Nicola Richards, Research Assistant, and Cathryn Rodway, Programme Manager and Research Associate, work for the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH). In this blog, they discuss the progress of national investment in suicide prevention, and give examples of good practice developed from local quality improvement plans that should help to reduce suicide rates at both a local and national level.

• The NCISH is an internationally unique project collecting in-depth information on all suicides in the UK. Our recommendations have improved patient safety in mental health settings and reduced patient suicide rates;
• The national suicide prevention programme sees NCISH working with experts in Quality Improvement from the National Collaborating Centre for Mental Health (NCCMH) to support local areas to strengthen their suicide prevention plans, and improve the quality of care they offer;
• Our toolkits of clinical standards associated with suicide reduction and high-quality care for self-harm have been developed as a basis for self-assessment by services.

The impact of a death by suicide is devastating for family, friends, and professionals. We have recently seen a 12% rise in the 2018 suicide rate – most prominently in young people and men. This rise could be partly explained by the change in standard of proof for suicide at inquest; however, further investigation is required to fully understand what factors could have contributed to the increase. It emphasises the need for, and importance of, suicide prevention interventions. Suicide prevention remains at the forefront of health priorities in many countries, including England. Last year, the NHS Long Term Plan committed to spend £2.3 billion annually on mental health over the next 10 years, and to widen the coverage of NHS England’s and NHS Improvement’s suicide prevention programme.

Across England, the first two years of the suicide prevention programme have seen 14 NHS and local council Sustainability and Transformation Partnerships (STP) – local areas with the highest level of need – establish or develop their multi-agency suicide prevention action plans. These plans cover three of the main priority areas identified in the National Suicide Prevention Strategy:

• Reducing risk in men;
• Prevention and response to self-harm;
• Improving acute mental health care.

Supporting quality improvement in local areas

Here at NCISH, we are working with local areas to expand their suicide prevention projects – specifically to help them understand their data and the national evidence base. This work was recognised last year when we won a “Making a Difference” social responsibility award for outstanding benefit to society through research, by demonstrating that directly implementing our research recommendations can improve safety in mental health and self-harm services. We are beginning to see examples of good practice and exciting innovation, including areas such as; improving self-harm services, particularly for young people; engaging “hard to reach” men through Men’s Sheds and other initiatives; and establishing pathways to improve access to support services. Together with NCCMH, we have actively fostered a learning culture which is starting to thrive, where local areas are now sharing ideas and seeking advice with one another. This learning is being facilitated in regular events bringing STPs together, and via monthly telephone ‘clinics’ open to anyone working on a suicide or self-harm prevention project.

Examples of best practice

In the two years of the programme so far, a diverse range of multifaceted, novel projects have been established covering the three priority areas. There is a lack of conclusive research examining interventions that might reduce suicide and suicide attempts in middle-aged men. What we do know is that men can be reluctant to talk about and seek help and support for their problems, and are less well-informed about mental health. Multiple, complex factors are often associated with suicide in this group, including economic pressures; social isolation; substance misuse; and physical illness. This knowledge has led to some of the most innovative work in the programme.

Middle-aged men

Media campaigns targeting middle-aged men have been launched in all local areas, with a shared goal of tackling mental health stigma. Other examples of innovative work include the “Release the Pressure” campaign in Kent and Medway, which is raising awareness and encouraging help-seeking in middle-aged men with a direct link to a 24/7 support line. In Norfolk and Waveney the “12^th man” campaign is delivering community-based mental health first aid training to those (i.e. barbers) who interact with men in everyday life. The HOPE project in Bristol is connecting with men in the community, providing short-term emotional and practical support for psychological distress, particularly bought about by economic adversity, housing problems and unemployment.

Self-harm prevention

Suicide prevention and self-harm awareness training (e.g. STORM, ASIST, PABBS, locally developed packages) has been implemented in many areas to increase the confidence and skills of health care staff, as well as other occupations (job centre staff, construction workers, the police), in recognising and asking about suicidal thoughts. In some areas, trained community champions deliver key suicide and self-harm prevention messages to frontline staff as well as parents and carers. New digital technology, such as the app “Stay Alive”, has been commissioned in many areas, providing information on sources of local support and allowing users to build their own safety plans.

Improving acute mental health care

Following recommendations from our “10 ways to improve safety”, interventions for reducing suicide in mental health patients have focused on early follow-up within 2-3 days of discharge from psychiatric in-patient care and personalised risk management.

Real time surveillance

A big challenge has been developing real-time surveillance (RTS) systems, to monitor local trends in suicide and to provide early bereavement support. Key to an early alert system is fostering good relationships with the police and coroners. Here, Lancashire and South Cumbria ICS are paving the way having developed a dynamic method of data collection that allows key stakeholders to view updates on suspected suicide and drug-related deaths.

Future direction

The University of Manchester’s NCISH research is the basis for this programme of local improvement and innovation. As it continues, we will work with local areas to embed our research recommendations to reduce suicide and improve safety. Local areas, not currently in the programme, can begin to evaluate their current suicide prevention efforts against recommendations in our toolkits, and can think about how they might measure the impact of their own interventions, using our data dictionary.

We are also working to ensure learning from this programme is shared nationally by developing a platform for open access resources which will include examples of good practice interventions and their impact in each of the three priority areas that organisations can adopt.

Suicide prevention is everyone’s responsibility, and collaboratively, we can make a difference.

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