Appendix 1
Brighton & Hove Suicide Prevention Strategy:
Action Plan 1 April 2016 - 31 March 2017
Contents
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Appendix 1: Map of deaths in public places
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Appendix 2: Membership of the suicide prevention strategy group & workstream groups
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- Rates of suicide and self-harm
Brighton & Hove has had a higher rate of deaths by suicide than the national average for over a century. Current rates are the ninth highest among local authority areas in England; Brighton & Hove is ranked 136 of 144 local authorities. Overall, the local rate, age-standardised and based on 3-year averages, is significantly higher than the rate for England.
The graph below left shows the trend in the rate for Brighton & Hove compared to England. Rates for deaths by suicide fell nationally in the first decade of the century, but have risen recently. There is more variation in the local rate as the numbers are smaller, but the pattern is broadly similar.
A new Suicide Prevention Profile has recently been published by Public Health England which gives more details about risk by age and gender.[1] Brighton & Hove has significantly higher rates of suicide among men aged 35 – 64. Detailed analysis of deaths among women is not published as numbers are too small at local level.
Source: Public Health England (based on ONS source data)
Self-harm
The rate of hospital admissions for self-harm among young people aged 10 – 24 years has been rising in Brighton & Hove, as it has across England.[2] In contrast, rates for hospital stays for self-harm among people of all ages have been falling locally. [3] In a local survey in 2012, one in ten adults said that they had deliberately self-harmed – this was highest in those aged 18-24 (19%). This rate is closer to the national average.[4]
Hospital stays for self-harm, all ages Hospital admissions for self-harm, 10 – 24 yrs People reporting self-harming (ever)
Brighton & Hove rate in blue, England in black Health Counts Survey of Brighton & Hove residents
- Key sources of guidance and information
The 2012 cross-government strategy Preventing Suicide in England[5] identifies priorities for action under six headings:
1: Reduce the risk of suicide in key high-risk groups
2. Tailor approaches to improve mental health in specific groups
3. Reduce access to the means of suicide
4. Provide better information and support to those bereaved or affected by suicide
5. Support the media in delivering sensitive approaches to suicide and suicidal behaviour
6. Support research, data collection and monitoring
Two follow-up annual reports have been published since, updating information about rates of suicide and risk groups, and making recommendations for local action.[6],[7]
The National Institute for Health and Care Excellence (NICE) has published guidance on the short and longer term clinical management of self-harm, and the national strategy for suicide prevention includes self-harm in its remit.
Local information
We have also based on priorities for action on local information including:
- Audit of HM Coroner’s records, to which she has kindly allowed access, to identify common circumstances, with the aim of focussing our efforts on those people or places or means that present particularly high risks.
- Information from emergency services about the location of incidents related to suicide.
- Information from significant incident reports and other learning following a death.
- Information from Public Health England on our local prevalence of mental wellbeing, ill-health and self-harm, as well as suicide rates.
- Risk groups
Groups at higher risk of suicide identified in national guidance:
· 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 the criminal justice system
- Specific occupational groups, such as doctors, nurses, veterinary workers, famers and agricultural workers
Groups identified in national guidance as needing a tailored approach to improve mental health:
- Care leavers or those who were looked after children
- Military veterans
- Lesbian, Gay, Bisexual and Trans people
- Black and Minority Ethnic groups and asylum seekers
The PHE site lists risk factors for suicide by area. Risk factors for which Brighton & Hove has higher rates:
- Looked after children & young people leaving care aged under 18
- Statutory homelessness
- People living alone – households occupied by a single person
- Older people living alone – households occupied by a single person aged 65 or more
Additional groups identified as at higher risk locally through the audit of Brighton & Hove HM Coroner’s records:
- People with a mental health diagnosis, especially depression – including those not in current treatment by mental health services
- People living in deprived areas or who are unemployed long term
- People living alone
- People who have suffered significant bereavement, recent relationship difficulties or separation
- People experiencing or perpetrating violence or abuse
- People abusing alcohol or drugs
- People experiencing chronic pain
Patient risk factors in general practice identified through the Clinicians’ meetings following a death:
newly registered patients, cultural groups with particular stigmas around self-harm (eg Chinese), patients for whom English is a barrier to communication, self-diagnosis with insomnia, previous impulsive behaviour, significant and painful anniversaries, socially isolated men, dual diagnosis, housebound people, patients on high risk medication for physical illnesses (eg insulin) who are also at high risk of mental ill-health, chronic pain and medically unexplained symptoms, physical presentations of symptoms associated with depression (eg weight loss), poor communication between GPs and care coordinators for mental health services.
Significant event analysis by Sussex Partnership has identified older people with a new diagnosis of dementia and their carers as a potential risk.
The national strategy report: Preventing Suicide in England: Two Years On identifies the following new specific risk groups:
- Men in prison who self-harm
- Men aged 35-44 years experiencing the impact of economic recession
- Older people who present at A&E following self-harm
- People who have been discharged from mental hospital within the past 3 months, especially in the first 2 weeks
- People who are in the care of crisis resolution home care teams
Public Health England identifies these risk groups for self-harm:
• Women - rates are two to three times higher in women than men
• Young people - 10-13% of 15-16-year-olds have self-harmed in their lifetime
• People who have or are recovering from drug and alcohol problems
• People who are lesbian, gay, bisexual or gender reassigned
• Socially deprived people living in urban areas
• Women of South Asian ethnicity
• Individual elements including personality traits, family experiences, life events, exposure to trauma, cultural beliefs, social isolation and income
- Hotspots
Most deaths in Brighton & Hove are by hanging at home but of those that take place in public spaces, many are near to the coast or city centre – see Appendix 1. The seafront and the railway have both been identified as local hotspots or high risk areas.
Nationally, there is evidence that physical barriers are effective.[8] Signage is also likely to be effective.[9] Increasing the likelihood of intervention by a third party (through surveillance and staff training) and encouraging responsible media reporting of suicide (through guidelines for media professionals) are also ‘promising’ approaches.[10]
- Gap analysis against national strategy: Preventing Suicide in England (2012)
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National strategy:areas for action |
Vulnerable groups |
Local action |
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1 |
Reduce the risk of suicide in key high-risk groups |
Young and middle-aged men
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A men’s outreach campaign is in development by Grassroots Suicide Prevention and Samaritans. A Men’s Shed is being set up in Kemp Town. |
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People in the care of mental health services, including inpatients |
Sussex Partnership Suicide Prevention action plans to be developed for each service area, including Brighton & Hove. |
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People with a history of self-harm |
Workstream 3 programme, see below. |
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People in contact with the criminal justice system |
Rethink’s Mendos group supports people leaving prison. The Samaritans provide a listening service in HM Prison Lewes and Brighton Bail Hostel. |
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Specific occupational groups, such as doctors, nurses, veterinary workers, farmers and agricultural workers |
Grassroots Suicide Prevention has provided support for specific occupational groups. The NHS Practitioner Health Programme (PHP) scheme supports doctors with mental health or substance misuse problems. The audit of Coroner’s records has highlighted education and health workers as a high risk locally; few agricultural workers. |
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Tailor approaches to improve mental health in specific groups |
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 |
Support for children and young people is commissioned by both the Public Health Schools Programme and wider commissioning of services by both the Clinical Commissioning Group and Council.
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Survivors of abuse or violence, including sexual abuse |
The CCG has commissioned a new service to support for victims of trauma. |
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Veterans |
Provision through Sussex Armed Forces Network. |
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People living with long-term physical health conditions |
Progress on lifestyle advice and health promotion for people with long term mental health conditions; some pathways eg MSK include mental health screening and referral. |
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People with untreated depression |
The Mental Health Locally Commissioned Service supports improved care at GP practices. NHS checks in deprived areas include screening for depression. |
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People who are especially vulnerable due to social and economic circumstances |
Public health commissions a programme of mental health promotion activities in deprived areas from Mind. Financial inclusion work at the Council also supports those at risk. |
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People who misuse drugs or alcohol |
Programmes of work for Substance misuse and Alcohol misuse are led by the public health specialist team at the Council. |
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Lesbian, gay, bisexual and transgender people |
MindOut, Allsorts Youth, Switchboard, Clare Project & other organisations provide support. |
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Black, Asian and minority ethnic groups and asylum seekers |
The Council’s Community Safety Team works closely with statutory and voluntary sector partners to ensure that the city’s services are responding to changes in patterns of immigration to the city, in particular the arrival and needs of very vulnerable migrants whose experiences of trauma and migration may lead them to have a higher suicide risk. The Trust for Developing Communities and a variety of voluntary organisations such as BMEYPP, BMECP provide support to some sectors of our Black and Minority Ethnic Communities. |
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Reduce access to the means of suicide |
Local ‘hotspot’ along the seafront |
Signage along seafront with Samaritans Freephone number. Training for seafront staff, RNLI and coastguards. |
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Some railway and woodland deaths also |
Work between Network Rail and national Samaritans. Training for city parks staff. |
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Provide better information and support to those bereaved or affected by suicide |
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Survivors of Bereavement by Suicide (SOBS) group. Survivors of Suicide (SOS) group. Cruse Bereavement support. Local information: Council webpage; leaflet to be developed. National information: Help is at hand, Support after Suicide website. |
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Support the media in delivering sensitive approaches to suicide and suicidal behaviour |
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Grassroots Suicide Prevention has provided training for the Argus staff, and has provided the Samaritans guidelines.
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Support research, data collection and monitoring |
Data sources include:
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ONS and Police data have been recently updated. Coroner’s audit: 2013 is incomplete. Restarting in 2014 or 2015. National guidance and research is also important. |
- Action planning for suicide prevention in Brighton & Hove
A multi-agency group has been meeting in the city since the 1990s to agree strategy and actions to reduce the rate of suicide. This group is currently chaired by a Consultant in Public Health and includes representatives from local voluntary, statutory and emergency services (see Appendix 2 for details).
To identify priorities for 2016-17, a planning meeting was held on 8 March 2016. A mid-year review will be held in October 2016, and an end of year and planning workshop in February or March 2017.
- Action plan for 2016-17
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Workstream |
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Action in 2016-17 |
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1 |
Research, audit and local data |
1.1 |
Continue to update all relevant local data, for review at the annual planning meeting in March 2017, and mid-year if relevant new data becomes available:
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1.2 |
New national guidance and key research articles to be circulated to the wider Suicide Strategy Prevention Group.
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Clinicians: pathways and learning
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2.1 |
Continue clinicians’ meetings between GPs and Sussex Partnership clinical staff. Annual summary report to be shared and actions taken as needed. Review communication between primary and secondary care, including risk assessment and escalation protocols. Ensure adequate arrangements are in place for follow up after discharge from secondary care.
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2.2 |
Consider any clinical recommendations from the Sussex Partnership Clinical Advisory Groups relevant to suicide or self-harm.
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2.3 |
Training for nurses in preventing suicide in LBG and trans young people.
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Self-harm
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3.1 |
Evaluate the pilot scheme for brief interventions by the Mental Health Liaison Team at the Royal Sussex County Hospital emergency department, and extend the scheme if appropriate.
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3.2 |
Review data about current levels of population need and service provision, including Public Health England data, serious case reviews, Wellbeing Service & CAMHS data from T2 and T3, Safe & Well at School Survey, organisations trained in Understanding Self-Injury by Grassroots SP, primary care knowledge about self-harm, public health schools programme, information from hostels, YMCA, social care, school counsellors, Right Here, etc.
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3.3 |
Social media: quality assurance for A Safer City, ensure that consistent messages and information are provided. Consider review of social media options for adults who self-harm. |
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3.4 |
Safety plans: share models currently in use to identify any benefits in sharing or coordinating templates.
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3.5 |
Other options:
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High risk groups and locations |
4.1 |
Hotspots: Continue to map areas of high risk through information on locations of deaths and attempts. Take action to reduce risk (eg install signage, barriers) and in line with evidence base. Provide training where this may support staff working at higher risk areas.
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4.2 |
Training: Map coverage of sectors/organisations by self-harm and suicide prevention training programme for frontline staff. Provide tailored training for frontline staff in occupational groups where required.
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4.3 |
Challenge to stigma: Suicide Safer City programme to be further developed, including suicide safer organisations. World Suicide Prevention Day 2016 to be supported. Update the Council webpages to ensure signposting is effective.
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4.4 |
Continue gap analysis of psychosocial support for vulnerable groups, working towards provision of new services where gaps are identified. Consider how best to reach people who may be at higher risk including men, people who don’t engage with services or are isolated, people with a new diagnosis of dementia, older people with multiple medications and long-term conditions, people with untreated depression, those in touch with criminal justice system.
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4.5 |
Crisis: Develop an email list for blue light services to communicate any changes in key information about crisis contact details. Consider developing a card or phone link. Continue work on diverting people with mental health needs from arrest, sectioning in police cells and imprisonment. Consider issues arising from work on the Crisis Care Concordat, including the ‘Prevention Concordat’. Consider the need for further provision of crisis support, such as a safe/calm space, including the needs of people with Personality Disorder.
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4.6 |
Clusters: Consider how we can better identify and respond to clusters or contagion of suicides or attempts.
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Steering group |
5.1 |
Suicide Safer City application: review action plan for additional gaps and consider how to shape the city suicide prevention action plan for 2017-18.
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5.2 |
Sussex Partnership Suicide Prevention Action Plans for each service: review for opportunities for joint working.
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5.3 |
Review other gaps arising in-year.
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5.4
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Monitor media coverage. |
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5.5 |
Seek views of those with lived experience on draft action plan.
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Appendix 1: map of deaths by suicide in public places
Appendix 2: membership of the Brighton & Hove City Suicide Prevention Strategy Planning group 2016-17
- Attendance at the annual planning meeting, 8 March 2016
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Jacky Austen |
Manager, Community Services in Brighton & Hove |
Sussex Partnership NHS Foundation Trust |
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Gillian Bendelow |
Professor in Sociology of Health and Medicine, School of Applied Social Science |
University of Brighton |
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Rachel Brett |
Director of Communities |
Downslink YMCA |
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Gill Brooks |
Commissioner, Children and Young People’s mental health |
Clinical Commissioning Group |
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Jo Bullen |
Team leader, paediatric liaison mental health team, Royal Alexandra Children’s Hospital |
Sussex Partnership NHS Foundation Trust |
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Daniel Cheesman |
Director |
Samaritans in Brighton & Hove |
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Kerry Clarke |
Commissioner for children and young people |
Public health, Brighton & Hove City Council |
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Greg Condry |
Outreach team |
Samaritans in Brighton & Hove |
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Debi Fillery |
Nurse consultant for safeguarding, Supervisor of midwives, RACH |
Brighton & Sussex University Hospitals |
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Ruth Finlay |
Project manager, Suicide prevention |
Public health, East Sussex County Council |
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Sarah Gates |
Mental Health Liaison Officer |
Sussex Police |
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Alex Harvey |
Office manager |
Grassroots Suicide Prevention |
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Jane Hoyle |
RSCH Mental Health Liaison Team |
Sussex Partnership NHS Foundation Trust |
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Peter Huntbach |
Older People’s Housing Manager |
Brighton & Hove City Council |
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Becky Jarvis |
GP, Clinical Lead for Mental Health |
Clinical Commissioning Group |
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Helen Jones |
Director |
MindOut |
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Peter Joyce |
CAMHS General Manager |
Sussex Partnership NHS Foundation Trust |
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Melinda King |
Inclusion and Partnership Co-ordinator |
East Sussex Fire & Rescue Service |
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Navpreet Mangat |
Intern |
Grassroots Suicide Prevention |
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Stuart Marks |
Manager |
Brighton & Hove Cruse Bereavement Care |
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Clare Mitchison |
Public health specialist |
Public health, Brighton & Hove City Council |
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Mike Newman |
Clinical services manager |
Pavilions |
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Gurprit Pannu |
Clinical Director, Brighton & Hove Adult Treatment Services |
Sussex Partnership NHS FoundationTrust |
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Eileen Remedios |
Costal Safety Officer |
Royal National Lifeboat Institution |
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Wendy Robinson |
Service Manager SOS & MENDOS Services |
Rethink |
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Launa Rolf |
Clinical Quality and Patient Safety Manager |
Clinical Commissioning Group |
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Anna Roscher |
Youth Volunteer Coordinator |
Allsorts Youth |
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Liz Tucker |
Research officer, DAAT |
Public health, Brighton & Hove City Council |
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Emma Wadey |
Director of Nursing Standards & Safety |
Sussex Partnership Foundation Trust |
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Becky Woodiwiss |
Public health specialist |
Public health, Brighton & Hove City Council |
- Workstreams and strategy steering group
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Membership: organisation (lead/chair in bold) |
Membership: individuals (lead in bold) |
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Steering group |
Brighton & Hove City Council, public health
Clinical Commissioning Group (CCG) Grassroots Suicide Prevention |
Katie Cuming, Consultant in Public Health Clare Mitchison, lead for Workstream 1 Gill, Brooks, lead for Working group 3 Miranda Frost, lead for Working group 4
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Workstream 1 (no formal meetings)
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Brighton & Hove City Council, public health
Coroner’s Office East Sussex Fire & Rescue service Sussex Police |
Clare Mitchison, Public Health Specialist
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Workstream 2 Clinicians’ meetings |
Brighton & Hove City Council, public health NHS Brighton & Hove, Clinical Commissioning Group (CCG)
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Katie Cuming, Consultant in public health
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Working group 3 Quarterly meetings |
CCG Brighton & Hove City Council, public health Grassroots Suicide Prevention Sussex Partnership NHS Foundation Trust Wellbeing Service YMCA Downslink Group
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Chair: Gill Brooks, Commissioner for CYP mental health
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Working group 4 Quarterly meetings |
Grassroots Suicide Prevention Allsorts Youth Project Brighton & Hove City Council, public health Cruse bereavement support Mind in Brighton & Hove MindOut Rethink, Survivors of Suicide Samaritans of Brighton & Hove Survivors of Bereavement by Suicide (SOBS) Sussex Partnership NHS Foundation Trust Wellbeing Service |
Chair: Miranda Frost, Grassroots Suicide Prevention
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