Cheshire and Merseyside is a region where suicides are eliminated, where people do not consider suicide as a solution to the difficulties they face. A region that supports people at a time of personal crisis and builds individual and community resilience for improved lives.
NO MORE suicide
Zero suicide is our ambition; to transform cultural attitudes to suicides, for it to be known that suicide is preventable and for behaviours to change. Cheshire and Merseyside’s suicide rate is similar to the national average and yet 2 of our 9 areas have some of the highest rates in the country.
Cheshire & Merseyside has a population of 2.5 million with 9 local authorities, 12 Clinical Commissioning Groups, 3 Mental Health Trusts, 2 coroners’ officers, 2 police forces, 2 fire & rescue services, one ambulance service and is represented by one NHS England Sustainability & Transformation Plan.
With so many services operating across the regional footprint and with a population that works and socialises across geographic boundaries, a joined-up approach increases economies of scale, effectiveness and efficiency.
The Champs Public Health Collaborative co-ordinates this joined up approach, with strategic direction and oversight by the NO MORE Suicide Partnership Board. The role of the Collaborative is to energise the whole system and influence strategic partnerships to focus on prevention and use the best data and evidence. Accountability is to the Directors of Public Health, their Health & Wellbeing Boards and the Cheshire & Merseyside Sustainability and Transformation Plan.
Five action areas will help us shift outcomes in preventing suicides:
- Safer Care
- Support After Suicide
The NO MORE Suicide Partnership Board seeks to influence and gain support for suicide prevention from strategic partnerships across Cheshire & Merseyside.
We have been inspired in our vision by contributions from Dr Ed Coffey from the Henry Ford system of Perfect Care, Prof Louis Appleby and Prof Rory O’Connor. We are fortunate to have Angela Samata on our Board and to have nationally renowned charitable programmes on our patch; Papyrus, State of Mind, Everton in the Community, Hub of Hope. Local champions, leaders and those with lived experience at every level underpin delivery of the action plan.
Suicide intelligence is essential for the targeting of suicide prevention interventions and efficient use of resources.
Joint Audit Reports provide information on the trends and needs of the local community for targeting preventative actions. We developed a Suicide Audit Toolkit for a systematic approach by all 9 local areas. The 2017 Report identified men, those who are isolated, young people, primary care and mental health services as key targets for action.
We began Real Time Surveillance across the 9 local authority areas in September 2017; a process whereby there is timely notification by coroner’s officers to public health of suspected suicides, all conducted through secure data sharing agreements. The first 6 months provided evidence of; quicker notification of suspected suicides, referrals to our suicide liaison service, Amparo and signposting to bereavement support, earlier warning signs of potential clusters, triggering of community response plans and greater ownership from senior council leaders and partners.
A Suicide Surveillance Group now combines the suicide audit and Real Time Surveillance information with data from partners, such as Highways England, police, ambulance and rail, to focus on specific sites or types of geographic areas where preventative actions can be implemented.
We campaign together using Time to Talk and World Suicide Prevention Day campaign materials on 4 specific days; Time to Talk Day, Mental Health Awareness Week, World Suicide Prevention Day, World Mental Health Day. This approach provides for stronger coherent messaging and greater cost-efficiency. In 2017 our WSPD Thunderclap reached 750,000 people.
A Suicide Prevention Training Framework ensures that awareness, knowledge and skills are pitched at the right level to the right audience. We have teamed up with the Zero Suicide Alliance and Mersey Care NHS Trust to promote the 20 minute See, Say, Sign awareness training; we have worked collaboratively with Wirral MIND on NO MORE Suicide Community Training, reaching 1500 frontline workers last year and our Mental Health Trusts use Connecting with People and other bespoke programmes.
Key elements for Safer Care in Mental Health and Primary Care Services are built into our strategy, see NCISH. Our three mental health trusts (Cheshire Wirral Partnership, North West Boroughs and Mersey Care) hold regular learning workshops and are currently benchmarking themselves against these elements to inform a sector-led improvement approach. The Primary Care recommendations are being piloted in two CCGS with high suicide rates.
Community-based ‘Places of Safety’ for people at risk of suicide are provided in Warrington and more recently in Liverpool through the charity James’ Place , whilst crisis café type provision is also improving. All 22 Merseyside Fire Stations have ‘Safe Havens’.
Both Cheshire and Merseyside have Street Triage provision. This is a mobile service, whereby a police officer and psychiatric nurse are able to provide an on-the-spot assessment and advice. This intervention has resulted in alternative strategies to a Section 136 being applied on many occasions.
Support After Suicide
Those bereaved by suicide have three times the risk of dying from suicide themselves. Alleviating the distress of those bereaved or affected by suicide reduces this risk and the risk for communities from suicide clusters or contagion and promotes healthy recovery of the affected community.
The jointly commissioned AMPARO ‘Suicide Liaison Service’ helps to prevent against further suicides, contributes to achieving zero suicide and reduces the economic burden of suicide.
The region is supported by a Survivors of Bereavement by Suicide (SOBS) service. These peer to peer support groups operate across Cheshire and Merseyside in Chester, Crewe, St Helens, Wirral and Liverpool.
Our position now is very different to where we were in 2008 when we first began working towards a joined-up approach to suicide prevention. On our journey we have encountered and overcome a wide range of barriers. Solutions have often involved co-ordinated efforts that have utilised the public health infrastructure in conjunction with charities, individuals with a passion for this area of work and relevant public-sector partners. Throughout we have endeavoured to ensure the voice of real people and those bereaved is not lost. Whilst much of the work is strategic and therefore long term, there is an urgency and deeply intrinsic human value to this work.