1. FOCUS AREA : SUPPORTING RESEARCH, DATA COLLECTION & MONITORING
1.1. For MDT reviews to involve families and other close relatives and clear process for sharing learning (duty of candour)
2. FOCUS AREA: PROVIDING BETTER INFO AND SUPPORT TO THOSE BEREAVED OR AFFECTED BY SUICIDE
2.1. WLMHT to consider referral to CRUSE / PAPYRUS/ CRIB.
2.2. To follow ‘death of the patient’ protocol.
2.3. All staff, patients and families/carers affected by a suicide or a serious suicide attempt are given prompt and open information and the opportunity to receive appropriate and effective support as soon as they require it.
2.4. Providing better information and support to those bereaved (D6 Death of Patient Policy).
3. FOCUS AREA: HIGH RISK GROUPS
3.1. Recently discharged
3.1.1. Follow up within 2-3 days
3.1.2.
3.1.3. Discharge CPA to include risk assessment and a plan involving the person
3.2. Co existing substance use
3.2.1. Over 50% Serious Incidents involve drug or alcohol
3.2.2.
3.2.3. Be aware of local strategies - FLOW guidelines/ Brief intervention, information and referral routes to specialist services
3.2.4.
3.2.5. Routine audits
3.2.6.
3.2.7. Include in assessment and formulation
3.3. Current financial difficulties/isolation
3.3.1. Awareness of emerging high risk groups
3.3.2.
3.3.3. Awareness of specialist knowledge and resources available
3.3.4.
3.3.5. Ensure there is a protocol for MDT discussion and risk appraisal and discussion
3.3.6.
3.3.7. Recovery teams to re-assess their prioritization criteria taking account of information published in the NCISH
3.3.8.
3.3.9. Involve 24 hour crisis assessment and treatment service
3.4. Loss of contact with services
3.4.1. Awareness of emerging high risk groups
3.4.2.
3.4.3. Awareness of specialist knowledge and resources available
3.4.4.
3.4.5. Recovery/EIP teams to have mechanisms in place to alert themselves when patients disengage
3.4.6.
3.4.7. Ensure there is a protocol for MDT discussion and risk appraisal and discussion
3.4.8.
3.4.9. Recovery teams to re-assess their prioritization criteria taking account of information published in the NCISH
3.4.10.
3.4.11. Involve 24 hour crisis assessment and treatment services
3.5. Unemployed
3.5.1. Awareness of emerging high risk groups
3.5.2.
3.5.3. Awareness of specialist knowledge and resources available
3.5.4.
3.5.5. Recovery/EIP teams to have mechanisms in place to alert themselves when patients disengage
3.5.6.
3.5.7. Ensure there is a protocol for MDT discussion and risk appraisal and discussion
3.5.8.
3.5.9. Recovery teams to re-assess their prioritization criteria taking account of information published in the NCISH
3.5.10.
3.5.11. Involve 24 hour crisis assessment and treatment services
3.6. Carers
3.6.1. Awareness of emerging high risk groups
3.6.2.
3.6.3. Awareness of specialist knowledge and resources available
3.6.4.
3.6.5. Recovery/EIP teams to have mechanisms in place to alert themselves when patients disengage
3.6.6.
3.6.7. Ensure there is a protocol for MDT discussion and risk appraisal and discussion
3.6.8.
3.6.9. Recovery teams to re-assess their prioritisation criteria taking account of information published in the NCISH
3.6.10.
3.6.11. Involve 24 hour crisis assessment and treatment services
3.6.12.
3.6.13. Explore isolation and refer to community services where appropriate
3.6.14.
3.6.15. MDT need to ensure that they correlate information from carers. All clinical staff receive training on carer’s rights and involvement in assessment, care planning and discharge.
3.6.16.
3.7. Recent migration
3.7.1. Awareness of emerging high risk groups
3.7.2.
3.7.3. Awareness of specialist knowledge and resources available
3.7.4.
3.7.5. Recovery/EIP teams to have mechanisms in place to alert themselves when patients disengage
3.7.6.
3.7.7. Ensure there is a protocol for MDT discussion and risk appraisal and discussion
3.7.8.
3.7.9. Recovery teams to re-assess their prioritization criteria taking account of information published in the NCISH
3.7.10.
3.7.11. Involve 24 hour crisis assessment and treatment services
3.8. Perinatal mental health
3.8.1. Suicide is now one of the leading causes of death in pregnant women and new mothers.
3.8.2.
3.8.3. Nationally, almost a quarter of women (23%) who died between six weeks and one year after pregnancy died from mental-health related causes, and one in seven women died by suicide.
3.8.4.
3.8.5. Nationally, NHS England is aiming to improve access to high quality, timely, evidence- based care for women experiencing mental ill health during the perinatal period.
3.8.6.
3.8.7. This is to be delivered through specialist support in the community and through mother and baby units for inpatient care. This overall aim is to improve outcomes for women and families, with a focus on prevention and early recognition, integrated, joined-up care for women and their families.
3.9. Children and young people
3.9.1. Studies of children and younger people have found that academic pressures, bereavement, bullying, alcohol or drug misuse and childhood abuse greatly increase the risk of developing mental health problems7. Nationally, professionals who work with children and young people are becoming increasingly concerned about mental health issues, including self-harm.
3.9.2.
3.9.3. Again at a national level, proposals have been made for increasing the focus on the mental health of children and young people, focusing on strengthening the mental resilience of younger people, preventing mental health problems and improving services available.
3.9.4. Understanding more about a young person’s risk of suicide
3.9.4.1. Suicidal ideation Have they ever thought about suicide? How often do these thoughts come into their
3.9.4.2. mind? Are these thoughts that they can ignore? Are there things that they can do to take their mind off
3.9.4.3. these thoughts? Do they ever hear these thoughts as voices telling you to harm yourself? Do they feel
3.9.4.4. hopeless about their future?
3.9.4.5. Intent Do they feel that they would act on these thoughts? Are they worried that they might act on
3.9.4.6. them? Do they feel safe right now? What stops them from acting on these thoughts?
3.9.4.7. Planning Have they ever made any plans to take their own life? What did they plan to do? Do they
3.9.4.8. have a plan at this time? Have they thought about when this might happen? Have they ever
3.9.4.9. researched methods or spoken to anyone else about ways to die?
3.9.4.10. Access to lethal means Do they have any thing that they would use to harm themselves such as pills,
3.9.4.11. weapons etc? Where is this?
3.9.4.12. History of past attempts Have they ever tried to kill themselves in the past? What happened? What
3.9.4.13. stopped them? Did they go to someone for help? Do they feel the same right now?
3.9.4.14. What to do next If suicidal thinking is fleeting, with no clear intent or planning and is contextual to a
3.9.4.15. wider mood issue, consider access to primary support e.g. school nurse, counselling service, etc. Are
3.9.4.16. parents aware? If not, what are the young persons concerns about telling them? If there is clear risk
3.9.4.17. you will need to inform them. If you are unsure about the level of risk or how to make sense of the
3.9.4.18. information you have gathered, it is important that you seek appropriate consultation. Where clear risk
3.9.4.19. is apparent, you need to consider your action plan
3.9.4.20. Safety planning - a safety plan is a collaborative agreement including the young person, family and
3.9.4.21. relevant practitioners. It should include;
3.9.4.22. The warning signs for distress Triggers? Situations?
3.9.4.23. What actions the young person will take to maximise safety Letting someone know, staying in public
3.9.4.24. areas, focusing on a distraction task, ‘safe pain‘ techniques, talking to positive friends etc.
3.9.4.25. What actions will family take? Remove access to lethal means, agree frequency of checks, keeping
3.9.4.26. room door open, spend time with the young person engaging in distraction, time to talk or listen, plan
3.9.4.27. activities. Ensure they have contact details for emergencies and a clear plan of action if they feel
3.9.4.28. unable to keep the young person safe.
3.9.4.29. What actions others will take? Provide a safe space in school, named adult to talk to, encouragement
3.9.4.30. to engage in lessons and activities, address underlying issues, review timetable as appropriate,
3.9.4.31. access to counselling or school nurse, build confidence and self esteem through positive activity and
3.9.4.32. responsibility.
3.10. Homelessnes
3.10.1. Awareness of emerging high risk groups
3.10.2.
3.10.3. Awareness of specialist knowledge and resources available
3.10.4.
3.10.5. Recovery/EIP teams to have mechanisms in place to alert themselves when patients disengage
3.10.6.
3.10.7. Ensure there is a protocol for MDT discussion and risk appraisal and discussion
3.10.8.
3.10.9. Recovery teams to re-assess their prioritization criteria taking account of information published in the NCISH
3.10.10.
3.10.11. Involve 24 hour crisis assessment and treatment services
3.11. Male and middle aged
3.11.1. Awareness of emerging high risk groups
3.11.2.
3.11.3. Awareness of specialist knowledge and resources available
3.11.4.
3.11.5. Recovery/EIP teams to have mechanisms in place to alert themselves when patients disengage
3.11.6.
3.11.7. Ensure there is a protocol for MDT discussion and risk appraisal and discussion
3.11.8.
3.11.9. Recovery teams to re-assess their prioritization criteria taking account of information published in the NCISH
3.11.10.
3.11.11. Involve 24 hour crisis assessment and treatment services
3.12. LGBT community
3.12.1. Mental health services The NIESR report cites a range of studies pointing to higher prevalence of mental health issues amongst LGBT people than the general population in the UK.
3.12.2. Just under a quarter of respondents to the survey (24%) had accessed mental health services in the 12 months preceding the survey. This figure was higher for trans people (30% for trans women, 40% for trans men and 37% for non-binary people) and cisgender bisexual people (29%).
3.12.3. Furthermore, 8% of all respondents had tried to access mental health services but had been unsuccessful.
3.12.4. 28% of respondents who had accessed or tried to access mental health services in the 12 months preceding the survey said it had not been easy at all. 28% said it had been easy. The most frequent reason given for difficulties was long waiting lists (given by 72%).
3.12.5. Around a fifth (22%) said that their GP was not supportive. When mental health services were accessed, respondents were generally positive or neutral about the support they received; only a fifth of respondents (22%) said they had had a negative experience.
3.12.6. Respondents to the optional free-text question talked about the importance of mental health services in the wider context of experiencing serious incidents such as verbal harassment and bullying.
4. FOCUS AREA: SUPPORTING THE MEDIA
4.1. WLMHT has recently signed up to the Zero Suicide Alliance and is promoting their training. For all staff to have access to this training and the message within.
4.2. Staff should refer to the Samaritans Media Guidelines for reporting suicide.
4.3. Promote the term 'completed' suicide
5. FOCUS AREA: TAILORING APPROACHES
5.1. Services to ensure that they are aware of emerging high risk groups and to be aware of specialist knowledge and resources within the geographical area to help with these issues
5.2. For men aged 45-64, consider other risk factors (unemployed) and ensure that risk plan is comprehensive and thorough.
5.3. For those accessing services who have recently come to the UK, promoting contact with agencies who can provide support.
5.4. Carers assessment should be mindful of the heightened risk of suicide in this group. To implement the triangle of care
5.5. Tailoring individual plans developed for each patient. To tailor:-
5.5.1. Medicine management
5.5.2. PH checks
5.5.3. MDT reviews
5.5.4. Management of leave and planning a dynamic assessment using a relational approach
5.5.5. UDS and breath tests
5.5.6. Involvement of carers/social services
5.5.7. Establish links with community supports/third sector organisations e.g. homeless persons units
5.5.8. Risk assessment at point of admission (at least within 72 hours)
5.5.9. Complex case forums
5.5.10. Reflective practices
5.5.11. Occupational and other therapies
5.5.12. Psychological therapies
6. MONITORING
6.1. Dashboards
6.1.1. Head of PPC/AUC
6.2. Training dashboards for clinical staff
6.2.1. Head of PPC/AUC
6.3. Use of interventions monitored via rio portal
6.3.1. Team Managers
6.4. Annual Audit
6.4.1. Trust suicide prevention lead
6.5. Local resource pack
6.5.1. Borough Lead
6.6. To audit that this information is shared and clearly displayed in each base
6.6.1. Team Managers
6.7. Audit of case notes
6.7.1. Team Managers and pathway seniors
6.8. Resource portfolios for local agencies to be available in all trust clinical sites
6.9. Audit of local resources
6.9.1. Team Managers
6.10. To audit that D6 policy followed and that guide accessible to all
6.10.1. Team Managers
6.11. a. Check that there is a record of whether a member of staff was made responsible for ensuring that
6.12. b. Gather list of all suicides and serious suicide attempts over the past year. Examine records of post incident reviews for the following:
6.12.1. i. Check that there is a record that family/carers were offered support.
6.12.2. ii. Check that there is a record that support for staff was made available and establish what this consisted of. Ask the manager how its adequacy is ensured.
6.13. Team managers to have an oversight of whether clinical staff have completed the training
6.14. Dashboards and Regular audits taken to CIG and on to SMT
6.15. To audit that D6 policy followed and that guide accessible to all
6.16. a. Check that there is a record of whether a member of staff was made responsible for ensuring that the family/carers were offered support and, with the patient’s consent, were kept informed of any developments.
7. IMPLEMENTATION
7.1. roll out West London co-existing substance use training
7.2. Send infographics from NCISH
7.3. Collate information regarding local services/ charitable organisations
7.4. To ensure disengagement protocols are followed within the teams
7.4.1. Zoning meeting to flag 7-day f/up
7.4.2. Care coordinators to f/up
7.4.3. Check WLBI
7.4.4. Duty to attend CPA if case is not allocated
7.4.5. Line managers to monitor risk assessments and care plans in supervision
7.4.6. on discharge from hospital, the highest number of suicides occur in he first three days; and the first three months remain a risk period.
7.5. To audit against NICE guidelines and ensure that those at highest risk have access to the full range of bio-psycho-social interventions.
7.6. Updates from NCISH to be shared on an annual basis with clear local links designed to appropriate support agencies
7.7. For case reviews to consider men in this age range and search for other risk factors
7.8. Carers assessment to consider suicide risk
7.9. To ensure all families and close friends have access to the NHSE guide ‘help is at hand’
7.10. For the D6 policy to be reviewed and clarified where the death occurs in the community
7.11. Zero suicide Alliance training to be circulated
7.12. To ensure that support was offered to the family/carers
7.13. For those identified as having significant self harm, a bio-psycho-social assessment and MDT care pl
7.14. For liaison psychiatry to post updates on RiO of any self-harm for known WLMHT patients
7.15. Allocation of responsibility for environment RA and ligature audit to be allocated and ideally undertaken on rotation to ensure that the assessment has a number of perspectives in its development.
7.16. Zero suicide Alliance training to be circulated
7.17. To ensure that support was offered to the family/carers
7.18. Training via exchange
7.19. Adhere to principles of medicines optimisation
7.19.1. Aim to understand the patient’s experience
7.19.2. Evidence-based choice of medicines
7.19.3. Ensure medicines use is as safe as possible
7.19.4. Make medicines optimisation part of routine practice
7.20. Suicide prevention board
7.21. Crib sheet in progress
7.22. Zero alliance Training
8. G Drive Documents- in progress
8.1. Death Self inflicted
8.2. Community suicide prevention - draft
9. The Strategy focuses on 7 key areas
9.1. KEY AREAS
9.1.1. Reducing the rate of suicide in High Risk Groups
9.1.2.
9.1.3. Tailoring Approaches to improve MH in specific groups
9.1.4.
9.1.5. Reducing Access to means of suicide
9.1.6.
9.1.7. Providing better information and support to those bereaved or affected by suicide
9.1.8.
9.1.9. Supporting the media in delivering sensitive approaches to suicide and suicidal behaviour
9.1.10.
9.1.11. Supporting research, data collection and monitoring
9.1.12.
9.1.13. Reducing rates of self harm as a key indicator of suicide risk
9.1.14.