Suicide
Prevention
Strategy
2017 - 2022
This strategy sets out our Trust’s commitment to
do all that it can to avoid the loss of life to suicide
NSFT Suicide Prevention Strategy 2017-2022
1
nsft.nhs.uk
..
Foreword
It is likely that we will know someone, directly or indirectly, who has died by
suicide. It may also be possible that some of us will know someone who is in
a place in their life where you are worried about their mental health. Reading
this, you may be one of the many who on a regular basis have thoughts about
ending their life.
This confirms to me the devastating impact suicide has on everyone in
society yet it is something we struggle to speak of openly and have a limited
understanding of.
As a provider of mental health services, Norfolk and Suffolk NHS Foundation Trust plays
a critical role within the community. Our Trust provides services for thousands of people,
across all ages, at any one time. Our Trust believes it can, alongside other organisations
in our community, make a difference for those vulnerable people who reach a point in
their life where suicide becomes a possibility.
There are many statistics regarding suicide and they play an important role but this
strategy is not going to present them in great detail. This is because I hope you have
started reading this booklet to find out what our Trust is doing for the benefit of all in
our community.
Together with our Trust and clinical strategies this strategy is an essential part within the
three core goals of:
1. Improving quality and achieving financial sustainability
2. Working as one Trust
3. Focussing on prevention, early intervention and promoting Recovery.
This strategy reinforces our Trust’s commitment to do all that it can to avoid the loss of
life to suicide. We will do this by providing the right care consistently, and implementing
tested as well as innovative approaches with partners in order to help people live
positive and meaningful lives.
Contents
Michael Scott
Chief Executive
..
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NSFT Suicide Prevention Strategy 2017-2022
Introduction 3
Section One: 4
What do we understand about suicide? Section Two: 6
Development of our strategy Section Three: 8
Our strategy Section Four: 11
Implementation and monitoring
Introduction
This strategy aims to support our staff with their continuous efforts to ensure
people can be safe to live meaningful lives. It sets out our understanding of
what has happened with suicides at a national and local level, including
drawing on data from our own services.
This information is important to guide our approach to reducing the number of people
we have contact with who take their own lives. We have spoken with a number of
service users and families who have informed our understanding, as well as our staff
who care deeply about preventing suicides. We know that it is vital to consistently
deliver good standards of fundamental care, and also to build on this, by constantly
evaluating what we do and the impact is has. Our strategy is described in the diagram
below. We will monitor its success both through data and feedback. It is designed to
work on annual review, so the first year priorities are set out in some detail, and future
years will then be based on what we have achieved, and what we know will make a
positive difference in the future.
Ref.1: Our Trust’s key priorities
Working with partners to
deliver countywide actions
Innovations
Supporting staff with
up-to-date skills and knowledge
Working with
families and carers
Clinical pathways that
support suicide prevention
Suicide Prevention
Fundamentals
NSFT Suicide Prevention Strategy 2017-2022
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Section One
What do we understand about suicide?
The impact of suicide is devastating for families, communities and people involved in
someone’s care. We know there are certain groups of people who are more vulnerable
than others, and that having a mental health diagnosis is one of the risk factors. Social,
economic and demographic factors also have a significant impact on rates of suicide,
and an understanding of the broad and specific issues is vital in being able to prevent
suicide. Individual agencies working alone will be less effective than system-wide
approaches to preventing suicide; so our strategy is closely linked to the county suicide
prevention strategies in Norfolk and Suffolk.
National trends
National data is compiled by the Office of National Statistics. The latest data available is
from 2015 which tells us:
• In 2015, 6188 suicides were registered in the United Kingdom (UK). This is a suicide
rate of 10.9 per 100,000 people (16.6 per 100,000 for men and 5.4 per 100,000
for women)
• The age group with the highest suicide rate in the UK was men aged 45-49 at 22.3
per 100,000
• Female suicide rates increased to 5.4 per 100,000 population, its highest since 2005
The chart below shows the rate of suicides per 100,000 population (age standardised
rate by sex) over the period from 1981. There was a steady decrease in rates of suicide
until 2007, when the rate began to rise again. Men are approximately three times more
likely to take their own lives than women. This matches what we see locally, but not in
the deaths of people in contact with our services.
Ref.2: Rate per 100,000 population
Persons
25
Males
Females
Rate per 100,000
20
15
10
5
0
81
19
8
19
3
8
19
5
87
19
8
19
9
91
19
9
19
3
9
19
5
97
19
9
19
9
20
01
20
03
20
05
20
07
20
09
11
20
13
20
15
20
Source: Office for National Statistics, National Records of Scotland, Northern Ireland Statistics and Research Agency
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NSFT Suicide Prevention Strategy 2017-2022
High Risk Groups
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We know there are certain groups who are at higher risk of taking their lives.
The issue of men aged 35-54 taking their lives at a much higher rate than any
other group is well-documented, along with factors such as isolation, debt, lack
of meaningful occupation and addiction. However, a number of other characteristics
are associated with higher rates of suicide:
• Mental illness is a risk factor, although the rate has been falling from 118 per
100,000 service users in 2004 to 87 per 100,000 service users in 2013
• Certain occupations are more at risk, including nurses, doctors, farmers /
agricultural workers and veterinary workers, possibly due to greater access to
means of self-harm and suicide
• Men from poorer backgrounds are 10 times more at risk than men from more
affluent backgrounds
• People in contact with the criminal justice system also have a higher risk of
suicide than the general population. People are at highest risk in their first week
of imprisonment
• Chronic pain, disability and living with life-limiting physical illness are associated
with higher rates of suicide
• Other groups of people who may have higher rates of mental ill-health (although
detailed data on suicide rates is lacking) include survivors of abuse or violence,
members of minority ethnic groups, and children who are especially vulnerable
such as looked after children, care leavers, and children in the youth justice system
• Gay men and lesbians are at increased risk of suicide; 3% of gay men and 5% of
lesbian or bisexual women say they have attempted to take their own life in the
last year
The local picture
Understanding the data at a local level is helpful in determining actions that can be
introduced to make improvements for our local communities. Public Health in Norfolk
and Suffolk are responsible for providing local audits to help shape suicide prevention
strategies. From recent audits (2012-2014) we know that:
• On average there are 77 suicides in Norfolk every year and 62 in Suffolk. The Suffolk
suicide rate per 100,000 was 8.7 compared to 8.9 for England. Norfolk had a higher
rate at 10.3
• A third of all people who die by suicide are aged 45-59
• 90% of people who had died by suicide had seen their GP in the 12 months prior
to their death and nearly a quarter of people (23%) had seen their GP in the week
before their death
• In Norfolk, 43% were known to have had some contact with mental health services
at some point in their lives (33% in the year before their death). The National
Confidential Inquiry data from this period cites 28% as having had contact, but this
figure excludes services such as liaison, well-being and addictions
• In Suffolk, there was a higher risk of suicide in residents who were born overseas
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Our Trust’s data
We have completed an audit into factors associated with unexpected deaths of
people who died due to suicide in our services from 2012 – 2016. From this audit,
we know that:
• The majority of people died at home or in the community, so we need to continue
to make our ward environments safe, but also to assess and care for people outside
of hospital as a priority
• The majority of people who took their own lives had a diagnosis of depression
• We can work to better understand deterioration in mental health and the risks
associated with this
• 38% of people were discharged from our services at the time of their death, and
we need to work with partners to strengthen support available for people in their
communities
• The majority of people had risk assessments, but not all had a crisis plan to steer
them towards appropriate help when they were becoming more unwell
This information has helped to inform our priorities.
Section Two
Development of our strategy
How we developed our strategy
The strategy has been developed in collaboration with staff, service users, carers
and multi-agency suicide prevention groups in Norfolk and Suffolk. We have used
information from national and local sources that have told us about trends and new
approaches to working to prevent suicide. We have also used our own information and
learning from deaths by suicide of people using our care to tell us what we need to pay
attention to and improve. Draft versions of the strategy have been reviewed by clinical
staff, service users and carers. We thank them for their support and time.
Suicide prevention fundamentals
Every day our Trust’s staff work with people who are experiencing significant difficulties
in their lives, providing care to help them through these periods. As an organisation,
we work to provide the staff with the appropriate environments, equipment and skills
to support their work preventing suicide. The Institute for Healthcare Improvement
has been supporting the concept of care bundles in physical healthcare for many
years, particularly in the area of infection prevention. A bundle is a structured way of
improving the processes of care and patient outcomes: a small, straightforward set of
evidence-based practices – generally three to five – that, when performed collectively
and reliably, have been proven to improve patient outcomes. Applied to suicide
prevention, we have determined a core set of fundamental commitments that decrease
the likelihood of suicide, and ensured these are embedded within our clinical pathways.
These fundamental commitments include the following examples:
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NSFT Suicide Prevention Strategy 2017-2022
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Training – Assessing the risk of suicide is a core skill. Research continues to
increase understanding of suicide and it is important to update and develop staff
knowledge. Staff require training that helps them to assess and support people
with the risks and challenges in their lives.
Providing safe places where we provide care – We work to make our
hospitals and community bases as safe as possible by removing or managing
items that could be used to cause harm.
Providing services to meet the needs of the community – The needs of the
community are always changing and we look to respond by providing services
that are up to date both in their ease of access and best practice. These include
the Wellbeing Service (to which people can self-refer) and increasing the hours
of General Hospital Liaison Services where demand has required it.
Seven-day follow up from in-patient services – The period of time following
discharge from hospital can be overwhelming for many. We ensure we meet the
national standard of making contact within seven days of a person’s discharge
from hospital.
Prescribing medication in safe amounts – Medication does much to help people
live full and meaningful lives. However, medication also has the potential to cause
harm. Using assessment at its core, we prescribe medication in a range of ways to
support the safety of its users.
Seeking to learn from events where people have died – When such tragic
events occur we use an investigation process that looks to identify lessons and
implement changes to prevent further deaths.
These fundamental commitments are already routinely monitored, and will continue
to form the basis for providing safe care. Accepting all these actions are made with
the intention to reduce the potential of suicide, the strategy will focus efforts on key
priorities. By using priorities we can respond to new understanding and emerging
themes, applying actions to local services as well as across the Trust. Making a
statement of these priorities is the first step in our commitment to action.
NSFT Suicide Prevention Strategy 2017-2022
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Section Three
Our strategy
Our Trust will do all that it can to avoid the loss of life to suicide,
acknowledging its complexity and the need to work with partners in the
community. It is our belief that priorities are about improving an area of
need and doing something new, stretching beyond what it is already doing.
We aim to ensure we deliver the fundamentals of safe care consistently, applying the
evidence for suicide prevention across all care pathways. These fundamentals include:
training; providing safe environments; providing services that meet the needs of people
in the community; following up on people discharged from in-patient care within seven
days; providing medication in safe amounts; and learning from events.
Applying new ideas and actions can be exciting and rewarding but must be completed
in an ordered way that ensures safety and supports people going through the change.
For a large organisation, such as the Trust, this requires thought and planning.
In order to have the best chance of success we believe we should focus on a defined
number of priorities with actions which are reviewed on a yearly basis. These
priorities have been formed through talking with service users, carers, staff and other
organisations we have contact with (e.g. multi-agency county suicide prevention
groups). We use information from national and local sources that tell us about trends
in suicide and new approaches to working. We have also used our own information
and learning from deaths by suicide of people in our care to tell us what we need to
pay attention to and improve.
The key priorities this strategy will focus on are:
• Clinical Pathways
• Working with family and carers
• Supporting staff with the most up-to-date skills and knowledge
• Innovations
• Working with partners to deliver countywide actions
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NSFT Suicide Prevention Strategy 2017-2022
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Clinical Pathways – We are all individuals and have different challenges and support
needs. Providing for such a range of needs requires the organisation to ensure the right
care is provided at the right time. In health these are called clinical pathways. Clinical
pathways can become very complex requiring regular review and amendment to ensure
they are meeting the evolving needs of its service users. Linking with the clinical and
recovery strategies, this priority will focus on the safety of pathways and how these
affect people’s risk of suicide. Through getting the essentials of assessment and care
planning right, every time, we can provide the best opportunity to make a difference
to our service users lives.
How will we do this…
• Increase the availability of male specific interventions across the community
• Develop the pathway of care for people experiencing affective disorders
(depression, anxiety)
• Develop the pathways of care for people experiencing crisis
• Integrate the recovery principles into our practice of care
• Seek to understand local needs in respect of differing population groups in
respect of suicide risk
• Ensure the right clinical support is available at the time it is needed
• Continue to ensure safety is critical in our decisions about the medication
people need
• Examine and develop the safety for service users at the time of discharge
from services
• Continue to examine and evaluate our understanding of suicide in the local area
transferring learning into clinical practice
Working with family and carers – Supporting a loved one who is experiencing
suicidal thoughts is a frightening experience. People are worried about how to act and
what practical support they can provide. It can also be overwhelming having contact
with a range of professionals who may be involved. This priority pledges us to further
enhance the way we support family and carers who in turn support service users
through these challenging times in their life.
How will we do this…
• Make every contact count with families and carers through listening and
responding to the information they provide
• Provide families and carers with increased information on the aspect of safety
and suicide risk
• Ensure families and carers are supported in their role
• Ensure we are open and provide as much information as possible to support their
role, with respect to the boundaries of confidentiality
• Continued implementation of the service user and carers strategy to ensure that
they are at the centre of their care
• Encourage family and carer education through the Recovery college
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Supporting staff with the most up to date skills and knowledge – Staff are
our most valued asset in providing high quality and safe care. It is critically important
staff are working with the most up to date skills and knowledge in order to enhance
understanding of suicide. The evidence base for suicide prevention continues to develop
and we pledge that staff will be supported in this area.
How will we do this…
• Review our risk assessment and suicide prevention training involving service users,
families and carers
• Provide staff with the skills and knowledge to support those with a chronic risk
of suicide
• Support staff in their knowledge and confidence of situations where it is
appropriate to discuss an individual’s risks with families and carers without their
explicit consent
• Support staff knowledge and skills in developing safety plans that meet the
needs of the individual
Innovations – Prevention of suicide is complex with wide ranging influencing factors.
Taking steps to prevent suicide relies on trying and testing new actions, pathways and
services that may not yet have an established evidence base. This priority pledges us to
apply innovations that have been developed elsewhere but also to look at creating and
testing new ideas.
How will we do this…
• Make follow up contact with people who have experienced acute distressing
events which have had a single or brief contact with Trust services e.g. acute
liaison services
• Establish a working group to explore the principles and implications of
Open Dialogue within clinical practice
• Explore how the Trust, in combination with partners, may introduce
community spaces where people in acute mental distress may seek support
• Development of safety cards which involve stay safe planning
• Explore how the Trust could introduce the ‘letter of hope’ within clinical practice
Working with partners to deliver countywide actions – Actions to prevent suicide
require partnership and collaboration. Both Norfolk and Suffolk have multi-agency
suicide prevention groups. As part of the Five-Year Forward Plan for Mental Health,
each county is working to a multi-agency suicide prevention plan supporting a
10% reduction in suicides nationally.
How will we do this…
• We will play a key role in supporting these countywide actions.
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NSFT Suicide Prevention Strategy 2017-2022
Section Four
4
Implementation and Monitoring
We will implement the suicide strategy over a five-year period, starting in 2017.
This strategy can only be viewed as a success when the words in this booklet are
translated into action. To help give these words life, the strategy will be overseen by
a steering group whose role will be to ensure the priorities are being implemented
through a series of actions. Membership of the group will involve service user and
carer representatives, and Trust staff.
The monitoring group will review the impact of the actions whilst looking for new
opportunities and interventions to apply, refreshing these on an annual basis.
The steering group will report to the Board of Directors on a quarterly basis via the
patient safety paper.
Reducing suicide is the primary aim of this strategy, monitored via Trust data for this
outcome. Due to the many factors influencing suicide, making judgement of the
progress of the strategy from this outcome measure alone is difficult. Additional
measures will focus on the outcomes and completion of actions within the five
key areas.
Overall outcome statements:
Clinical Pathways – The strategy will influence the provision of clinical pathways
with safety at its core. This will be measured through the effects of improvement
methods influencing design of pathways of care.
Working with family and carers – The strategy will develop and enhance the
way the Trust works with family and carers who support people at risk of suicide,
using a range of measures to capture their experience.
Supporting staff with the most up to date skills and knowledge – The
strategy tasks our Trust to support staff with the most up-to-date skills and
knowledge through a range of learning methods. The outcome measure will be
the breadth of learning opportunities available.
Innovations – The strategy supports the Trust to apply innovations in order
to develop the ways in which the Trust supports people at risk of suicide. The
outcome measure will be the number of innovations applied and assessment of
their impact.
Working with partners to deliver countywide actions – The strategy
supports the Trust to be an active partner in taking action to reduce suicide
in our community, with the measures defined within the county suicide
prevention groups.
NSFT Suicide Prevention Strategy 2017-2022
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Norfolk and Suffolk NHS Foundation Trust values and celebrates the diversity of all the communities we
serve. We are fully committed to ensuring that all people have equality of opportunity to access our service,
irrespective of their age, gender, ethnicity, race, disability, religion or belief, sexual orientation, marital or
civil partnership or social and economic status.
Patient Advice and
Liaison Service (PALS)
NSFT PALS provides
confidential advice,
information and support,
helping you to answer any
questions you have about
our services or about any
health matters.
Trust
Headquarters:
Hellesdon Hospital
Drayton High Road
Norwich
NR6 5BE
12
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alternative format or a
different language, please contact PALS
and we will do our best to help.
Email: [email protected]
or call PALS Freephone 0800 279 7257
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nsft.nhs.uk
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NSFT Suicide Prevention Strategy 2017-2022
© April 2017. NSFT. Product code: 17/082. Review date: January 2022 GFX4622