Health and Adult Social Care Select Committee
26 September 2019
West Sussex Suicide Prevention Strategy 2017-20
Report by Director of Public Health

Summary Suicide is the biggest killer of men aged 49 and under, and the leading cause of death in all people aged 20–34 years in the UK. The West Sussex Suicide Prevention Strategy 2017-20 outlines priority areas for preventative action in the county and the West Sussex Suicide Prevention Steering Group is the multi-agency body maintaining oversight of suicide prevention activity in the county. Self-harm prevention is one of the priority areas in the strategy. Reducing emergency admissions for self-harm is also a corporate priority in the West Sussex Plan. Focus for scrutiny Further to a recommendation from the House of Commons Health Select Committee, the Health and Adult Social Care Select Committee is asked to consider the West Sussex Suicide Prevention Strategy 2017-20 to ensure that the plans within it have been effective in their implementation. The Chairman will summarise the output of the debate for consideration by the Committee.

Proposal

Background and Context

Suicide is the biggest killer of men aged 49 and under, and the leading cause of death in people aged 20–34 years in the UK. Suicide has a profound and enduring impact on families, friends, colleagues and the wider community.

There are also serious economic impacts; it is estimated that in England the average cost per completed suicide for those of working age is £1.67m (at 2009 prices). In West Sussex this equates to estimated suicide-related costs of £367.4m between 2013 and 2015. This includes lost output, police time and funerals, as well as intangible costs such as loss of life and distress of relatives. 60% of these costs relate to those bereaved.

Office of National Statistics data on the number / rate of people who have completed suicide in West Sussex is available up until 2016-2018 (three year bands are used due to small numbers). Although they are not statistically significantly lower than England, rates in West Sussex have declined from 10.0 per 100,000 population in 2013-15 to 8.5 100,000 population in 2016-2018. The rate for males in 2016-18 is 13.2 per 100,000 population and for females it is 4.0 per 100,000 population.

Figure 1: Suicide rate per 100,000 population for West Sussex and England from 2001-03 to 2016-18

In 2012 the Government published its national strategy ‘Preventing Suicides in England’ outlining priority areas for action. This recommended that all local areas develop a suicide prevention action plan. The multi-agency West Sussex Suicide Prevention Steering Group (SPSG) coordinates and maintains oversight of local implementation of national strategy and policy and addresses local priorities.

To improve understanding of local issues, West Sussex Public Health Research Unit carried out an audit of suicides in West Sussex between 2013 and 2015. This collected data on demography, circumstances of death, personal circumstances, risk factors, physical and mental health problems and access to support. The audit was used to inform the West Sussex Suicide Prevention Strategy 2017-20 (see Appendix B), which was formally signed-off in March 2018.

The priority areas for action in the strategy are:

Focus on reducing suicides in vulnerable middle aged and older people, particularly those experiencing financial difficulties and social isolation

Focus on preventing suicides in people in contact with mental health services, particularly those recently discharged or disengaged from care

Focus on preventing suicide in people who misuse alcohol or drugs, particularly those with a dual diagnosis

Focus on reducing self-harm, particularly in young people

Focus on preventing suicide in people with long-term conditions or requiring end of life care, and their carers

Improve support for people bereaved or affected by suicide

Increase confidence and skills of paid and volunteer workers to support people at risk of suicide, maximising the use of existing resources and support

Reduce access to the means of suicide, focusing on self-poisoning, railways and other public places

Monitor suicide patterns and trends in West Sussex

See Appendix A for a summary of activity across the strategy’s nine priority areas.

Suicide prevention is also a priority mental health area for Sussex Health and Care Partnership [Sustainability and Transformation Partnership (STP)] which covers Brighton and Hove and East Sussex as well as West Sussex. Resource has been awarded to the STP specifically for suicide prevention activity for 2019-20; activity in other STP workstreams will also impact on this area. A programme manager has been recruited to oversee delivery.

Self-harm

While preventing self-harm is a strategic priority for suicide prevention in the county, it should also be considered as a separate area in its own right. While a third of all people who complete suicide are known to have self-harmed previously, there are significant differences between the two areas in terms of risk factors.

Self-harm can be defined as the act of deliberately causing harm to oneself either by causing a physical injury, by putting oneself in dangerous situations and / or self-neglect. In 2017-18 there were 1,743 emergency admissions for self-harm in West Sussex, a rate of 222 per 100,000 population.

In terms of trends, over the five year period from 2013-14 to 2017-18, emergency admission rates in the county have been consistently higher than for England. They have not shown a significant increase or decrease. The numbers of admissions for 2016-17 and 2017-18 are lower than those for the previous three years. Emergency hospital admissions for intentional self-harm is a key indicator for the Strong Safe and Sustainable component of the West Sussex Plan,with a reduction in activity of 176 admissions per 100,000 population set for March 2020. Figures for hospital admissions for self-harm 2017-18 are attached at Appendix C.

In 2016-17 and 2017-18, single admissions represented less than two-thirds (63.6%) of all admissions. Around 50 individuals (2% of total number of people) accounted for 370 self-harm admissions that occurred in 2016/17 to 2017/18 (11% of the total number of admissions). These persons were admitted for self-harm five or more times during the two year period.

Females (all ages) are more likely than males (all ages) to be admitted for self-harm – 68.5% compared to 31.5% in 2017-18. However, the majority of people who self-harm will not present at hospital and be included as part of the statistics. Only the most serious cases are admitted to acute care and these form the ‘tip of the iceberg’.

West Sussex Public Health Team self-harm rapid needs assessment was signed-off in August 2019. This provides a detailed analysis of activity in the county and identifies key areas for action. West Sussex County Council has commissioned an emotional wellbeing service for schools and a self-harm lead focussing on preventing self-harm in educational settings came into post in August 2019. The Council and the NHS continue to commission services at all tiers of Child and Adolescent Mental Health Services (CAMHS). There are a number of services promoting children and young people’s emotional and mental health and wellbeing including Mind The Gap, Youth Emotional Support, YMCA Downslink and Find It Out Centres.

Proposal

In 2017 the House of Commons Health Select Committee published a report following its inquiry into suicide prevention. The report made the following recommendation:

‘We recommend that health overview and scrutiny committees should also be involved in ensuring effective implementation of local authorities’ plans. This should be established as a key role of these committees. Effective local scrutiny of a local authority’s suicide prevention plan should reduce or eliminate the need for intervention by the national implementation board.’

This report has been written to support the Health and Adult Social Care Select Commitee in considering the progress in the nine areas for action (which includes self-harm), as highlighted in the West Sussex Suicide Prevention Strategy 2017-20 (see Appendix A for a summary of activity across the strategy’s nine priority areas).

Resources

This paper has no additional resource implications for West Sussex County Council.

Factors taken into account

Issues for consideration by the Select Committee

3.1	Further to a recommendation from the House of Commons Health Select Committee, the Health and Adult Social Care Select Committee is asked to consider the West Sussex Suicide Prevention Strategy 2017-20 to ensure that the plans within it have been effective in their implementation. The nine areas of action are set out in Appendix A and the Strategy is attached as Appendix B.

Consultation

4.1	As part of the development of the West Sussex suicide prevention strategy, a stakeholder consultation was undertaken. The specific objectives of the consultation were:

to determine frontline workers’ confidence in approaching/ signposting people contemplating suicide and people bereaved by suicide

to estimate availability and uptake of suicide prevention training, and barriers to accessing training

to understand barriers to frontline workers supporting people at risk of suicide

to gather views on what resources, processes and services would help to reduce suicide in West Sussex

4.2	Local frontline workers were invited to take part in an online survey conducted via the “Have Your Say” online portal. The survey was available for completion between 6 March and 28 April 2017.

Risk Implications and Mitigations

Risk	Mitigating Action (in place or planned)
Strategic priorities identified in strategy are not effectively addressed resulting in both safety and reputational risk	Oversight of operational delivery maintained by West Sussex Suicide Prevention Steering Group
Strategy does not address emerging issues resulting in both safety and reputational risk	Evaluation and refresh of strategy carried out in 2020

Other Options Considered

Not applicable for this report.

Equality Duty

The strategy impacts on people and groups with protected characteristics in several areas:

Age and sex: Suicide is the biggest killer of men aged 49 and under, and the leading cause of death in all people aged 20–34 years in the UK

Females (all ages) are more likely than males (all ages) to be admitted for self-harm.

Sexuality: LGBT people are at increased risk of both suicide and self-harm

Marital status: The process of becoming widowed (bereavement) increases the risk of suicide and self-harm.

Social Value

Not applicable for this report.

Crime and Disorder Implications

9.1	Not applicable for this report.

Human Rights Implications

10.1	Not applicable for this report.

Anna Raleigh

Director of Public Health

Contact: Daniel MacIntyre, Acting Consultant in Public Health

Appendices:

Appendix A: West Sussex Suicide Prevention Strategy 2017-19 – an overview of activity.

Appendix B: West Sussex Suicide Prevention Strategy 2017-20

Appendix C: Hospital admissions for self-harm 2017-18 briefing

Appendix A: West Sussex Suicide Prevention Strategy 2017-20 Priority areas and overview of key activity

Priority Area 1: Focus on reducing suicides in vulnerable middle aged and older people, particularly those experiencing financial difficulties and social isolation

There is a comprehensive range of support for mental health and wellbeing at all tiers in the county, including:

The Pathfinder consortium (10 voluntary sector organisations and Sussex Partnerhship NHS Foundation Trust) provides non-clinical support, advice and signposting, engaging with 4119 indiviudals in 2018/19.

Sussex Community Foundation Trust’s ‘Time to Talk’ service provides Cognitive Behavioural Therapy for people suffering from anxiety and depression as part of the national Improving Access to Psychological Therapies programme (IAPT). In Coastal West Sussex CCG and Horsham and Mid-Sussex CCG around 20% of people suffering from anxiety and depression are entering therapy which is line with the England rate. For Crawley CCG this increases to 25% which is greater than the England rate.

Over the next 12 months there will be a major expansion of NHS mental health crisis services in West Sussex

The Samaritans provide emotional support to anyone in emotional distress, struggling to cope, or at risk of suicide over the phone, in person, or via email or letter. They also provide a targeted programme of support for workplaces, schools, prisons and the military. Published national data shows that in 2018, Samaritans volunteers responded to over 3.6m calls for help by telephone, 675,757 calls for help by SMS – 17% more than in the previous year - as well as 332,411 calls for help by email, an increase of 15%. Samaritans volunteers responded to around 1,200 calls for help by letter and provided face to face support on over 30,000 occasions.

Citizens Advice Bureau (CAB) provides advice to those experiencing financial difficulties. Social prescribing programmes providing non-clinical referral in primary care are being rolled out across the county and provide support and signposting for those experiencing financial difficulties. 51,940 cases of client assistance took place across all channels in 2017-18.

West Sussex County Council commissions a wide range of services tackling social isolation for older people. 3,200 older people attended day activities on 65,800 occasions in in 2018-19 and 4,615 received befriending support. West Sussex adult social care also focusses on tackling social isolation as part of preventative social care.

There are a very large number of voluntary sector activities taking place in West Sussex that bring people together. The Men in Sheds project aims to encourage social connections, friendship building and skill sharing amongst men.

Priority Area 2: Focus on preventing suicides in people in contact with mental health services, particularly those recently discharged or disengaged from care

Suicide prevention is a key strategic priority for Sussex Partnership NHS Foundation Trust, the county’s mental health trust as detailed in their Towards Zero Suicide strategy, currently in draft form. The Trust provides follow-up activity to psychiatric patients discharged from acute hospitals within 72 hours.

Priority Area 3: Focus on preventing suicide in people who misuse alcohol or drugs, particularly those with a dual diagnosis

Public Health commissions Change Grow Live to provide drug and alcohol treatment services in the county; there were more than 1500 users of the service in 2018/19. The service specification explicitly states that the provider will work with other services in contact with individuals with a dual diagnosis to provide more integrated and effective care packages to achieve mutual outcomes. There are a number of homeless support services to improve access and care for homeless individuals, a group with high rates of dual diagnosis.

Priority Area 4: Focus on reducing self-harm, particularly in young people

West Sussex Public Health Team self-harm rapid needs assessment was signed-off in August 2019. This provides a detailed analysis of activity in the county and identifies key areas for action.

The Council has commissioned an emotional wellbeing service for schools and a self-harm lead focussing on preventing self-harm in educational settings came into post in August 2019.

The Council and the NHS continue to commission services at all tiers of Child and Adolescent Mental Health Services (CAMHS). There are a number of services promoting children and young people’s emotional and mental health and wellbeing including Mind The Gap, Youth Emotional Support, YMCA Downslink and Find It Out Centres.

Priority Area 5: Focus on preventing suicide in people with long term conditions or requiring end of life care, and their carers

Sussex Community Foundation Trust’s Time to Talk Health service focusses specifically on people living with long-term conditions. The service offers phone consultations, one-to-one sessions and group work with others who experience the same symptoms. 1170 patients have completed treatment since the services launch in May 2017.

Promoting Compassionate Communities supporting improved end of life care is one of the four strategic priorities in the West Sussex Joint Health and Wellbeing Strategy 2019-24. West Sussex Public Health has convened a county wide multi-agency working group to drive improvements in this area which will hold its first meeting in September 2019.

West Sussex County Council commissions a programme of Carers’; Support. This includes the following:

Advice, information and support service - 60 carer support groups running each month

Carers assessments

Carer Learning and Wellbeing Programme (Modula training, 12 topics)

Emotional support and counselling

Emergency planning and support - Carers Alert Card

Carer short break respite services (planned & emergency)

Health and wellbeing payments

Assistive technology/equipment for independence offer

Specialist carer bereavement support

Return to work/training support

Carers Health Team

Priority Area 6: Improve support for people bereaved or affected by suicide

Sussex Community Foundation Trust Child Death Service is for families who have experienced the death of a child from age 0 up to their 18th birthday. A home visit is made initially to make an assessment of the needs of those in the family with ongoing visits from a keyworker.

There is a range of voluntary and community sector bereavement support including: Winston’s Wish offers bereavement services to families with children under 18 who have experienced a traumatic bereavement; Cruse offers support, advice and information to children, young people and adults when someone dies; Survivors of Bereavement through Suicide offers peer support throughout the county.

West Sussex County Council Public Health Team are leading on developing an agreed bereavement pathway for the county including sudden and unexpected deaths to improve coordination of support.

Priority Area 7: Increase confidence and skills of paid and volunteer workers to support people at risk of suicide, maximising the use of existing resources and support

Coastal West Sussex Mind provides mental health awareness training to the wider workforce and staff within primary care.

Grassroots is a Brighton based suicide prevention charity which delivers a number of training courses and also provides resources and information

Sussex Partnership NHS Foundation Trust has a requirement for all staff to undertake suicide awareness / prevention training

West Sussex County Council continues to provide mental health training to employees and Private, Voluntary and Independent (PVI) service providers

Sussex Armed Forces Network website provides online training in mental health issues affecting the armed forces and suicide prevention

Priority Area 8: Reduce access to the means of suicide, focusing on self-poisoning, railways and other public places

Network Rail and British Transport Police continue to review incidents and make environmental modifications where necessary. For example, there have been extensive modifications at Durrington Station at which there were a number of fatalities.

Priority Area 9: Monitor suicide patterns and trends in West Sussex

In addition to monitoring national data, there have been a number of detailed analyses of local patterns and trends. These include:

West Sussex Suicides Audit 2013-15

West Sussex Drug Deaths Audit 2015-17 (forthcoming)

Self-harm in West Sussex: a rapid needs analysis (2019)

Sussex Health and Care Partnership is currently reviewing optimum way of monitoring suicide in order to identify trends and potential contagion.