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Reducing Suicide Summit 2011 - Part 1

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The first part of the presentations from the ground-breaking Reducing Suicide Summit 2011, hosted by CALM and focusing on the Cheshire & Merseyside regions of the UK. More info at http://www.thecalmzone.net

Published in: Health & Medicine, Spiritual
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Reducing Suicide Summit 2011 - Part 1

  1. 1. Welcome to the Reducing Suicide Summit 2011 Hosted by CALM On behalf of the Cheshire & Merseyside Suicide Reduction Network
  2. 2. Colin Vose Network Director MH Chair of Cheshire & Merseyside Suicide Reduction Network
  3. 3. Cheshire Mersey Suicide Reduction Network <ul><li>History: </li></ul><ul><ul><li>3 years old </li></ul></ul><ul><ul><li>This is the 2 nd major event </li></ul></ul><ul><ul><li>Network is accountable to CHAMPS </li></ul></ul><ul><ul><li>Partner in EU Suicide Prevention Project </li></ul></ul>
  4. 4. <ul><li>What have we done: </li></ul><ul><ul><li>Conference 2010 </li></ul></ul><ul><ul><li>Bringing together people, supporting initiatives </li></ul></ul><ul><ul><li>Regional Suicide Audit Database </li></ul></ul><ul><ul><li>Support for SOBS </li></ul></ul><ul><li>But PEOPLE ARE STILL DYING </li></ul>Cheshire Mersey Suicide Reduction Network
  5. 5. <ul><li>“ An ounce of action is worth a ton of theory” </li></ul><ul><li>Friedrich Engels </li></ul>Cheshire Mersey Suicide Reduction Network
  6. 6. Regional Stats Overview Richard Holford Public Health Development Manager NHS Knowsley
  7. 7. Suicide Statistics Overview Suicide Summit September 2011
  8. 8. National Suicide Statistics Headlines <ul><li>In 2009, 4,400 people took their own life. </li></ul><ul><li>‘ That’s 1 death by suicide every 2 hours!’ </li></ul><ul><li>Quoted from: Consultation on preventing suicide in England: A cross-government outcomes strategy to save lives (2011) </li></ul><ul><li>1 in a 100 of all deaths are suicides (may be under reported) </li></ul><ul><li>Leading cause of death in young men (aged under 35) </li></ul><ul><li>Males 3 times more likely than females </li></ul>Source: Office of National Statistics
  9. 9. Source: NCHOD
  10. 10. Suicide Deaths (2009) <ul><li>People aged 40 – 49 now have highest rate. </li></ul><ul><li>Around 1,200 people in care of Mental Health Services (27%) </li></ul><ul><li>Around 950 had history of self harm (21%) </li></ul><ul><li>Around 2,000 were adult men under 50 (45%) </li></ul>Source: Office of National Statistics
  11. 11. Deaths from Suicide and undetermined injury by method and sex, England 2009 Males Females Source: Office for National Statistics
  12. 12. Suicide Attempts? <ul><li>No definitive source / clear picture </li></ul><ul><li>Multiple sources of suicide attempt data: </li></ul><ul><ul><li>Ambulance call out data </li></ul></ul><ul><ul><li>Self harm hospital admissions </li></ul></ul><ul><ul><li>Railways / highways / police </li></ul></ul><ul><ul><li>Support services e.g. Samaritans contact logs </li></ul></ul><ul><ul><li>Deliberate Self harm data </li></ul></ul>
  13. 13. Intentional self harm (2009) <ul><li>3019 hospital admissions for Merseyside residents </li></ul><ul><li>Over half (56%) females </li></ul><ul><li>Around a 1/3 aged 18 – 29 years old </li></ul><ul><li>More than 2x the number of females aged 0 – 17 compared to males </li></ul><ul><li>Over ½ (58%) incidents occurred in the home. </li></ul><ul><li>Most common method – Intentional self poisoning. </li></ul>Source: Trauma & Injury Intelligence Group (TIIG) Self‐harm in Merseyside: an analysis of emergency department, hospital admissions and ambulance data
  14. 14. Ambulance call out data Source: Trauma & Injury Intelligence Group (TIIG) Self‐harm in Merseyside: an analysis of emergency department, hospital admissions and ambulance data
  15. 15. Merseyside and Cheshire Perspective
  16. 16. Merseyside & Cheshire Headlines <ul><li>191 Suicide deaths (3/4 are males) </li></ul><ul><ul><li>Merseyside – 95 </li></ul></ul><ul><ul><li>Cheshire – 96 </li></ul></ul><ul><ul><li>Source: NCHOD </li></ul></ul><ul><ul><li>Some identified Hotspot areas </li></ul></ul><ul><li>Based on National picture, it can be estimated that of the 191 deaths (in 2009); </li></ul><ul><li>Around 50 people - in care of mental health services </li></ul><ul><li>Around 40 - history of self harm </li></ul><ul><li>Around 86 - likely to be adult men under age of 50 years old. </li></ul>Source: Office of National Statistics
  17. 18. Knowsley Suicide profile Suicide Audit findings
  18. 19. Knowsley Suicide Profile <ul><li>CHARACTERISTICS </li></ul><ul><li>Around 9 – 10 per year (peaked 2009/10 – N = 13); ( Calendar year 2009 – N =17 ) </li></ul><ul><li>All White British, mainly males; age range 14-84 years, peak between 30 – 44 year olds. </li></ul><ul><li>Around half in employment </li></ul><ul><li>METHOD </li></ul><ul><li>Hanging, in home environment most common method, No hot spots. </li></ul><ul><li>CONTRIBUTING FACTORS </li></ul><ul><li>1/2 consumed Alcohol; 1/ 3 taken some form of non-prescription drug </li></ul><ul><li>In majority of cases, personal events perceived as triggering the individual to carry out the act </li></ul><ul><li>(i.e. an argument with girlfriend) </li></ul><ul><li>CONTACT </li></ul><ul><li>Around a 1/3 in contact with GP in last 12 months </li></ul><ul><li>Only a 1/3 in contact with Mental Health Services </li></ul>Source: Knowsley Public Health Intelligence & Evidence Team - Suicide Audit database
  19. 20. Thank you <ul><li>Richard Holford </li></ul><ul><li>Public Health Development Manager </li></ul><ul><li>Richard. [email_address] . nhs .uk </li></ul>
  20. 21. Simon Howes Merseyside CALMzone Coordinator
  21. 22. <ul><li>Professor Louis Appleby </li></ul><ul><li>National Clinical Director for Health and </li></ul><ul><li>Criminal Justice </li></ul><ul><li>England </li></ul>
  22. 23. <ul><li>Professor Louis Appleby </li></ul><ul><li>National Clinical Director for Health and </li></ul><ul><li>Criminal Justice </li></ul><ul><li>England </li></ul>
  23. 24. Suicides per 100,000 population (WHO, 2008)
  24. 25. Suicide as a public health problem <ul><li>4,500 deaths per year </li></ul><ul><li>leading cause of death in men <35 </li></ul><ul><li>main cause of life years lost in severe mental illness </li></ul>
  25. 26. National Suicide Prevention Strategy: 6 goals <ul><ul><li>reduce access to and lethality of suicide methods </li></ul></ul><ul><ul><li>reduce risk among high risk groups </li></ul></ul><ul><ul><li>promote mental well-being </li></ul></ul><ul><ul><li>improve reporting of suicidal behaviour in the media </li></ul></ul><ul><ul><li>promote research on suicide prevention </li></ul></ul><ul><ul><li>improve monitoring of progress towards OHN targets </li></ul></ul>
  26. 27. Death rates from Intentional Self-harm and Injury of Undetermined Intent in England 1993-2009 Death rate per 100,000 population Rates are calculated using the European Standard Population to take account of differences in age structure. 3 year average Suicide rate in England H I A T Health Improvement Analytical Team Monitoring Unit
  27. 28. Suicides under 35 years Clinical factors <ul><li>mental illness (OR = 25.7) </li></ul><ul><li>self-harm (OR = 31.7) </li></ul><ul><li>drug/alcohol misuse (OR = 10.06) </li></ul><ul><li>personality disorder (OR = 7.08) </li></ul><ul><li>Source: Appleby et al, BJP 1999 </li></ul>
  28. 29. Suicides under 35 years Psychosocial factors <ul><li>Unsettled accommodation (OR = 4.83) </li></ul><ul><li>No friends (OR = 5.6) </li></ul><ul><li>Relationship problems (OR = 10.6) </li></ul><ul><li>Childhood abuse (OR = 7.75) </li></ul><ul><li>Recent life events (OR = 15.6) </li></ul><ul><li>Source: Appleby et al, BJP 1999 </li></ul>
  29. 30. Suicide in young men Age standardised death rate per 100,000 population Males 20-34 Persons, All Ages Three-year average rate , plotted against middle year of average (1969-2009) Males 35-49 2008 Source: ONS H I A T Health Improvement Analytical Team Monitoring Unit
  30. 31. Why are young male suicide rates falling? <ul><li>awareness of risk in front-line agencies </li></ul><ul><li>specific initiatives, e.g. in-patient safety </li></ul><ul><li>good economic circumstances </li></ul>
  31. 32. Suicide rate by age and gender, England 2009 Source: ONS Mortality data 0 2 4 6 8 10 12 14 16 18 20 22 Under 10 10 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80 and over Age group Males Females Age standardised death rate per 100,000 population Source: ONS Mortality data 0 2 4 6 8 10 12 14 16 18 20 22 Under 10 10 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80 and over Age group Males Females Age standardised death rate per 100,000 population
  32. 33. In-patient suicides - methods Source: National Confidential Inquiry into Suicide and Homicide by People with Mental Illness
  33. 34. Inpatient suicides
  34. 35. Suicide after absconding
  35. 36. Patient suicides: treatment refusal and missed contact
  36. 37. Prison suicides: time since reception (n=529)
  37. 38. Prison suicides: method <ul><li>493 (93%) died by hanging </li></ul><ul><li>311 (61%) used bed-clothes as ligatures </li></ul><ul><li>251 (49%) used window bars </li></ul>
  38. 39. Prison suicides: diagnosis (n=259, 49%)
  39. 40. Source: HM Prison Service Year Self-inflicted deaths in prison England H I A T Monitoring Unit
  40. 41. Suicide after prison release Time from release (28 day periods) Source: Pratt et al, Lancet 2006 No. suicides
  41. 42. Rate of suicide by method, 1987-1998, men 15-49 Source: Amos et al, Psych Med 2001 No. deaths per 100,000 pop.
  42. 43. Suicide methods England 2009 Source: Office for National Statistics (ONS) 56% 15% 5% 4% 7% Males total deaths 3,336 7% 4% 2% 39% 33% Jumping/lying/falling before moving object Hanging, strangling and suffocation Drug - related poisoning Other poisoning including motor gas Sharp object Smoke, fire & flames Firearms & explosives Drowning Jumping/falling from high place Other 3% 3% 3% 3% 1% 3% 8% 2% 0.4% Females total deaths 1,063 2% Key Source: Office for National Statistics (ONS) 56% 15% 5% 4% 7% Males total deaths 3,336 7% 4% 2% 39% 33% Jumping/lying/falling before moving object Hanging, strangling and suffocation Drug - related poisoning Other poisoning including motor gas Sharp object Smoke, fire & flames Firearms & explosives Drowning Jumping/falling from high place Other 3% 3% 3% 3% 1% 3% 8% 2% 0.4% Females total deaths 1,063 2% Key
  43. 44. Effects of restricting paracetamol pack size <ul><li>22% fall in fatal overdoses </li></ul><ul><li>11% fall in non-fatal overdoses </li></ul><ul><li>20% fall in large overdoses (>32 tablets) </li></ul><ul><li>30% fall in liver transplants over 4 years </li></ul>
  44. 45. Source: Hawton et al, BMJ, 2009 Suicides by analgesic poisoning
  45. 47. Preventing suicide at hotspots <ul><li>physical barriers </li></ul><ul><li>telephone helplines </li></ul><ul><li>safety patrols </li></ul><ul><li>no publicity </li></ul>
  46. 49. National Suicide Prevention Strategy: media guidelines <ul><li>omit details of suicide method </li></ul><ul><li>avoid sensational/positive tone or images </li></ul><ul><li>include facts about suicide and mental health </li></ul><ul><li>give information on how to get help </li></ul>
  47. 50. A new outcomes strategy for England <ul><li>Objectives: </li></ul><ul><li>Reduce the suicide rate </li></ul><ul><li>Better support for those bereaved or affected by suicide </li></ul><ul><li>Consulting now on draft strategy </li></ul><ul><li>Final strategy expected in early 2012 </li></ul>
  48. 51. Draft Strategy: Six areas for action <ul><li>Reduce risk in high risk groups </li></ul><ul><li>Tailor approaches to improve mental health in specific groups </li></ul><ul><li>Reduce access to the means of suicide </li></ul><ul><li>Provide better information and support to those bereaved or affected by suicide </li></ul><ul><li>Support media in delivering sensible and sensitive approaches to suicide and suicidal behaviour </li></ul><ul><li>Support research, data collection and monitoring </li></ul>
  49. 52. High risk groups <ul><li>2011 </li></ul><ul><li>Men under 50 </li></ul><ul><li>People under mental health care </li></ul><ul><li>Offenders </li></ul><ul><li>People who harm themselves </li></ul><ul><li>High risk occupational groups </li></ul><ul><li>2002 </li></ul><ul><li>Young men </li></ul><ul><li>People under mental health care </li></ul><ul><li>Prisoners </li></ul><ul><li>People who harm themselves </li></ul><ul><li>Occupational groups e.g. farmers, doctors </li></ul>
  50. 53. Whole population approach <ul><li>2002 </li></ul><ul><li>Socially excluded , </li></ul><ul><li>Drugs and alcohol </li></ul><ul><li>Older people </li></ul><ul><li>Bereaved by suicide </li></ul><ul><li>Children and young people </li></ul><ul><li>BME groups </li></ul><ul><li>Survivors of abuse </li></ul><ul><li>(LGB groups) </li></ul><ul><li>Perinatal women </li></ul><ul><li>2011 </li></ul><ul><li>Social and economic vulnerability </li></ul><ul><li>Drugs and alcohol </li></ul><ul><li>People with untreated depression </li></ul><ul><li>Children and young people </li></ul><ul><li>BME groups </li></ul><ul><li>Survivors of abuse </li></ul><ul><li>LGBT groups </li></ul><ul><li>Other groups with protected characteristics </li></ul><ul><li>Veterans </li></ul>
  51. 54. Making it happen <ul><li>Nationally: </li></ul><ul><li>Outcomes frameworks </li></ul><ul><li>Implementation of No health without mental health </li></ul><ul><li>National Suicide Strategy Implementation Advisory Group </li></ul><ul><li>Samaritans’ Call to Action </li></ul><ul><li>Locally: </li></ul><ul><li>Health and wellbeing boards will be key </li></ul><ul><li>Jointly assessing needs and developing joint health and wellbeing strategies </li></ul>
  52. 55. Next steps <ul><li>Public consultation until 11 October 2011 at: </li></ul><ul><li>www.dh.gov.uk/en/Consultations/Liveconsultations/DH_128065 </li></ul><ul><li>Call to Action: </li></ul><ul><li>www.samaritans.org/support_samaritans/campaigns/call_to_action_campaign_2011.aspx </li></ul>
  53. 56. Colin Vose Network Director MH Chair of Cheshire & Merseyside Suicide Reduction Network

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