Suicide Prevention – a partnership approach

Mark Smith

Head of Suicide Prevention and Mental Health

Fundamental Issues• Mental Health and Vulnerability

• Vulnerability and Risk

• Risk and Consequence

– Victimisation– Criminality & criminalisation– Danger to others– Danger to self– Impact on families & communities– Impact on resources– Economic impact– Liability issues

The Rail Network• A draw for the vulnerable

• Transient population

• Equality Issues(access to services)

– Immigration status– Homelessness – Learning difficulties– Alcohol & substance misuse– Race and culture

BTP National Analysis• 350 fatalities a year• 84% believed to be suicides • 41% of deceased had a mental health

history • 1700 incidents a month which involve

mental health issues• 2700 incidents of suicidal behaviour per

year• 680 suicide prevention plans opened in

one year • Evidence of vulnerable people travelling

great distances to attempt suicide and importing demand for services

• In a 3 month period only 5 out of 11 people involved in suicidal incidents in Camden lived in the Borough

• London North hotspot area with 30% of suicides & 37% of all related incidents

Suicidal Incidents

01/04/12 - 31/03/13 2738 incidents

• 296 suspected suicides• 89 injurious attempts• 313 non injury attempts or life

saving interventions• 44 reconnoitring• 796 threats with no attempt• 630 third party reports• 570 Para-suicide events

BTP Approach• 2010 new Suicide Prevention Policy and SOP• Vulnerability assessment tool & structured suicide prevention plans• Public Protection Units & Mental Health Liaison Officers• Close working with Rail Industry Partners and the Voluntary sector

• However barriers to effective working identified - – Unfamiliarity with local Health & Social Care services and structures– Reluctance of many agencies to share information – Lack of medical oversight of police decision making– Differences in local Health and Social Care service provision– Inconsistency in clinical judgements– Detention under S136 often ineffective in reducing risk

• Need for a new approach to overcome these barriers• Need to secure appropriate diversions & free up police officer time

2013 - New Partnerships

• January - BTP & Network Rail (NR) agree a 3 year project to better coordinate activity in relation to Mental Health and Suicide Prevention which includes closer working with Samaritans

• February - BTP, NR and NHS London agree 3 month funding to provide a pilot joint health and police intervention capability – ‘Operation Partner’

• April - NHS England (London) agree further 6 month funding for Operation Partner

• April - BTP and London Underground agree a 12 month project to join and enhance Operation Partner

• September - BTP join ‘Street Triage’ programme funded by Department of Health and will seek to re-create Operation Partner outside London

Operation Partner

• Combined Public Protection Unit• BTP operational & analytical

resources • Supported by Mental Health

Professionals • Key elements;

– Medical operational review of BTP interventions and PIER plans

– Support to BTP custody – Outreach interventions & assessments– Fast access to data– Transition from Crisis to Care

689 people reviewed in 2013 – Only 1 later completed suicide on the railway and 1 away from the railway

A New Model

Identifying Vulnerability• Assessment tool• Custody Screening• Analysis – people & places

Joint Intervention Team

Managing Risk• Intervention• Diversion• Situational

solutions

Providing Care• Care Plan• Family support• Information sharing• Escalation process

A life saved – Op Partner

• 09/03/13 - Male seen acting strangely at station by rail staff

• 13/03/13 - Male returns – rail staff report to BTPwho attend, gain CCTV images & circulate to rail staff

• 14/03/13 – PPU circulate Image to all local GPs and local police. MHP circulate to all local Mental Health Units

• 15/03/13 - Male returns - rail staff call BTP who detain him under S136. Suicide note found in subject’s pocket and he tells officers he was going to do it ‘today or tomorrow’

• MHP liaised with hospital and after assessment he is further detained

• MHP have maintained contact with hospital re ongoing treatment and status

• One life saved – one railway fatality prevented

Suicide Prevented at Twyford Railway Stn 15/03/13

Key Benefits

• Early access to relevant information • More informed and robust decision making• Support to frontline officers assisting them to access

places of safety/services • Better outcomes for vulnerable people• Savings in police officer/staff time within the PPU• Savings in Officer/PCSO time on the front line• Defined progression from Crisis to Care• Up-skilling of PPU staff• Many examples of MHP intervention being invaluable in

breaking down organisational boundaries

Life Saving InterventionsInterventions, Suicides and Injurious Attempts 2013

0

10

20

30

40

50

60

70

80

April May June July August Sept

Month

Incid

en

ts Life Saving Interventions

Supspected Suicides

Injurious Attempts

Key Issues

• Funding challenges• Transport Health Needs Assessment – transient

demand• Most people presenting in mental health crisis

or with suicidal behaviour are not offenders• Commissioning – strategic fit• Care Bill requirements for vulnerable adults• Concordat commitments• S136 improvement plan for London