Suicide prevention

A couple of weeks ago, the Commons Health Select Committee published an interim report about suicide prevention. Its intention was to influence the Government’s forthcoming update of its suicide prevention strategy, expected in January 2017. I compared the interim report with Gloucestershire’s suicide prevention strategy to see how well they agree.

The Select Committee’s Suicide prevention: interim report, which I’ll just call the report, is based on evidence heard by the Committee, which included more than a hundred written submissions. Around twenty witnesses gave evidence to the Committee in person, and they included Joy Hibbins, founder and CEO of the Gloucestershire charity Suicide Crisis.

The Gloucestershire Suicide Prevention Strategy, which I’ll just call the strategy, dates from July 2015 but appears to have been updated in July 2016. It was created by a partnership of around twenty statutory and voluntary organizations, together with some individuals. The Gloucestershire Suicide Prevention Partnership Forum (GSPPF) continues to meet regularly.

Along with the strategy there’s an action plan, which is updated from time to time. The latest version I have, dated June 2016, doesn’t appear to be public (although previous versions can still be found). I’ll just call it the action plan.

The scale of the problem

The report begins by telling us that 4,820 people are recorded as having died by suicide in England in 2015, adding:

…but the true figure is likely to be higher.

The strategy does not reveal actual numbers, only rates and percentages. The rate is a little higher in Gloucestershire than in England as a whole, suggesting around 70 suicides a year, an excess of roughly 10 a year over the England rate.

The report then mentions some factors linked to suicide—the “postnatal” period following pregnancy, being in prison or recent discharge from prison, and poor economic circumstances.

Neither the strategy nor the action plan mentions the postnatal risk at all. Prison and discharge from prison are mentioned in passing in the strategy, but they’re missing from the action plan. Poor economic circumstances are mentioned in both the strategy and the action plan, but the actions are marked “Longer term” to indicate, presumably, that there’s been no action.

The report goes on to examine five aspects of suicide prevention in more detail.

Implementation

Regarding implementation, the Select Committee report says:

“[I]mplementation of the Government’s 2012 suicide prevention strategy has been characterized by inadequate leadership, poor accountability, and insufficient action. Over the past four years, there has been a failure to translate the suicide prevention strategy into actual improvements.”

Another report showed that 30% of local authorities did not have any form of suicide prevention strategy in place. Gloucestershire is not in that category.

The report’s recommendation is that there should be

“a clear implementation programme, with strong external scrutiny”

Gloucestershire’s action plan gives the appearance, at least, of being a clear implementation programme, but neither the strategy nor the action plan mentions any kind of scrutiny. A note at the end of the action plan says progress will be reviewed only by the GSPPF itself.

Unhelpfully, the note goes on to say that completed actions will be removed from the plan, and new ones added, so it’s not easy to verify that any actions at all have been completed.

Vulnerable people

The report next discusses people who are vulnerable to suicide, noting that around a third are not in contact with health services at all, a third are in contact with their GP, and the remaining third are under the care of specialist mental health services.

The strategy mentions the first group in passing, recommending that:

“Friends, family and colleagues should be enabled to identify and act on suicide risk in others to help reduce deaths in those who do not consult GPs.”

However, this didn’t seem to make it into the action plan.

The second group is mentioned in both the strategy and the action plan, where one of the priority areas is:

“Identification of ‘at-risk’ patients in primary care and provision of further assessment/support”

However, the only action in the plan was to provide training for GPs. After it was discovered that most GPs wouldn’t attend the training, the next idea was to include it in GPs’ “protected learning time” but there’s no information on whether this has happened or what the outcome was.

The third group is mentioned in the strategy but didn’t make it into the action plan. In particular, the plan doesn’t propose any special training for staff of secondary mental health providers.

Sharing information with families

The report supports the idea that more can be done to share information with families of people who are known to be at risk of suicide:

“Although a patient’s right to confidentiality is paramount, there are instances where professionals sharing information—with consent—with a person’s trusted family or friends could save their life. Stronger action needs to be taken…”

The strategy gives the clear impression that information is only to be made available to families after there has been a death—after it is too late. In the action plan, information for the bereaved is very first priority area. Other than that, the only concern is sharing of information between professionals.

Statistics

Next, the report recommends better suicide statistics:

“…more rapid provisional notification of suicide at the time when a suspected death by suicide occurs.”

Although this isn’t mentioned in the strategy, it is the subject of an action:

“Develop on-going surveillance of ‘real-time’ data around completed/attempted suicides within Gloucestershire”

But there’s no report of any progress yet.

Media

Finally, the report criticizes the reporting of suicides in the media:

“The guidelines must have teeth and the refreshed suicide prevention strategy must make clear who is responsible for dealing with breaches by the media, at national and local level.”

This is mentioned in both the strategy and the action plan, and according to the action plan some work has been done on it.

I searched the Internet for recent reports about suicide in local media, and the first one I found, from October, doesn’t fully comply with the guidelines. For example, it mentions some details of the method someone used to take his own life, and it fails to mention where anyone in similar circumstances can get help. So the progress made on this action isn’t very convincing.

I was surprised, too, by how few local reports of suicide I was able to find, considering that on average one or two a week occur in Gloucestershire. Maybe a side effect of the guidelines is to inhibit reporting, making the problem seem less serious than it really is.

Conclusion

The report concludes:

“Our evidence has made clear that suicide is preventable and that much more can and should be done to support vulnerable individuals.”

Despite the existence on paper of a strategy and action plan, and the regular meetings of the GSPPF, it seems to me that this remains as true for Gloucestershire as for anywhere else.

The first of the Committee’s recommendations to the Department of Health is:

“The refreshed suicide prevention strategy must be underpinned by a clear implementation strategy, with strong national leadership, clear accountability, and regular and transparent external scrutiny. In the words of a bereaved parent, ‘we cannot allow more lives to be lost because we do not have effective governance and implementation’.”

It doesn’t look as if Gloucestershire’s local strategy has been very coherent or has led to effective implementation of anything very significant. Perhaps this national approach is going to be the only way to make real change happen.