Gloucestershire LINk invited members to comment on the suicide prevention strategy and plan published by NHS Gloucestershire, the primary care trust.
However, the consultation itself is not listed on the PCT’s Consultations page, so the basis for the LINk’s invitation is a little mysterious.
Anyway, I reviewed the documents and here are my comments.
There are three documents listed on the LINk’s Consultations page.
Final Gloucestershire Suicide Prevention Strategy
Glos Suicide Prevention Activity Profile
The LINk suggests answering four questions about the documents:
- How easy are the documents to read and understand?
- Are the documents comprehensive enough?
- Can you identify any gaps in the policy(ies)/service?
- Are there any key points or comments that you would like to have included in our response?
Here’s a summary of my review of the documents. It’s followed by a little more detail about each document in turn.
Summary
Of the three documents provided, only the strategy is complete. All three are very confusing because they lack focus, introducing a lot of material that has little to do with suicide prevention, or little to do with Gloucestershire. This makes them very difficult to understand.
There are significant gaps in all three documents. Most significantly, there are gaps in the strategy, which:
- does not follow on from the outcomes of the previous (2006 – 2010) strategy,
- is not based on an effective analysis of actual suicides in Gloucestershire,
- sidelines rural communities, and
- lacks clarity of focus on preventing deaths by suicide.
In addition to these gaps, all three documents show evidence of suicide prevention goals being diluted with other goals, (relating to self-harm, well-being and various other things).
The most important point to be made is that this strategy and the outline plan describe a floundering approach that spreads resources thinly in many directions with no clarity of outcome. The strategy will apply in future years when the NHS will be expected to target resources with precision towards specific outcomes that the public can see. In that respect, therefore, I do not think the strategy and plan are fit for purpose.
Detail
Gloucestershire Suicide Prevention Strategy 2010 – 2015
This document is very difficult to understand because it combines general background information, statements about national policy, and Gloucestershire’s actual strategy, in a haphazard and bewildering way.
Only two of its five sections relate specifically to Gloucestershire, and these are the only sections that I will review.
Section 3: Gloucestershire Rates and Trends
This section comes to the conclusion that:
The pattern of suicides in Gloucestershire does not differ substantially from the national picture.
However, another document that was not included in the consultation tells a different story, with a more than 300% difference in suicide rates (the dark purple bars) between the most affected and the least affected districts of the county:
In my opinion not enough has been done to understand suicide rates and trends in a way that is specific to Gloucestershire.
Section 5: Gloucestershire Suicide Prevention
This section defines Gloucestershire’s strategy for preventing suicide. Even within this section, the text jumps back and forth from Gloucestershire’s strategy to information from other bodies. This makes it very confusing.
The strategy does not appears to be based on any lessons whatsoever from the outcomes of the previous (2006 – 2010) strategy. This means that statements about continuous improvement are difficult to take seriously.
There is no information about how the nationally-identified high risk groups correlate with actual suicide numbers in Gloucestershire.
Of the six goals, only two are relevant in that they directly affect people who might take their own lives. The other four are things that might be very nice, but they are not suicide prevention goals.
Gloucestershire’s two relevant strategic goals (pages 24 and 25), “To reduce the risk of suicide in high-risk/priority groups” and “To reduce the availability and lethality of suicide methods” do not correlate with the information in the two-page section “What works in preventing suicide in priority/high risk groups” (pages 19 and 20). No reasons are given for this.
The first of Gloucestershire’s relevant goals, for example, makes no reference to rural populations, even though Gloucestershire does have rural populations, and rural populations are specifically mentioned on page 20.
The second of Gloucestershire’s relevant goals, for example, makes vague references to hotspots and making homes safer, but it fails to mention individualised restriction of access to preferred means of self harm (page 20). This means that if, say, an individual is known to be stockpiling drugs or spending long periods on the roofs of tall buildings, Gloucestershire’s strategy would be to ensure his home has nowhere convenient to tie a rope.
Another problem with this section is that it confuses three quite separate things: suicide, self-harm and well-being.
Self harm and suicide are not directly related. There is no reason to believe that reducing the incidence of self harm will reduce the incidence of suicide. This is clear from page 6 (my italics):
…women of the same age [25 – 44] are among the least likely to die through suicide but are far more likely to self-harm.
Well-being and suicide are not directly related either. Nothing in the page-after-page of background information indicates that they are directly related.
A strategy for preventing suicide should not meander into other areas like self-harm and well-being that are not directly related.
Gloucestershire Suicide Prevention Outline Implementation Plan 2011- 2012
This document suffers badly from the confusions created by the strategy. To reiterate, only two of the six goals are suicide prevention goals, and again this document confuses the three quite separate things: suicide, self-harm and well-being. As a result, the plan lacks focus on suicide prevention.
The format of the document is completely bewildering and impossible to make sense of as a whole. Merely a hotchpotch of vague proposals, some of which are vaguely related to suicide, it gives no clear picture that could sensibly be called a plan.
The Timescale column makes it obvious that no element of the previous (2006 – 2010) strategy is ongoing.
There is no indication of priorities or dependencies, no costing, and no specific outcomes.
Current Suicide Prevention Activity in Gloucestershire (November 2011)
This mostly empty document lists only three activities. The first and last confuse well-being with suicide prevention. The second confuses self harm with suicide prevention.
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A Greater Say 