support services.
4.2.5 Support the media in delivering sensitive approaches to suicide and suicidal behaviour
The media can have a significant influence on behaviour and attitudes. We want to ensure that we work with our partners to ensure that positive messages about suicide support are available through our localities especially for young people.
The Communications team will continue to work with the media to help promote the responsible reporting and portrayal of suicide and suicidal behaviour, particularly in the wake of a specific death involving suicide within services delivered by the trust.
We will support specific events such as world mental health or world suicide prevention day
4.2.6 Support research, data collection and monitoring
We will work within the organisation and with our partner agencies to collate, review and analyse data to ensure clear understanding of local demographics and risks. We will ensure that learning from deaths is embedded as part of trust culture and practice
4.2.7 Reducing the rates of self-harm as a key indicator of suicide risk
- We will ensure that self harm remains a key aspect of risk assessment and clinical intervention.
- All incidents of self harm and deaths are reported and investigated.
- All Serious Incidents have a robust root cause analysis investigation.
- Ensure staff follow policies and procedures in relation to leave, observation and risk.
6 Implementation of the strategy
The strategy sits with the mortality surveillance group led by the executive medical director however will feed into other work streams and groups within the organisation.
The structure of our strategy and implementation plan is set, in part, by the national drivers, with additional input from a trust perspective based on local intelligence and lessons that we have learned from deaths and incidents.
The trust has established a suicide prevention group that will oversee and evaluate the work in this strategy. This group will report though it’s chair to the mortality surveillance group which in turn reports to the quality committee providing governance oversight on behalf of the board of directors.
The trust lead will provide a quarterly report for the mortality surveillance group which will form part of the executive director’s quarterly report to the quality committee and will also be included in the annual mortality report.
7 Suicide prevention
7.1 Within the trust, action plan
The trust developed and submitted a 2 year action plan ‘Living Safe Living Well’ to NHS England in April 2019. The plan was developed based on the key strategy and policy documents, current research on suicide and suicide prevention and was considered alongside suicide prevention action plans in each of the trust’s three localities.
The plan supports a trust-wide inter-agency approach and prevention structure with the aim to reduce the risk of suicide for those under the care of RDaSH services.
This plan includes targets that will meet key objectives, as well as including elements that we have included locally that have arisen as a result of learning lessons from previous incidents within the trust.
The suicide prevention action plan is a live document and if learning is identified as part of the trust business or national guidance or evidence this may be updated to include actions required against these.
8 References
- Appleby, L. National Confidential Inquiry into Safety in Mental Health. Manchester: 2018 and 2019.
- National Institute for Health and Care Excellence (NICE Royal College of Psychiatrists. Toolkit Assessment for Suicide Prevention. London: 2018 (opens in new window).
- British Medical Journal. New standard of proof for suicide at inquests in England and Wales: BMJ 2019;366:l4745 DOI: 10.1136 or bmj.l4745 (Published 29 July 2019). Accessed via internet on 10 October 2019 (opens in new window).
- HM Government or Department of Health. Cross-Government Suicide Prevention Work plan. London: January 2019.
- HM Government or Department of Health. Preventing Suicide in England: A cross-government outcomes strategy to save lives; London: September 2012. Accessed via internet 13 October 2019.
- National Confidential Inquiry into Suicide and Safety in Mental Health. Annual Report 2018 October 2018.
- National Institute for Health and Care Excellence (NICE). National Guidance NG105. Preventing suicide in community and custodial settings. London: September 2018. Accessed via the internet on 13 October 2019 (opens in new window).
- Office of National Statistics (ONS) Local Authority Statistics 2013 to 2018: 3 September 2019 (publication date) Accessed via internet 10 October 2019.
Document control
- Date approved: December 2019.
- Name of originator or author: Dr N Ahluwalia, Executive Medical Director and Sharon Greensill, Trust Lead for Mortality, Inquests and Suicide Prevention.
Page last reviewed: April 30, 2024
Next review due: April 30, 2025