08 / 3 / 2017 10.33am
The Health Select Committee has published its full report on suicide prevention, following the interim report in December 2016. This report is based on the committee’s inquiry which involved hearing evidence from a wide range of organisations and individuals including the transport industry, mental health and national leaders.
The committee report focuses on implementation, services to support people vulnerable to suicide, self-harm, confidentiality and consent, support for those bereaved by suicide, media and data.
In summary the message heard throughout the inquiry was that suicide is preventable and the current rate of suicide is unacceptable and is likely to under-represent the true scale of this avoidable loss of life. It was felt that the underlying government strategy is sound but the problem lies with inadequate implementation.
Key recommendations from the committee’s report
- 95 per cent of local authorities have a suicide prevention plan in place or in development. However there is currently no detail about the quality of these plans
- It is essential that there is a strong and clear quality assurance process to ensure that local authorities’ plans meet quality standards. This will also enable more support to be provided to local authorities where it is needed. In its response to this report, the Government should set out how the quality assurance process will work, who will be responsible for it, how it will report, how often it will be carried out and when it will start.
- The committee recommend that Public Health England’s suicide prevention planning guidance for local authorities should be developed into quality standards against which local authorities’ suicide prevention plans should be assessed.
Ensuring effective implementation
- The implementation board should have responsibility for overseeing the implementation of the other aspects of the Government’s suicide prevention strategy.
- 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.
- The Government should consult the National Suicide Prevention Strategy Advisory Group on whether the implementation board should also be responsible for the quality assurance process of local authorities’ plans, or whether that responsibility should rest with another body.
- Guaranteed funding provision for suicide prevention for 2018/19 – 2020/21 is welcomed but it is cautioned that unless it is supported by other funding already committed by the Government to mental health, and unless that funding actually reaches the front line, there is concern that it will not be sufficient to fund the suicide prevention activity required both to meet the Government’s target of a 10 per cent reduction in suicides and to implement the strategy.
- •The Government must make clear who has overall responsibility in each area (whether that is a CCG, the director of public health, or another body) to ensure that the money is allocated in the right places within the area to fund both NHS initiatives and public health activity. The Government should set out how the additional funding will be distributed and accounted for so that local authorities and CCGs can plan their suicide prevention work effectively.
Services to support people vulnerable to suicide
People not in contact with any health services
- Local authorities should keep and maintain a record of services of a suitable standard to which individuals can be signposted for practical and emotional support.
- Local authorities should promote a joined-up, multi-agency, collaborative approach to suicide prevention to improve data sharing and knowledge between different sectors.
- Organisations and services at high risk locations including the police and Network Rail should be involved in the development and implementation of local authorities’ suicide prevention plans.
- Local authorities should include in suicide prevention plans a strategy for how those who are at risk of suicide but unlikely to access traditional services will be reached.
People in contact with primary care services
- The GMC should ensure that all undergraduate medical students receive training in the assessment of suicide risk as well as depression (extending to the training and examination for GPs through the Royal College of General Practitioners and Health Education too).
- Strong and coordinated national leadership is required to ensure that GPs and primary care nurses receive adequate ongoing training in detecting suicide risk with Public Health England responsible for national oversight.
Drug treatments and suicide
- NICE guidelines on the appropriate use of drug treatments for depression should be promoted and implemented by clinicians.
People under the care of specialist mental health services
- All patients discharged from inpatient care should receive high quality follow up support within three days of discharge. This should be in addition to a further instance of follow up support within the first week post-discharge. The Government must ensure sufficient funding for crisis resolution home treatment teams to ensure that they have enough resource to provide adequate support.
- There should be enough trained staff to establish and sustain liaison psychiatry services in every acute hospital.
- The Health Education England Mental Health Workforce Strategy must set out what the Government is going to do to ensure that there are enough trained staff to implement the Mental Health Taskforce recommendations.
- IAPT should be properly integrated in to mental health teams supporting people with complex mental health conditions to ensure that patients being supported by the IAPT programme who experience suicidal ideation can be supported effectively and quickly.
- All patients who present with self-harm must receive a psychosocial assessment in accordance with NICE guidelines. Patients who present at A&E with self-harm should have a safety plan, co-produced by the patients and clinician, and properly communicated and followed up.
Confidentiality and consent
- There should be a named responsible individual within Government to support the National Suicide Prevention Strategy Advisory Group in discussions with the Royal Colleges and to raise awareness of the Consensus Statement and training of staff in this area.
- Training for medical staff on the Consensus Statement and on how to seek consent should include educating medical professionals on the importance of action when a patient has given consent for information to be shared with a friend or family member.
Support for those bereaved by suicide
- Ensuring high quality support for all those bereaved by suicide should be included in all local authorities’ suicide prevention plans.
- Those bereaved by suicide should receive a copy of ‘Help is at Hand’ within a maximum of 48 hours, but where possible when contact is first made with the family/friends of the deceased individual.
Guidelines for responsible reporting of suicide
- There is a lack of detail on the action that may be taken if concerns about irresponsible media reporting are escalated to PHE.
- The Committee urges the Department of Health and Public Health England to be vocal and proactive in their support for the work ensuring responsible reporting of suicide.
- A clear message must be sent to the media that the Government supports Samaritans’ media guidelines and the work the charity do in helping journalists report suicide responsibly.
- When producing and updating suicide prevention plans, local authorities should include work with local media to ensure good practice in local media sources and to ensure timely follow up discussions when a guideline has not been followed.
- IPSO Editor’s Code of Practice should replace the term “excessive detail” with “unnecessary detail”.
Social media and the internet
- The Government should clearly set out its expectations of social media companies and relevant stakeholders relating to processes for dealing with harmful content on social media. There should be responsibility within Government for ensuring that these organisations have robust processes in place and for monitoring adherence to the processes.
- The Government should closely examine the findings of research projects relating to the online environment, of which the Samaritans are involved and report back on the action that it proposed to take as a result.
Data - Standard of proof
- The standard of proof for conclusions of death by suicide should be changed to the balance of probabilities rather than beyond reasonable doubt.
- The Chief Coroner should be given adequate resourcing to allow clear oversight of the variation in the recording of suicide. There should also be mandatory training for all coroners, both those already in post and newly appointed, on the use of short form and narrative conclusions, to ensure consistency across England and Wales.
- Training for coroners should include the importance of including sufficient detail in a narrative conclusion about the deceased individual’s intent and method used in order to minimise the number of hard-to-code narrative conclusions.
- There should be training and guidance for coroners about the importance of timely information sharing with public health and mental health teams where appropriate in order to identify possible clusters and the proliferation of emerging new methods of suicide.
The Committee intend to hold a follow up hearing after there has been opportunity for the Government and other relevant stakeholders to implement the measures set out in the latest progress report and the Committee urges the Government to take forward the recommendations made in the report.