The City of London Corporation’s suicide prevention work – Nov 2019 update

The National Suicide Prevention Alliance recognises the importance of promoting good mental health at work, and the vital role this can play in suicide prevention. The City of London Corporation, a member of the NSPA, is raising awareness of workplace well-being in the city, promoting help seeking and providing practical support.  You can read about some of the important work they are doing below. (Find their previous update here.)

Mental Health Street Triage

The City of London Corporation Mental Health Street Triage initiative started in May 2017 as a pilot scheme after the Corporation noticed numerous people in crisis were attracted to the square mile to attempt suicide. It was initially implemented from Thursday to Saturdays, and City of London Police officers were accompanied on their 5pm to 3am rounds by NHS mental health nurses who provided on the spot advice and guidance to officers as well as assessing and triaging vulnerable individuals to a place of safety.

Encouraged by the impact of the pilot, the service was extended from 3 to 7 nights a week and over the 2.5 years existence of this service, has supported 681 people in crisis, many of whom would have been transported to a police station should the Mental Health Street Triage have not been in place. The project was awarded NHS team of the year at the end of 2018.

Find out more here.

Business Healthy

During 2019, Business Healthy has been engaging with the business community in the City and further afield, as well as other key stakeholders on the topic of mental health – particularly where it relates to City workers and working-age adults.

Examples of this work include:

  • Delivery of three Suicide Prevention Awareness sessions to the City’s business community, in partnership with Samaritans and the City of London Police (February, June and October 2019). 55 individuals representing 20 different organisations were trained across the three sessions, including Heads of HR, Security and Facilities, as well as employees with an interest in mental health. Feedback showed that, on average, 97% of attendees who responded felt that the session had helped them to feel more confident in identifying and approaching someone who is at crisis point and who might be considering suicide. The sessions also helped to generate income for Samaritans.
  • Showcasing the City of London Corporation’s work on promoting and improving mental wellbeing among the local worker population and suicide prevention at events including the National Suicide Prevention Alliance’s annual conference and a Revo meeting on suicide awareness and prevention in March 2019 (Revo is a national consortium of shopping centre owners), and in publications such as the St John Ambulance blog (for Mental Health Awareness Week 2019), City Security magazine and the Royal Society for Public Health blog. Business Healthy was also an event partner for the Mad World Summit 2019 – a high-profile event focusing on mental health and the workplace.
  • Business Healthy continues to support wider efforts to tackle mental health-related stigma in the workplace, improve mental health literacy among the UK’s workforce and advocate for mental health as a business priority, by its representation on the Steering Group of the Lord Mayor’s Appeal’s “This is Me in the City” and green ribbon campaigns, and as an Operational Lead for the City Mental Health Alliance.
  • Earlier this year Business Healthy conducted qualitative research into the health and wellbeing needs of City workers, which found that mental health and work-life balance are seen as priority areas for City workers and their employers alike, with regard to wider workforce health and wellbeing.
  • Business Healthy also hosted a free webinar on problem gambling, mental health and the workplace, in partnership with charity GamCare and City law firm Squire Patton Boggs.

Find out more here.

Dragon Café in the City

Following a successful pilot in 2018, Dragon Café in the City secured funding which will allow it to be delivered from April 2019 until at least April 2021.

Dragon Café in the City, which operates from Shoe Lane Library fortnightly on Wednesdays (12-7.30pm), offers a range of free and creative activities aimed at providing City workers and residents with an opportunity to release the pressure from day-to-day life. The vast majority of visitors providing feedback have said that attending has helped to improve their mental health.

Dragon Café in the City has also hosted “special” sessions aimed at engaging specific target audiences within the City’s resident and worker populations, including a speaker session, a “Day of the Dead” session focusing on bereavement and a special session to mark National Carers’ Week.

The City of London Corporation’s Public Health team was invited to share insights and best practice from Dragon Café in the City at the City Health International Conference 2019.

Find out more here.

BarberTalk in the City of London

Set up by inspirational British barber Tom Chapman after losing a friend to suicide in 2015, the Lions Barber Collective is turning barbershops into safe spaces for men, using the opportunity of a regular haircut to start conversations about mental health. This international group of barbers helps raise awareness of mental illness and aims to prevent suicide by creating and delivering a specific training for barbers enabling them to recognise, talk and listen out for symptoms of depression in clients and signpost them to relevant support services. Tom developed Barber Talk with the help of psychiatrists and mental health professionals; it is an adaptation of Safe Talk for barbers.

To support the Lions Barber Collective and promote the great work they achieve in making barbershops safe places for men to talk about potential mental health issues, the City of London Corporation supported a promotional event on 7 October 2019 at the Worshipful Company of Barber-Surgeons’ Livery Hall. Ambassadors and volunteers shared their stories and the mission of the Lions Barber Collective, leading to a celebratory ‘first cut’ in the hall in centuries, under Holbein’s painting of Henry VIII with his Barber-Surgeons and Apothecaries.

The City of London Corporation is hopeful that other local authorities will want to promote and support barbers in their area being trained and helping save lives.

Find out more here.

The Listening Place – A Short History

Since it was established in 2015, The Listening Place’s (TLP) exceptional growth has enabled it to support over 2,800 people who felt life was not worth living.

The charity was set up with the objective of reducing the number of people taking their own lives by giving them ongoing, confidential, face-to-face support. It has received over 4,500 referrals in its short history. Clinical qualitative evaluation of the support given to 1000 visitors showed a highly significant reduction in suicidality and distress after three and six months’ support.

In 2015 TLP was open two days a week. It currently operates seven days a week, 9am-9pm. It has recruited and trained 600 volunteers of all ages, from all walks of life. The common denominator is their commitment to supporting their visitors. They support 900 visitors from London and the Home Counties from two sites in London. A third London site is scheduled to open in early 2020 and more premises are planned.

The volunteers are themselves supported by senior supervising volunteers on each shift, a separate small network of experienced listening volunteers on whom they can call at any time, and a separate network of senior healthcare professionals who hold regular supervision sessions at TLP and to whom listeners and their supervisors can look for support and advice with, for example, visitors who are at particular risk.

Two thirds of TLP’s visitors are referred by the NHS, some by other charities, police, social services, universities and some visitors self-refer.

Each person who is referred has an initial assessment. If it’s agreed that TLP can offer the right kind of support, the visitor will be offered six sessions when they can talk openly, without being judged and in complete confidence. Feedback from visitors shows consistently that it is the confidentiality and non-judgemental nature of their sessions that are of the greatest value. After the first six sessions a review of progress can result in visitors being offered further sessions.

In October 2019 The Listening Place won the Third Sector Volunteer Team of the Year Award and was short listed for the Small Charity of The Year. It won the Foundation for Social Impact, Small Charity Big Impact Award and was highly commended for the Outstanding Volunteer Contribution Award from London’s Westminster Council.

The BBC Radio 4 programme “All In The Mind” is well known for its reporting of mental health issues. It featured The Listening Place in one of its weekly broadcasts, with powerful first-hand testimony from one of its visitors who told the programme: “Structural therapies are trying to solve a problem. The best thing about TLP is that if you have got to a level where you are at risk, you just want someone to listen”.

The Office of National Statistics latest report on suicide showed it to be a continuing, challenging issue for the country.  TLP’s hope is that it can continue to play a significant, and hopefully growing, part in managing this ever-increasing  problem.

Read more at www.listeningplace.org.uk.

First national guidelines for delivering bereavement support groups published

The first national guidelines for delivering bereavement support groups have been published. The guidelines are informed by the national Bereavement Care Service Standards (BSA & Cruse Bereavement Care 2014) for individuals or organisations wishing to set up and deliver a bereavement support group for adults. They are designed as a non-prescriptive guide, to raise awareness, facilitate reflection on the potential challenges of running a support group, and to encourage careful planning. Together, this guide can help to avoid pitfalls and ensure the sustainability and quality of a support group for any kind of bereavement.

The guidelines are suitable for voluntary groups or statutory agencies who would like to deliver a support group for those facing any type of bereavement whether facilitated by volunteers, people with “lived experience” of grief and loss, or professionals, such as counsellors or nurses.  They cover what should be in place to deliver a safe and effective group, different types of groups and other key points to consider, including sections for specific recommendations for different types of bereavement, such as suicide.  There is also a section which addresses legal requirements which apply to all service providers, whether voluntary or statutory, in the UK.

The guidelines were co-edited by Alison Penny of the National Bereavement Alliance, and Anne Embury of the Support After Suicide Partnership (SASP) and Outlook South West’s Suicide Liaison Lead for Cornwall & the Isles of Scilly. They include a foreword written by Julia Samuel, MBE, Founder Patron of Child Bereavement UK and Patron of the SASP until her retirement in 2019. Supported by a grant from the Esmée Fairbairn Foundation, the project was managed by the SASP with input from a number of bereavement organisations who contributed their expertise and experience.

How to access a copy?

To order a hard copy, email info@supportaftersuicide.org.uk

Or download online by visiting the Resources pages at hub.supportaftersuicide.org.uk

NSPA response to Prevention Green Paper, October 2019

The NSPA worked with policy teams from some of our members to inform our response to the Government’s Green Paper: Advancing our health: prevention in the 2020s – consultation document.

Which health and social care policies should be reviewed to improve the health of people living in poorer communities or excluded groups?

Living in poorer communities and being part of excluded groups is not only detrimental to physical and mental health, but as Samaritan’s ‘Dying from inequality’ report acknowledges, “as area-level deprivation increases, so does suicidal behaviour”. The response to this needs to be cross-governmental and is not solely about reviewing policy; the NSPA believes that there is much good policy across government, but there is little funding to implement it. Any funding review should ensure appropriate funding for local authorities, whose staff provide vital support for many people experiencing poor mental health or at risk of suicide. We also support the Centre for Mental Health’s call, in their ‘Briefing on social care funding’, for any new financial settlement to:
• Provide parity of esteem for mental health with other social service functions
• Secure fair funding for people of working age
• Resolve the confusion between health, housing and social care funding for people with ongoing care needs
• Enable local councils to invest for the future in their workforce and their community.

We also recommend a review of implementation of policy, to ensure that those in poorer communities and excluded groups are enabled and supported to access universal and early intervention services, including GPs, IAPT, Health Visitors, and school health teams. Those delivering these universal services must also have a better understanding of mental health and suicide prevention.

There are many factors affecting people’s mental health. How can we support the things that are good for mental health and prevent the things that are bad for mental health, in addition to the mental health actions in the green paper?

Local authorities and local areas are responsible for many of the things that we know make a positive difference to people’s mental health and wellbeing: physical activity, the physical environment, decent housing, employment and the local economy. Additionally, cuts to local services such as drug and alcohol services and domestic abuse services can have terrible impacts on the mental health and suicidal ideation of those that need them. The government should ensure that money for local authorities and local areas is commensurate to their role, particularly following the Samaritans/University of Exeter report into local suicide prevention plans, which found some ambitious and impressive plans, but that support is needed to enable them to be delivered.

Reaching people in the early years of their life will have an impact on their mental health throughout their lives, and health visitors make a crucial difference here. If they are supported with the time (and money) to make the most of the opportunities of being in people’s homes, to understand the challenges that families are facing and support the parents of very young children, that work would reap benefits for decades.

Have you got examples or ideas about using technology to prevent mental ill-health, and promote good mental health and wellbeing?

Various NSPA members are using technology to support mental health and prevent suicide, including:
• Stay Alive app – www.prevent-suicide.org.uk/stay_alive_suicide_prevention_mobile_phone_application.html
• Good Thinking London – www.healthylondon.org/resource/the-good-thinking-journey/
• Shout crisis text service – www.giveusashout.org/
• Isolutions to isolation – www.keep.eu/project/19362/isolutions-to-isolation
• Samaritans’ web chat service
• Using paid Google ads to target people searching for information around self-harm or suicide and directing them to support pages

However, whatever technological opportunities there are to support good mental health, it’s important to implement them in line with best practice and ethics around technology usage, ensuring that those implementing them are trained, and using them as part of blended care.

Have you got examples or ideas for services or advice that could be delivered by community pharmacies to promote health?

Community pharmacies are already alert to some issues around suicide prevention, including the hoarding of potentially dangerous medication. This could be further enhanced by standardised training in mental health awareness and suicide prevention, enabling staff to be more aware of possible signs of deterioration in mental health and what they could do in response to support or refer people. However, this must be based on strong evidence and consistency of approach. Our member Medicspot is already providing online access to GPs via pharmacies, and this kind of intervention could be further developed to include mental health and suicide prevention.

It would also be valuable to consider the co-location of pharmacies alongside GPs and non-clinical services such as debt advice, housing support, addiction services, and community activities. Communication, referral and social prescribing would be facilitated, all of which would have an impact on suicide prevention.

What could the government do to help people live more healthily: in homes and neighbourhoods, when going somewhere, in workplaces, in communities?

When thinking about helping people live ‘more healthily’, the NSPA would encourage government to ensure that their definition includes mental health as well as physical health.

For suicide prevention, loneliness and isolation can be key issues – both for older adults, but also young people, as DCMS’ Community Life Survey 2016-2017 found that young people aged 16 to 24 report feeling lonely more often than older age groups. This can be particularly problematic in rural communities where the lack of public transport, and high cost of what transport there is, contributes to physical isolation. Further support for local community building work, befriending schemes, and improved local transport would be of benefit.

Workplaces have a large role in supporting well-being and preventing suicide. There is good work being done by many of our members to deliver suicide prevention and mental health awareness training to private employers, and we are keen that growing numbers of employers support their staff. The government can continue to encourage businesses to develop this work, but also has a key role in ensuring that public sector staff nationally and locally, are also supported. This is particularly true in the health service, where some staff, particularly female nurses, are at a higher risk of suicide themselves (www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/suicidebyoccupation/england2011to2015).

What is your priority for making England the best country in the world to grow old in, alongside the work of PHE and national partner organisations?

Older adults have a similar risk of dying by suicide to the rest of the population, but there is little research providing evidence of what the factors might be with this age group; possibilities include increasing physical health problems affecting mental health, lack of purpose post-retirement, bereavement, caring responsibilities, isolation, financial worries, or a complex combination of factors. It would be valuable to investigate this issue, to better inform spending nationally and locally on mental health and suicide prevention in older adults, and ensure that work to increase longevity also prioritises quality of life.

We do know that one in five over-65s is affected by depression yet older adults are less likely to use IAPT services (www.england.nhs.uk/mental-health/adults/iapt/older-people/). It is important for GPs and others in touch with older people to understand “symptoms often attributed to ‘old age’ but where a mental health diagnosis and follow-up is more appropriate” as NHS England recommend in their ‘Primer on Mental Health in Older People’ (www.england.nhs.uk/publication/a-practice-primer-on-mental-health-in-older-people/).

What government policies (outside of health and social care) do you think have the biggest impact on people’s mental and physical health? Please describe a top 3.

Suicide prevention needs a cross-government approach as a crisis can arise from a combination of factors, including poor physical or mental health, changes in employment, living conditions, social isolation, educational attainment and more. Our top three areas of concern are welfare reform, housing and employment, however issues as diverse as education, transport and communities/social inclusion will all affect suicide prevention. We are also aware that wider, international issues can also affect people’s mental health, such as climate change and Brexit, which could have wide-ranging negative impacts on issues connected to suicide prevention, including people’s livelihoods, families, communities and mental health.

Whenever government policies are revised to consider physical and mental health, thought needs to be given to how to measure the impact, and including key indicators in policy to enable that measurement. The idea of a Composite Health Index to track the nation’s health alongside GDP could be of benefit, but careful thought must be given to how it will be implemented and how it will then influence cross-government decisions.

How can we make better use of existing assets – across both the public and private sectors – to promote the prevention agenda?

The public sector workforce is a valuable existing asset, and the Making Every Contact Count campaign has potential to reach large numbers of people and promote the prevention agenda. It is vital, however, that mental health and suicide prevention is part of that, enabling any member of the public sector workforce to be able to have conversations around mental health, self-harm and suicide with anyone they are in contact with.

There is also potential if local and national government shifted towards more progressive use of their land and property; for example, by co-locating clinical services with non-clinical services such as debt advice, housing support, addiction services, as well as community activities. This would facilitate better communication, referral and social prescribing, all of which would have an impact on suicide prevention.

More progress could also be made by effectively implementing existing government policy – for example the Children and Young People’s Green Paper. The plans for school mental health teams could have a very strong impact on suicide prevention, particularly if the staff recruited have a strong understanding of self-harm and bereavement support. The impact would be even greater if the proposals become a universal offer, not just for a small proportion of schools.

What more can we do to help local authorities and NHS bodies work well together?

The Samaritans and University of Exeter report on the progress of local suicide prevention plans shows that local areas are trying to do more with fewer resources, and local authorities also have an important role in reaching the two thirds of people who take their lives but are not in touch with mental health services. They must therefore be given the financial support to do this.

The government could also promote the requirement for the NHS to work together with local areas, for example ensuring that NHS suicide prevention plans are co-produced, that any new NHS structural reform or strategy integrates mental health and suicide prevention, and NHS or government expectations of suicide prevention or bereavement support activity are appropriately funded to enable delivery.

The experience of the NSPA and our members is that health, mental health and suicide prevention are not just the work of local authorities and the NHS, but also benefit from the involvement of police, coroners, the voluntary and private sectors, including rail services. Government communication and funding should encourage and support partnership and co-operation between these diverse groups.

What other areas (in addition to those set out in this green paper) would you like future government policy on prevention to cover?

Suicide is a serious, and preventable, public health issue, and as such the NSPA and our members were disappointed it did not feature more prominently in the green paper. This process presents an opportunity to ensure suicide prevention receives more sustainable public health funding.

As suicide is a cross-government issue decisions made by Departments as diverse as the Treasury, Department for Education and the Ministry of Justice could all impact people’s well-being, however much of the thinking in this green paper seems to take a siloed approach. All new government policy should have tests in place to consider what impact they will have on health and mental health. The effective implementation of the Composite Health Index that is considered across all government departments as policy is made could help with this.

Data collection, including real-time suicide surveillance, can impact the speed and effectiveness of local suicide prevention responses and support for those bereaved and affected, who can be at higher risk of taking their own lives. Additional funding and support, and the exploration of a national data capture system, could allow local areas to further improve their suicide prevention work.

NSPA Members’ Survey 2019: what we learned

76 organisational members completed the survey this summer, which is nearly half of our membership – thank you very much to those that took the time, it has been very helpful.

Our key findings include:

When asked about their top 3 achievements in 2018-19:

  • 43% of members mentioned delivering suicide prevention training in their communities and for other organisations, while 14% provided training to their own staff and volunteers
  • 32% of members were involved in campaigning and awareness-raising activities
  • 31% provided bereavement support or postvention advice
  • 23% made improvements to their organisational strategies or policies
  • 23% developed and delivered new services while 18% grew existing services
  • 19% worked in new partnerships and collaborations and
  • 4% believe they achieved changes in policy through their influencing and lobbying work

“Delivering suicide prevention training to 400+ people across [our area].    Providing 1:1 intensive mental health support for 1000+ beneficiaries … through our … service.   Delivering training to workplaces.”

“Produced an … intervention pack and resources to give guidance and support to senior managers, HR, line managers following a sudden death or suicide.  Suicide awareness and suicide awareness plus training.  Free mental health workshops for our supply chain where suicide stats and prevention is covered.  Run World suicide prevention day campaign annually.”

“Reviewing our local suicide action plan in line with the National and [local] Suicide Prevention Strategy.  Launched the Bereaved by Suicide support service.   Worked with all our key local partners to identify possible [high frequency location]. Starting work with workplaces to reduce stress and [improve] mental health.”

When asked about their priorities for 2019-20:

  • 55% of members plan to grow and improve the services they deliver
  • 37% will engage in campaigning and awareness-raising
  • 32% will be providing bereavement support services
  • 27% of members plan to deliver training outside their organisation, and 13% will train their own staff and volunteers
  • 15% will work on improving the data they have on local deaths by suicide and the impact that will have on improving and better focussing their services, many of these mentioned implementing or continuing real-time surveillance

“1. Maintain [our] campaign for everyone in our community in collaboration with [volunteers], partners and our local community. 2. Reach at-risk groups through targeted campaigns focusing on men and particularly Eastern European men in [our area]. 3. Continue to equip local people and professionals with suicide prevention skills for free through training.”

“Continue to increase public awareness of (and willingness to call) our 24-hour support line. Train over 1500 additional people in suicide prevention. Make long term and sustainable changes to strategic policies and clinical pathways.”

We also asked about the challenges they are facing in 2019-20:

  • 55% identified financial pressures as an issue for them, which may well be linked to the 53% who are facing an increase in demand for their services and the 37% who mentioned staffing issues
  • 20% were concerned about the external environment, including Brexit, and how that would impact them

“We are a small team. It has been a challenge continuing to run the service whilst making significant changes in our service delivery to meet funders requirements for areas such as reporting.”

“[Our area] has one of the highest levels of social deprivation in Northern Europe and has relied heavily on EU funding which will not be replaced by Westminster.  This is having an indirect impact on social programmes, housing and community initiatives to promote wellbeing.  There is no hard evidence that the current political situation and Brexit is having a detrimental impact, but it is probably having an indirect impact on the increased number of suicides in [our area] across all age groups.”

We asked members what they found valuable about being members of our alliance:

  • 63% mentioned how much they value that we keep them informed of news and research, provide useful resources, and enable them to learn
  • 45% value the opportunities to network and collaborate that we provide, with 13% specifically mentioning our conference and members’ meetings
  • 34% appreciate that we share good practice from others, with 13% also valuing the opportunity to share their own good practice via the NSPA
  • 16% talked about how lonely the work can be, and how much they value the support from the NSPA team
  • 13% appreciate our ability to influence at a national level

“It is so important to feel connected with other people working in the same field, so that we can learn from one another, share our experience and knowledge, and grow stronger together in our aims and mission to prevent suicide. Being a member of such an important body, also raises our status as an organisation and we feel welcomed and supported.”

“Being part of a wider family, all of whom are trying to achieve the same goals. Sharing of best practice and the evidence base. Relationships. Simply not being alone when one needs to reach out.  Contacts.”

“Ability to share practice and learn from other. Also working purely in the field of Suicide Prevention is very isolating and long term – hence difficult to keep up motivation. The support from the NSPA either in events or personal has been so positive and supportive it keeps you focused.”

When we asked how else the NSPA could help members in their work or if they had any other comments nearly 50% said thank you and that we were doing good work.  However, there were various suggestions that we will reflect on, including holding more events outside London, using online discussions or webinars more, and how we can support the work our members do even more.

Thank you again to everyone who took the time to complete the survey, your feedback is invaluable. If you would like any further information on our findings, please email us at info@nspa.org.uk.

NSPA Annual Members Meeting 2019

“Thank you for one of the best events of the year”

Our Annual Members Meeting took place on 11th June at NCVO, London. A wide range of organisational members attended from across the public, private and voluntary sectors alongside individual members.

A selection of NSPA members presented about their work on the day, alongside updates on real-time surveillance and the review of local authority suicide prevention plans.  All attendees also spent time discussing topics such as local plans and local multi-agency groups, workplace suicide prevention, and suicide prevention in children and young people, and sharing ideas of good practice and working with people with lived experience of suicide.

Feedback from the event has been overwhelmingly positive, with many attendees commenting on the value of sharing ideas, challenges and hopes in such a diverse group who all care so much about suicide prevention and bereavement support. Thank you to those members who came along and made it such a fantastic day.

Below is information on each of the presentations from the day, please click on the title to view the slide sets.

Update from the NSPA

Penny Fosten (NSPA Executive Lead) updated members on some of our work in 2018-19, including the launch of our Resources Hub, the growth of our national conference, our World Suicide Prevention Day activities, and the increase in our social media presence. She also outlined plans for the coming year including how best to share information and support cross-sector collaboration whilst continuing to enhance connections and communication with and between members and represent our members nationally.

Institute of Mental Health at the University of Birmingham – Working alongside young people to develop and deliver mental health-related research

Maria Michail (Senior Birmingham Fellow), Niyah Campbell (Youth Participation Lead) and Layne Boyden (Member of the Youth Advisory Group) spoke about their work to establish a Youth Advisory Group as part of the Institute, which can contribute to their aim to create a transformational change in our understanding, conceptualisation and response to self-harm and suicide prevention in research, clinical practice, policy-making and community practices.

Rural Community Council (Leicestershire & Rutland) – The RCC’s role in suicide awareness

Mike Wilbur (Delivery Manager Community Wellbeing) presented on the community-based work of the RCC in suicide awareness raising and tackling taboo. He spoke about the Start a Conversation initiative which aims to encourage people to be more open about their worries and show them where to seek help and to break the stigma around suicide.

Merseyside Fire and Rescue – Effective emergency service employee health and wellbeing support

Kelly Patterson (Senior Occupational Health Officer & Psychological Therapist) and Mark Thomas (Group Manager) talked us through the ground-breaking implementation of Mental Health First Aid and Critical Incident Stress Management undertaken by their fire service and the positive impact it has had on staff and the service as a whole.

Mental Health Foundation

(no slides used)

David Crepaz-Keay (Head of Empowerment and Social Inclusion) spoke about the about the progress made in attitudes and approaches to mental health in the 70 years since the Mental Health Foundation began its work.  He also stressed the vital importance of “less focus on illness and broken individuals, more focus on communities and relationships”.

Jonathan’s Voice – Workplace engagement – working with the legal sector

Graham McCartney (Trustee) talked about their road to becoming a charity and what drives the work of Jonathan’s Voice. He also spoke about outreach and raising awareness through their networks in the legal sector.

Real-time suicide surveillance – review of current practice and recommendations for future development

Jonathan Ling (Professor of Public Health, University of Sunderland) gave an overview of the findings of the Public Health England-funded research exploring 2 questions:

  • Whether a police and/or coroner led RTSSS could lead to earlier more effective monitoring and improved support for people bereaved by suicide and
  • What action is required to implement a RTSSS across the UK effectively?

Samaritans – Local suicide prevention planning in England – research findings

Jacqui Morrissey (Co-Chair, NSPA and Assistant Director of Research and Influencing, Samaritans) gave a preview of research findings from the Samaritans joint report with the University of Exeter which provides the first ever nation-wide view of the breadth and depth of suicide prevention planning within local authorities in England. You can access the full report here.

 

NSPA response to NICE suicide prevention quality standards consultation

Last week we submitted our response to NICE’s (National Institute for Health and Care Excellence) consultation on suicide prevention quality standards.  We were very pleased to see that NICE have taken on board the comments from ourselves and our members in drafting the quality standards, particularly in relation to: the inclusion of people with lived experience on local multi-agency groups; more use of real-time surveillance; supporting professionals to ask about involving family or carers when someone is feeling suicidal; and better support for those bereaved by suicide.

The key areas we believe could be improved in the draft quality statements are:

  • More focus on a diversity of people with lived experience participating in local multi-agency suicide prevention groups
  • More effective support of those with lived experience who are involved in local multi-agency suicide prevention groups
  • Stronger reference to professionals acting upon permission to inform the family or carers of someone with suicidal thoughts, not just asking about it
  • Ensuring that support for those bereaved and affected by a suspected suicide is timely – within 72 hours

You can read our full response here.

Many thanks to the NSPA members who helped us with our response.

Surrey and Borders Partnership NHS Foundation Trust: Developing a new training programme for suicide prevention

Following the award of funding from Health Education England, Surrey and Borders Partnership NHS Foundation Trust have spent 2 years developing a new training programme for suicide prevention, with co-production at the heart of every stage of the process.

The training programme was developed by setting up a co-production working group consisting of different professional staff groups, people who had lived experience of thoughts and feelings of suicide, and families, friends and carers who had been affected or bereaved by suicide.

Collectively it was decided to create a new programme tailored to specific needs. The training content was determined by designing three levels of training, all with very similar content but specific to the project group. The following tiers of training were developed:

  • Recovery College (2 hour session x 4)
  • Mental Health Clinician Level (1 full day)
  • GP Level (90 minute seminar x 2)

The training sessions cover several topics, and include video examples, case discussions, and real-life stories of people’s experience; and are very interactive in nature. Some of the topics covered across the training programmes include:

  • How it feels to be at the point of suicide
  • Having conversations around suicide
  • Safety planning, and crisis and contingency planning
  • Risk assessment and identifying those at high risk from suicide
  • Understanding data around suicide
  • Supporting families, friends and carers

In the training design, co-production was included at every level to ensure that all benefited from the value of lived experience. Opinions from all perspectives were treated equally when determining training content and format, and the training was formatted by someone with lived experience.  The training was filmed using a specialist film company with lived experience of mental health, and there was a lived experience consultant on hand to support and advise the actors. The Recovery College level training is co-facilitated between a clinician and between someone with lived experience.

Since successfully piloting and rolling out this training within the Surrey and Borders Partnership NHS Foundation Trust, over 450 people in Surrey have been trained across these three levels. Everyone, across all levels has rated the training as good or excellent.

At Recovery College level training, everyone who attended achieved their self-set goals, and saw an improvement in their feelings of wellbeing, alongside a reduction in their self-rated levels of personal distress. Some of the feedback comments from Recovery College course participants include:

“It made me aware of people who are struggling and how to help”

“This was of great value and importance to me”

“Course is fantastic and can only evolve”

In relation to training delivered to GPs and to mental health clinicians, there has been the biggest pre and post training shifts for staff in the following areas:

  • Knowing how to talk to people who use services about suicide
  • Doing a risk assessment and formulation
  • Writing safety plans and crisis and contingency plans

Some of the comments made on course evaluations include:

“I feel more confident in dealing with the risks of suicidal ideation after today”

“All parts of the training were extremely good and useful”

“Videos were really useful and it was good to talk about the breakdown of demographic factors”

Following this incredibly positive feedback, Health Education England are helping to roll out this training more widely. Initially, the training packages (with local adaptations) will be rolled out across Kent, Surrey and Sussex. A dedicated trainer has been recruited for each region to support this roll out.

In October 2018, Health Education England published the first competency framework on what is required for suicide prevention and self-harm training, and all the training levels have been successfully mapped against the requirements listed in this framework.

To find out more about the training, please follow the progress via twitter @Qi_team_sabp and if you have any questions, please email qi@sabp.nhs.uk or send a message via twitter.

Surrey and Borders Partnership NHS Foundation Trust: Suicide Prevention Information Network (SPIN)

SPIN (Suicide Prevention Information Network) events are half-day information sharing events that shine a spotlight on different key areas of suicide prevention, currently particular identified high-risk groups who are at an increased risk from suicide. Local speakers and local services are used where possible to showcase what they are doing, and to raise the profile of what is happening around suicide prevention in our local communities. Information stands are present, and people can take information away for further reflection.

At the end of each event, people are asked to write a “pledge”. This asks them to reflect on what they have been inspired by during the event, and to make a commitment to themselves to take something away. This is important as it ensures people are active participants and are learning from the presentations and speakers and think around what they may like to do differently. This helps people leave feeling energised to make things better, and with an idea of where they can start.

Pledges from previous events include:

“I will think more about how we include families, friends and carers in our initial assessments”

“I will not feel afraid to ask people about suicide”

“I will think more about ensuring I am asking open ended and inclusive questions”

“I will pay attention to the role of demographic factors in my assessments”

SPIN events occur every quarter and are open to everyone who wishes to book a place. There are up to 100 spaces available, and places are always completely free, enabling rich and varied audiences. These include clinical staff, staff from other sectors and from charitable organisations, people with lived experience of suicide, families, friends and carers and students. These varied audiences ensure discussions and questions come from a variety of perspectives, further contributing to the impact of the events. Plenty of breaks are scheduled, ensuring there is time for people to reflect, meet each other and discuss the topics – many key connections have been made during this time.

SPIN events are mindful of psychological safety because of the nature of the topics that are being discussed. At the opening of each event, we always talk about how we keep ourselves safe during the event, ground rules, and what to do if anyone becomes distressed. Staff are on hand to provide support should this occur, and there is a designated “quiet room” – a safe space where people can go to reflect at any time during the event. It is set up with comfy chairs, refreshments, and plenty of tissues! A trained member of staff will check in with anyone who uses the quiet room and see if they want to be alone or if they would like to talk to someone. However, so far the quiet room has been used very little. People report finding the events very safe and supportive, and although they can be emotional and impactful at times, the ethos of the events feels positive and people report leaving the events feeling hopeful and empowered.

At the end of each SPIN event, people evaluate their experience of the event, and, to date, the events have only ever been rated as good or excellent. Regardless of the perspective they are coming from, people have said how valuable they find the events, and how they like the balance of speakers from different viewpoints. People also suggest topics that they would like covering in the future, and we use these to shape future plans and agendas.

Topics covered so far this year in relation to suicide in high risk groups have included:

  • Suicide prevention in men
  • Suicide prevention in the LGBTQI population
  • Suicide prevention for perinatal women
  • Bereavement by suicide

Topics planned for the rest of 2019 are:

  • Suicide prevention for veterans and for those in the military
  • Suicide prevention in older adults
  • Suicide prevention for children and young people

Samaritans of Cornwall – more than a listening service

Samaritans of Cornwall at Truro have been providing emotional support to the people of Cornwall and beyond since 1970, and today provide almost 24/7 listening support through a team of 120 volunteers. The branch is the only one located in Cornwall and covers almost all of the county, with volunteers travelling up to an hour from as far away as Launceston in the east and St Just in the west to cover their shifts.

The branch is located in the county’s only city, Truro, however the team try to get out to the more remote areas through the provision of outreach services in some of the most deprived areas in Europe. The branch is supported by a market stall that operates three days a week, selling ‘pre-loved goods’. The stall brings in about one third of the branches annual running costs.

In addition to providing support to over 53,000 people via phone, text and email each year, Samaritan volunteers in Cornwall play an active role in trying to reduce the very high level of suicides in the region. Cornwall has an average of 14.1 deaths by suicide per 100,000 of population compared to the national average of 10.1.

Working with partners to prevent suicide

  • The branch is an active member of the Multi Agency Suicide Prevention Group (MASPG) and has collaborated and presented at three Towards Zero Conferences, including running workshops on listening skills. As part of the MASPG they were involved with the postvention planning for schools and education, helping to devise a pathway of support available to students, teachers, parents and the wider community.
  • Volunteers worked with Cornwall Partnership Foundation NHS Trust, St Austell Brewery and BBC Radio Cornwall on the Don’t Flush Your Life Away campaign to provide posters to pubs, sports clubs and workplaces raising awareness of mental health in places like men’s toilets. The pictures focus mainly on men, but new versions are published regularly addressing different sectors of the community. This initiative has been picked up in other regions throughout the country.
  • The branch collaborates with other local and national initiatives to raise awareness of the need to reach out for and provide emotional support, and to remind people that Samaritans is there in times of crisis.

Providing support

  • The branch has volunteers who work with local public spaces to provide support in the event of a suicide and to raise awareness, they currently have a stand at a local station promoting Brew Monday in January and had one in July promoting Time to Talk.
  • On Friday nights, two volunteers take part in an outreach programme at Royal Cornwall Hospitals NHS Trust A&E from 10pm to 1.30am providing emotional support for staff, patients and their families/carers.
  • There is a monthly outreach programme at the Plant Eat and Teach project in Penzance where volunteers work alongside people who have experienced major life events and mental health issues, or who are struggling to cope with life.
  • The branch provides third party referral support to the Psychiatric Liaison Team, Cornwall Housing, Newquay Community Orchard, Camborne, Pool and Redruth Foodbank, Penryn Campus student services and the Community Adult Social Care Team.
  • There is an active educational programme, organising talks at schools and colleges throughout the county, as well as a busy Talks Team who go into workplaces and community groups, WI’s, Rotary etc to raise awareness of their services.

What does the future hold for the branch?

The next initiative is to open a satellite branch on Penryn Campus at the University of Exeter and Falmouth University aimed at raising awareness of Samaritans support, and to attract volunteers from the staff and student bodies. Initially this will provide phone, email and text support as part of the wider organisation, but once there are sufficient volunteers the aim is to provide a face-to-face drop-in at weekends.

Alongside this, the team have reviewed their current premises and agreed they aren’t fit for purpose for the future. A major fundraising and awareness campaign has been launched and the search is on to find a new home that will provide better access for volunteers and callers, be more economically efficient to run and potentially provide an income to reduce the requirement for fundraising.

NSPA members’ newsletter, October 2018

If you would like to receive our monthly newsletter, please join the alliance as either a member or supporter via this link.

In this month’s newsletter:

  1. NSPA news and activities
  2. New alliance members
  3. Updates from our members
  4. Top suicide prevention stories
  5. The latest research news
  6. Funding opportunities
  7. Upcoming Events

NSPA news and activities

Save the date: NSPA annual conference, Tuesday 5th February 2019, London

Our national suicide prevention conference brings together over 200 people with a professional and personal interest in suicide prevention to share the latest research and good practice, promote collaboration and enable networking.

 

The theme for this year’s conference is ‘Suicide prevention across the life course’. We will reflect on preventing suicide in children and young people, those of working age, and older adults – hearing from academics and practitioners about their understanding and experience of working with these different groups. In our workshops you can hear more detail about suicide prevention and bereavement activities from across the country, and explore how to take that learning back to your own work.

 

Confirmed speakers include:
Professor Louis Appleby, Chair of the National Suicide Prevention Strategy Advisory Group and Professor of Psychiatry at the University of Manchester
Professor Nav Kapur, Head of Research at the Centre for Suicide Prevention at the University of Manchester
Lisa McNally from Bracknell Forest Council talking about their social inclusion approach to suicide prevention

Bookings will be open soon, so you can let us know you’d like to attend by emailing us and you can find out more on our website.

 

New alliance members

Since our last newsletter Beachy Head Chaplaincy Team, Butterflies Bereavement Support, Changing Lives Through Changing Minds and Health and Care Working Together in South Yorkshire and Bassetlaw have joined the NSPA. Please join us in welcoming them. If you’d like to learn more, click their logo below to visit their membership page.

 

Updates from our members

Equally Well from the Centre for Mental Health

The life expectancy of someone with a mental illness is 15-20 years shorter than average, and while some of this is due to suicide, the main cause of premature loss of life is poor physical health. People with a severe mental illness are at least twice as likely to have diabetes or heart disease, and if they have cancer they are more likely to die from it.

Equally Well UK is a new collaborative that seeks to bring about significant and sustained change to this. Based on the Equally Well collaborative that has been running for four years in New Zealand, Equally Well UK is bringing together organisations that have a part to play in supporting the physical health of people with a mental illness. That includes health and care providers of all kinds (not just those specialising in mental health care), commissioning bodies, local authorities, education and training organisations, charities, user and carer organisations and many more.

So far more than 50 organisations have come forward to join Equally Well UK and agreed to sign up to the Charter for Equal Health.

Equally Well comes with three essential principles. The first is that no one should experience poorer physical health, or less than good care, just because they have a mental illness. The second is that everything they do will be co-produced and co-designed between people with lived and professional expertise. And the third is that Equally Well is a genuine collaborative of equal partners, all of whom have a unique part to play, but who together can achieve more than if they work in isolation.

Help become a part of the change. To find out more visit www.equallywell.co.uk and follow them on twitter @EquallyWellUK.

Suicide Bereavement UK conference

Suicide Bereavement UK held their 7th annual conference, Breaking the Silence, in Manchester on 26th September. Over 400 delegates heard from a range of speakers including those who had been touched by suicide or had academic insight into the field.

The conference provided a platform for Dr Sharon McDonnell to share the preliminary findings for the national suicide bereavement survey, which attracted over 7,700 responses from UK residents. Analysis of the demographics of participants included their age, gender, ethnicity, employment status and their relationship to the person bereaved. A report of the survey findings will be officially released at next year’s Suicide Bereavement UK conference in Manchester, which you are able to book onto here. Dr McDonnell will also be providing a further update on the findings at the NSPA conference in February next year.

Support after Suicide Partnership: Invitation to tender 

The Support after Suicide Partnership is inviting expressions of interest from people or organisations who could lead a piece of work to help them develop the idea of a central hub of resources, information, evidence and guidelines to make it easier to set up local suicide bereavement support services.

They would like help to define the scope of the hub, set out how it might work in practice and propose the structure required to develop and sustain it.

You are able to read a brief of the tender here. Proposals are to be submitted no later than Friday 12th October 2018. 

Please direct your submission or any queries to the Support after Suicide Partnership Chair, Hamish Elvidge.

Bereaved children in Bristol to receive crucial support thanks to new Winston’s Wish service 

Winston’s Wish, a charity that supports children, young people, and their families after the death of a parent or sibling, is set to expand their successful face-to-face services to Bristol.

Every day, more than 100 children are bereaved of a parent in the UK, 260 children are bereaved of a parent each year in the city of Bristol alone. It is also notable that the suicide rate in Bristol is above the national average. Winston’s Wish supports bereaved children with services across the country and the new service in Bristol will offer bereaved children, their families and the professionals who look after them a range of face-to-face support.

For bereavement support, or to find out more about what services the charity offers, visit www.winstonswish.org or call the National Freephone Helpline 08088 020 021.

 

Top suicide prevention stories

New NICE guidelines for suicide prevention in community and custodial settings

Public Health England worked alongside the National Institute for Clinical Excellence (NICE) to launch NICEs new guidelines for suicide prevention in community and custodial settings. The guidelines cover ways to reduce suicide and help people bereaved or affected by suicides. It aims to:

  • help local services work more effectively together to prevent suicide
  • identify and help people at risk
  • prevent suicide in places where it is currently more likely.

You can read the guidance on the NICE website.

 

The latest research news

Childhood abuse and neglect increase the risk of self-injury and suicide attempts

McMahon, Hoertel, Olfson, Wall, Wang, and Blanco (2018) Childhood maltreatment and impulsivity as predictors of interpersonal violence, self-injury and suicide attempts: a national study. Psychiatry Research Vol 269

This large study from the U.S found that a history of childhood abuse and neglect increased the risk of suicide attempt, self-injury and violence towards others. Findings suggest abuse/neglect has a stronger effect on self-injury and suicide attempt than on violence; also sexual abuse increases risk more than other types of abuse/neglect. The authors suggest this association may be explained through the association between childhood abuse/neglect and depression, self-criticism, posttraumatic stress symptoms, and difficulty in maintaining positive feelings and wellbeing.

Suicide-related Twitter posts receive more replies and a faster response than non-suicidal posts

O’Dea, Achilles, Larsen, Batterham, Calear, and Christensen (2018) The rate of reply and nature of responses to suicide-related posts on Twitter. Internet Interventions Vol 13

We know that Twitter is used by people to communicate suicidal thoughts and intentions, but we didn’t know how people respond to suicide-related posts. This study compared replies to suicide-related posts with replies to non-suicidal posts. Suicidal posts received more replies (although 1 in 5 did not receive a response), had a faster rate of reply, and fewer retweets or likes than non-suicidal posts. The majority of first replies were potentially helpful (e.g. discouraging suicide, caring or clarifying), but some were dismissive or encouraging of suicide. The authors highlight that further research is needed to understand the effects of replies on suicidal thoughts or intentions, and to explore whether Twitter could be used to intervene, increase help seeking, or provide anti-stigma campaigns.

 

Funding opportunities

Suicide prevention in high risk groups research funding

The PHR Programme launched a new fund on World Suicide Prevention Day. It funds research to generate evidence to inform the delivery of non-NHS interventions intended to improve the health of the public and reduce inequalities in health. Our scope is multi-disciplinary and broad, covering a wide range of interventions that improve public health.

The primary aim of the programme is the evaluation of practical interventions. They will fund both primary research (mainly evaluative, but also some preparatory research) and secondary research (evidence synthesis); precise methods will need to be appropriate to the question being asked and the feasibility of the research. The deadline for applications is 19th March 2019, and you can apply via this link.

 

 

Upcoming events

Don’t forget to take a look at the NSPA Events page.
Updates this month include:

Date/Time Event Location
07/10/2018 Walking Out Of Darkness 2018 – Birmingham Victoria Square, Birmingham
17/10/2018 ManChat Conference The Showroom, Lincoln
30/10/2018 NHSE/PHE/NHSI Midlands & East regional Suicide Prevention conference- ‘Working Together to Prevent Suicide’ Leicester City Football Club, Leicester
14/12/2018 Towards Zero Suicide: Preventing Suicide, Saving Lives De Vere West One Conference Centre, London,Marylebone
18/12/2018 Can Anyone Hear Me? One day summits run by and for young adults on mental health Imperial College London, LONDON
05/02/2019 NSPA 5th Annual Conference – suicide prevention across the life course The Kia Oval, London
25/09/2019 Suicide Bereavement UK’s 8th International Conference Mercure Manchester Piccadilly, Manchester

Preventing suicide in Cheshire and Merseyside

Our ‘Vision’

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:

  • Leadership
  • Intelligence
  • Prevention
  • Safer Care
  • Support After Suicide

Leadership

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.

Intelligence

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.

Prevention

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.

Safer Care

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.

In Conclusion

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.