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Suicide (2023)

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Topic title Suicide (2023)
Topic owner Nottingham & Nottinghamshire Suicide Prevention Strategic Steering Group
Topic author(s) Safia Ahmed, Serena Coultress, Lucy Jones, David McDonald, Sid Basu
Topic quality reviewed November 2023
Topic endorsed by Nottingham & Nottinghamshire Suicide Prevention Strategic Steering Group
Topic approved by Nottingham & Nottinghamshire Suicide Prevention Strategic Steering Group
Current version 2023
Replaces version 2018
Linked JSNA topics

Executive summary

Introduction

Suicide is preventable and Nottinghamshire County Council, Nottingham City Council and local partners work towards reducing suicide in the local population by proactively improving population mental health and wellbeing, and by responding to known risks for suicide in the population.

The previous Joint Strategic Needs Assessment on Suicide Prevention was approved in February 2016. Seven years on, and post the coronavirus pandemic, research has shown increased psychological morbidity in UK populations. In terms of suicide risk, systematic review research has shown that the way people seek help for suicidal behaviour has changed, with no overall rise in suicide deaths.

A renewed understanding of local needs for those at risk of suicide is needed. Since 2019, Nottingham City and Nottinghamshire County have collected data on suspected suicide deaths (pre-Coroner’s inquest) as part of a Real Time Suspected Suicide Surveillance (RTSSS) system. Insight from RTSSS provides an improved local assessment of suspected suicides, which along with nationally reported data, ensures actions to prevent suicides are based on local data and intelligence.

This executive summary contains findings in terms of unmet need, knowledge gaps, and recommendations. The full JSNA document provides the detail of who is at risk, what this tells us and what to do next.

This JSNA is owned by the Nottinghamshire and Nottingham City Suicide Prevention Strategic Steering Group. Development of the JSNA was driven by a dedicated task and finish group, consisting of stakeholders from within the owning group. This included representatives from Nottingham and Nottinghamshire Integrated Care Board mental health commissioners, Nottinghamshire County Council Public Health, Nottingham City Council Public Health, Nottinghamshire Healthcare Foundation Trust, Bassetlaw Place Based Partnership, and the voluntary sector (the Samaritans).

Unmet need and gaps

The following unmet needs were identified:

  1. Current school-based mental health support does not specifically address suicide prevention. Evidence suggests vulnerability to suicide can be partly established early in life and that taking early intervention and school-based approaches can be preventative.
  2. There is a need for additional work to tailor support for men to reduce risk factors and antecedents for suicidality. These include economic adversity, alcohol and drug use, relationship stresses and lack of social connections.
  3. There is a need to support health seeking behaviours in men. National data suggests that 9% of middle-aged men experiencing suicidality are not in contact with any support.
  4. Voluntary and community services report a need for increased skills and knowledge in how to help people experiencing self-harm and suicidality access a continuum of appropriate holistic support.
  5. Ensure evidence-based approaches support social connectedness and emotional wellbeing to reduce self-harm and suicidality among LGBTQ+ young people in current school-based and community-based locations.
  6. Further collaborative work is needed to improve access to support services for Gypsy Roma and Traveller communities.
  7. Systems are needed to ensure professionals in community, healthcare, money help and other public-facing roles have up-to-date knowledge and can support access to financial advice and wellbeing and mental health support. This should include knowledge and pathways at a local level.
  8. Follow-up support is commissioned after first attendance to emergency departments for suicide ideation, and not commissioned for later attendances. Effective follow-up care has the potential to help people who self-harm to access the right support and prevent suicide.
  9. There is a need to identify effective interventions to address the mental health needs and prevent suicide for people with long term physical health conditions.
  10. Greater links and shared learning between domestic abuse and suicide prevention teams is needed. National data and research highlight that women are disproportionately affected by domestic abuse suicide.
  11. There is a need to better support the needs of children and young people who are in crisis and present to the emergency department with self-harm or suicidal ideation. Looked after young people and those transitioning from CYP to adult services, were identified as groups of particular need.
  12. There is a need to address online safety and suicide-related internet use. In the absence of local data, we look to national data which indicates a general increase in suicide-related internet use since 2011.

The following knowledge gaps were identified:

  • Evidence is currently limited on the effectiveness of interventions to prevent suicide and self-harm in people using substances.
  • Limited understanding of the links between gender, domestic abuse and suicide (particularly sexual violence).
  • Effective and appropriate links between RTSSS and Mental Healthcare provider self-harm and suicide data to inform antecedent themes and prevention action.
  • Prevalence and means of self-harm, including understanding of self-harm presentations to VSCE organisations and the scale of potentially unmet need.
  • Understanding gambling harm local intelligence in relation to suicide risk factors to inform targeted interventions.
  • Limited understanding of approaches to reducing suicidality in people in contact with probation and youth justice services.

Recommendations for consideration

The following recommendations have been identified and are aligned to components of the new Suicide Prevention Strategy for England (2023 to 2028):

 

 

Recommendations

Lead(s)

 

Improved Data and Evidence

 

1

Improve data and intelligence sharing between partners including through the local Real Time Suspected Suicide Surveillance (RTSSS) system in order to ensure the quality of the RTSSS data and learning reviews after a suicide death has occurred and to improve the understanding of local need and gaps.

 

Local authority Public Health teams/ Nottinghamshire Healthcare Trust/ partners in RTSSS working group

 

2

Establish protocols for appropriate sharing and analysis of data on self-harm and suicide attempts among key partners working with groups at increased risk of suicidality, including mental health, domestic abuse, drug and alcohol use services to inform preventative actions.

Local authority Public Health teams/ Nottinghamshire Healthcare Trust

 

 

Reducing access to means and high frequency locations

 

3

Continue to prioritise action on reducing access to means for suicide within public places using intelligence from Real Time Suspected Suicide Surveillance (RTSSS) and through the RTSSS Working Group.

Local authority Public Health teams and partners in RTSSS working group

 

 

Providing tailored and targeted support to target groups.

 

4

Develop integrated suicide prevention approaches for children and young people (CYP) in school settings via the Whole School Approach and CYP Mental Health Transformation Programme

Local authority Public Health and Education teams/CYP Mental Health Transformation leads

5

Facilitate the development of services and support, co-produced with men, to address suicide risk factors and promote social connections in informal settings. 

Local authority Public Health teams/VSCE sector

6

Develop targeted suicide prevention communications for men to support engagement in and access to support services.

Local authority Public Health teams/ Nottinghamshire Healthcare Trust

7

Work with partners (including VSCE and primary care) to better understand where people experiencing self-harm or suicide ideation come into contact with services and what further action is needed to identify and support them, particularly for those whose needs do not meet the threshold for secondary mental healthcare.

All commissioners in Local authority Public Health teams

 

8

Develop communication resources to support people experiencing self-harm to access the right support at the right time.

Local authority Public Health teams

9

Integrate evidence-based approaches to supporting social connectedness and emotional wellbeing for LGBTQ+ people into school and community-based approaches and services.

Local authority Public Health teams/CYP Mental Health Transformation leads

10

Partner with community champions and existing organisations to improve access to appropriate support services for people from Gypsy Roma and Traveller communities.

Local authority Public Health teams

 

 

Addressing risk factors

 

11

Use learning from local pilot projects and listening events to improve access for groups who are at increased risk of not accessing self-harm and suicide prevention support such as:

-          Gypsy Roma Traveller groups

-          LGBTQ+ groups

-          Men

-          Those who are financially vulnerable, unemployed or people with a gambling problem

-          People with neurodevelopmental conditions

-          Young people/adults at risk of self-harm/suicide

-          People bereaved by suicide

Local authority Public Health teams/CYP Mental Health Transformation leads

12

Support the community and voluntary sector to support people from at-risk groups who are experiencing self-harm and suicidality such as: men, people with financial difficulty, LGBTQ+ communities, people experiencing loneliness, and people in contact with the criminal justice system.

Local authority Public Health teams/VSCE sector

13

Work with services providing financial support/advice and wellbeing support to improve the pathways between psychosocial support and money help, promote workforce awareness of financial advice and wellbeing support, and strengthen links between financial support and mental health services. 

Local authority Public Health teams

14

Identify contacts and foster links with commissioners and providers of chronic pain and cancer pathways to explore how to improve access to appropriate support services.

Local authority Public Health teams/ Nottinghamshire Healthcare trust

15

Develop links with probation, youth justice and community-based services for people in contact with criminal justice system to develop training and involvement with the Suicide Prevention Stakeholder Network and Suicide Prevention Strategic Steering Group.

Local authority Public Health teams

16

Review mechanisms for sharing learning from Domestic Homicide Reviews relating to suicide with the suicide prevention partnership and consider opportunities for links between Assurance Learning Implementation Groups (ALIG) and the Suicide Prevention Strategic Steering Group.

Local authority Public Health teams

 

Effective crisis support

 

17

Work with the Integrated Care Board to identify support following Emergency Department attendance for every incident of suicide ideation.

Integrated Care Board

18

Work with the Integrated Care Board’s Children and Young People (CYP) team to identify opportunities to promote the mental health and wellbeing and appropriate crisis support for CYP and looked-after children and ensure pathways for support are aligned to facilitate easy access for CYP.

Integrated Care Board (CYP and looked-after children’s team)

 

Online safety:  

 

19

Develop an approach to promote online safety, informed by the national online excellence programme.

Local authority Public Health teams, Education and Children’s social care teams.

 

 

Key contacts

Safia Ahmed, Specialty Registrar, Nottinghamshire County Council
Safia.ahmed@nottscc.gov.uk

Serena Coultress, Public Health Manager, Nottingham City Council
serena.coultress@nottinghamcity.gov.uk

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