Nottingham Insight

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):

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