TRUST BOARD MEETING

25 July 2019

Paper Title: Suicide Prevention Update

Lead Director: Patrick Scott, Chief Operating Officer

Paper Author: Simon Long, Head of Nursing – Mental Health

Agenda Item: 10Presented For: Information

Paper Category: Quality

Executive Summary:Death by suicide accounts for 800,000 deaths globally each year. In 2017 there were 5,821 suicides registered in the United Kingdom. During the period 2001-2017 an average of 40 people died each year in the Bradford district due to suicide. The Five Year Forward View for Mental Health set out an ambition to reduce the number of suicides in England by 10 per cent by 2020 and the NHS Long-term Plan reaffirms the NHS's commitment to make suicide prevention a priority over the next decade.

Bradford District Care Foundation Trust (BDCFT) is adopting a zero suicide philosophy and is working with local and regional partners to ensure that the Trust is aligned with national, regional and local strategies for suicide prevention and continues to develop and improve services in order to reduce and whenever possible prevent people from taking their own lives.

The paper provides a summary and update of progress on work within suicide prevention and reduction across the integrated care system within West Yorkshire and Harrogate, the Bradford region and developments within the Trust.

Recommendations:That the Board:

Acknowledges the internal and partnership working to date, on suicide prevention

Governance/Audit Trail:

Meetings where this item has previously been discussed (please mark with an X):Audit Committee

Quality & Safety Committee

Remuneration Committee

Finance, Business & Investment Committee

Senior Leadership Group

Directors Chair of Committee Meetings

Mental Health Legislation Committee

Council of Governors

This report supports the achievement of the following strategic aims of the Trust: (please mark those that apply with an X):Quality and Workforce: to provide high quality, evidence-based services delivered by a diverse, motivated and engaged workforce

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Integration and Partnerships: to be influential in the development and delivery of new models of care locally and more widely across West Yorkshire and Harrogate STP

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Sustainability and Growth: to maintain our financial viability whilst actively seeking appropriate new business opportunities

This report supports the achievement of the following Regulatory Requirements: (please mark those that apply with an X):Safe: People who use our services are protected from abuse and avoidable harm XCaring: Staff involve people who use our services and treat them with compassion, kindness, dignity and respect

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Responsive: Services are organised to meet the needs of people who use our services

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Effective: Care, treatment and support achieves good outcomes, helps to maintain quality of life people who use our services and is based on the best available evidence.

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Well Led: The leadership, management and governance of the organisation make sure it's providing high-quality care that is based around individual needs, encourages learning and innovation, and promotes an open and fair culture.NHSI Single Oversight Framework

Suicide Prevention Update2

1. Background and Context

Death by suicide accounts for 800,000 deaths globally each year. In 2015, 4820 people are recorded as having died by suicide in the United Kingdom, however In 2017 there were 5,821 suicides registered in the UK, a rate of 10.1 deaths per 100,000 population. Males accounted for three-quarters of suicides registered in 2017 (4,382 deaths), which has been the case since the mid-1990s. The highest age-specific suicide rate was 24.8 deaths per 100,000 among males aged 45 to 49 years; for females, the age group with the highest rate was 50 to 54 years, at 6.8 deaths per 100,000. Generally, higher rates of suicide among middle-aged males in recent years might be due to this group being more likely to be affected by economic adversity, alcoholism and isolation. Furthermore, it could be that this group are less inclined to seek help.

During the period 2001-2017 an average of 40 people died each year in the Bradford district due to suicide. Although rates have fluctuated over the years, in recent years (2014 – 2017) the suicide rated in the district has fallen and has been lower than both the regional and national average with 9.0 deaths per 100 000 population.

Each year thousands of people with suicidal thoughts get the help and support they need from local mental health and voluntary services. We also know that the majority of people who die by suicide do not have any contact with mental health services in their last year of life.

The Five Year Forward View for Mental Health set out an ambition to reduce the number of suicides in England by 10 per cent by 2020 and the NHS Long-term Plan reaffirms the NHS's commitment to make suicide prevention a priority over the next decade. It commits to rolling out funding to further Sustainability and Transformation Partnership (STP) areas, implementing a new Mental Health Safety Improvement Programme, as well as rolling out suicide bereavement services across the country.

In 2012, the Government published the cross-Government National Suicide Prevention Strategy, which was updated in 2017, to strengthen delivery of its key areas for action, The National Suicide Prevention Strategy is implemented by partners across Government and Local Authorities working individually and collectively to address suicide prevention within their sector.

The new Minister for Suicide Prevention, announced in October 2018 plans to implement a Cross-Government Suicide Prevention Workplan, to drive implementation of the National Strategy.

Bradford District Care Foundation Trust (BDCFT) is adopting a zero suicide philosophy where each death by suicide is seen as preventable. Suicide will no longer be viewed as inevitable, or a terminal prognosis. We know that where this same approach has been taken internationally, there have been dramatic results.

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Organisations from across the region continue to work together to reduce suicide across the region. This includes NHS mental health organisations, emergency services, local authorities, prison services, and voluntary/third sector services.

2. Suicide Prevention in West Yorkshire and Harrogate

During 2017, A Suicide Prevention Advisory Network was developed (SPAN) chaired by Dr M Doyle from South West Yorkshire Partnership Foundation Trust (SWYPFT). Bradford District Care foundation Trust (BDCFT) is a member of the SPAN and worked collectively with partners to develop a suicide prevention strategy across West Yorkshire. The West Yorkshire and Harrogate health care partnership launched the West Yorkshire and Harrogate Suicide Prevention Strategy in November 2017, led and co-ordinated by the three West Yorkshire NHS Trusts that provide mental health services in Bradford, Leeds and South West Yorkshire. The strategy is closely aligned with public health local plans. The strategy provides a framework and an opportunity for the regions’ partners to work collaboratively to prevent suicide.

Previously presented to the Board, in summary the overall aim of this five-year suicide prevention strategy is to develop working relationships between partner agencies to provide an evidence-based but practical framework across the West Yorkshire region to help reduce the frequency of suicide and can be summarised as follows:

Launch a West Yorkshire suicide prevention strategy and disseminate widely Agree a memorandum of understanding across the NHS trusts Conduct a learning needs analysis across West Yorkshire and share training and

learning resources Explore the links and barriers to being able to share data between the NHS

providers, Clinical Commissioning Groups, Local Authorities, public health and other partners

Scope out a “real time” system for identifying apparent suicides Set up a mortality review system for apparent suicides Refine and pilot the non-mental health ‘high risk’ decision support tool Develop an evidence-based suicide prevention app Develop suicide bereavement services across West Yorkshire Agree an evidence-based shared pathway for those at risk of suicide based around

critical time interventions

The SPAN met four times in 2018 and continues to meet during 2019. The membership includes representation from the three mental Health Trusts, local authority public health teams, West Yorkshire Police, West Yorkshire Fire and Rescue Service, HM Prison and Probation Services, Care UK and Yorkshire Ambulance Service. The aim of the SPAN is to support the delivery of the West Yorkshire suicide prevention strategy and plans from across West Yorkshire agencies, to include:

- Sharing good practice, plans & innovations - Learning lessons from each other’s experience - Monitor progress of the WY suicide prevention strategy and plans - Continued development of WY suicide prevention strategy and actions,

aligning actions led by NHS providers with population approaches - Review and advise on suicide incidents and statistics

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- Develop a shared approach to agreed outcomes, both at a population level and for specific groups

- Receive and advise on updates and reports in relation to suicide prevention initiatives across the partner agencies

- Collaborate on bids for resources from commissioning bodies and similar agencies.

In addition, A West Yorkshire Federation of NHS Trusts (FONT) was formed, which is a formal collaboration between the three NHS trusts who provide mental health services – Bradford District Care Foundation Trust (BDCFT), Leeds and York Partnership Foundation Trust (LYPFT) and South West Yorkshire Partnership Foundation Trust (SWYPFT), with a shared agreement to work collaboratively on all matters relating to suicide prevention across the West Yorkshire and Harrogate area.

3. Suicide Prevention in Bradford

In West Yorkshire there are five local authorities in Bradford, Calderdale, Kirklees, Leeds & Wakefield Each local authority has a public health department and each of these departments is have developed a local suicide prevention plan.

Bradford District Care NHS Foundation Trust is a member of the Bradford District Suicide Prevention group that is led by Public Health within the Bradford Local Authority.

The Bradford District Suicide Prevention group created an action plan for Bradford. This group (consisting of BDCFT; City of Bradford Metropolitan District Council, West Yorkshire Police, Bradford CCGs, Samaritans, West Yorkshire Fire and Rescue, and Bradford MIND) is also part of the West Yorkshire and Harrogate health care partnership.

The Bradford District Suicide Prevention group has recently appointed a new chair, Duncan Cooper and as a consequence the group is currently revising the action plan to make it more streamlined, creating seven priorities for focus within the district. These include:

1: Reduce the risk of suicide in key high-risk groups 2: Tailor approaches to improve mental health in specific groups 3: Reduce access to the means of suicide 4: Support those bereaved or affected by suicide 5: Sensitive media approaches to suicide/suicidal behaviour 6: Support research, data collection and monitoring 7: Self-harm prevention

In order to ensure that the strategy will be delivered within Bradford, BDCFT have a suicide reduction steering group which meets monthly and has representation from corporate and operational services within the trust and service user and carer representation. The group leads on developments, sharing learning and ensuring that the Trust developments are in line with the national, regional and district strategies.

4. Developments

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As discussed the partnerships across West Yorkshire are now fully established and progress on both the West Yorkshire strategy and more local aims continues.

The suicide reduction steering group within BDCFT continues to lead on the continued development of suicide prevention within the Trust and is developing a Trust draft strategy that links in with the wider Bradford and West Yorkshire strategies.

Alongside partners within the SPAN, FONT and the Bradford District suicide prevention group has now developed the following:

4.1 Training needs analysis & Suicide Awareness The Trust had no specific suicide assessment training in place. There are numerous training programs available internationally and different Trusts have utilised different training packages. A training needs analysis has been completed by the FONT and agreement made to initially invest in suicide prevention training and Train the Trainer approach in the form of ASIST (Applied Suicide Intervention Skills Training) and SafeTALK (Suicide Alertness for Everyone). Out of the initial investment from the West Yorkshire and Harrogate partnership (WY&HCP), four places were agreed for ASIST and three Places for SafeTALK. The patient safety lead for BDCFT completed the train the trainer training for both SafeTALK and ASIST and co delivers training across West Yorkshire and within the Bradford area. SafeTALK training sessions have been successfully delivered across West Yorkshire. The sessions have been well attended with the feedback being very positive. ASIST training delivery plan began in November 2018 with the aim to deliver a minimum of four sessions (2 days training) over the course of 2019. This will be in addition to further Safe TALK sessions as part of a programme of suicide prevention training available to all WY&H partners. Over 30 staff within the first response team have already been trained in ASIST within the Trust with more training places being offered across the intensive home treatment teams and community mental health services in the first instance. The current training plan across West Yorkshire is as follows:

ASIST 2 Day Training4 and 5 July 2019 – Huddersfield Fire Station29 and 30 August 2019 – 10 places available for BDCFT at Fieldhead Hospital, Wakefield

SafeTALK 3.5 Hours trainingJuly 12 – Bradford Fire StationAugust 09 – Dewsbury Fire StationSeptember - 13 Dewsbury Fire StationOctober 11 - Dewsbury Fire StationNovember 15 - Dewsbury Fire StationDecember 06 - Dewsbury Fire Station

In addition to the already funded places, additional investment had been awarded by Local Workforce Action Board (LWAB) to pay for a further four Train the Trainer places in ASIST and five Train the Trainer places in SafeTALK. These places have been secured for the West Yorkshire Fire and Rescue Services staff and will provide an additional resource.

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The Wellbeing College, within the Trust, has a developed a suicide awareness package that can be delivered in short sessions across services, organisations and the general public (appendix one). The Bradford suicide prevention group is currently studying other mental health awareness training (for example Mental Health first aid) and availability to look at developing both mental health awareness and suicide awareness sessions/training across the Bradford Community.

In March 2019, the Trust, under the direction of Jaspreet Sohal Chief Pharmacist, hosted Yorkshire Pharmacy in Psychiatry Group session on suicide prevention where local pharmacists participated in a presentation Dr Hayley Gorton on suicide, prevention and lessons learnt for America and Canada.

4.2 Thematic Review & Risk Assessment

Following 15 serious incidents of service users within the Intensive Home Treatment Team and acute care services between January 2018 and February 2019 the Trust commissioned an independent thematic review that resulted in 13 recommendations across 4 themed areas that was presented to the Board in February. A development action plan has been created and this too has been presented to the board with a progress report due to be presented in January 2020. Some areas the review highlighted have already been acted upon:

Risk assessment - The review and outcomes of serious incident recommendations have highlighted a need to review and revise the Trusts current clinical risk training/provision. The Service and Clinical managers for acute care services and the clinical risk trainer have worked together on developing a training model for In Patients and IHTT, with a second, linked package for CMHTs and other services. This involves both the current e-learning and face to face core clinical risk training being reviewed and further bespoke training being developed with specific training models for inpatients and IHTT initially. Further bespoke packages are to be developed for community mental health teams to enhance the current risk training. The face to face specialty training for both inpatients and IHTT commences in July 2019.

Further to this a review of the current clinical risk assessment tools used in mental health services is to be initiated and led by the Head of Nursing for Mental Health in Quarter 2, 2019. This also forms part of an action from the recent Care Quality Commission inspection.

Serious incident investigations and reports – the review also recommended some improvements within the serious incident investigation and support processes.All serious investigation reports once finalized are now presented to a panel consisting of the Medical Director, Chief Operating Officer and Director of Nursing for approval. The initial 24 hour reporting has been improved and the serious incident investigation process is being supported by a Rapid Process Improvement Workshop in September 2019.

A steering group has also been initiated to explore the support needs, availability and developments required for staff and services involved in serious incidents. To date, the serious incident investigators have been the substantial providers of

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support (both practically and emotionally) for staff involved in such incidents and the recommendation from the independent review is that the support should be separated from the investigation process.

Following serious incidents and the Care Quality Commission inspection (CQC), the Trust has revised its ligature assessment process and a detailed report has been presented to the Quality and Safety Committee. The ligature assessment process has been reviewed by exploring other NHS Trust approaches to grading ligature risks. The Manchester Audit Tool approach has been adopted which grades ligature risk based on four factors. These four factors are informed by the CQC Guidance for Inspection Teams. The review of the ligature risk assessment process has improved both the recognition and the understanding of ligature anchor points within our Trust buildings as well as the mitigations required to be put into place. Ligature awareness training has been designed and currently being rolled out across all inpatient areas. Following a clinical summit, a business case is currently being presented through the organisation proposing a phased approach for the installation of an anti-ligature door alarm system.

4.3 Zero Suicide Action Plan

During March 2019, Professor Tim Kendall , MH National Clinical Director for NHS England and NHS Improvement wrote to Mental Health Trusts requesting that zero suicide action plans be created against quality check pointers circulated in 2018, and be presented to NHSE and NHSI via the STP suicide prevention leads. With partners across the SPAN a zero-suicide plan has been created and submitted following Trust approval. The plan (appendix 2) was written against the NHSE quality check pointers and will be monitored by the suicide reduction group within the Trust as well as the FONT.

4.4 West Yorkshire Project Development

Postvention services (support for people whom have experienced someone who has died from suicide) have only been formally provided by Leeds MIND on behalf of LYPFT previously. The SPAN on behalf of the ICS successfully applied for funding for three specific projects, postvention being one (£173k). As a consequence, three posts have now been advertised to strengthen the delivery of the Leeds MIND postvention service and offer this to the whole of the integrated care system across West Yorkshire and Harrogate.

The other successful funding bids are for Military Veterans campaign, (£10,000), and a Targeted Pathway for hard to reach men, (£114,000). The funding will be held centrally by ICS and released specifically to support the programmes proposed.

5. Assurance & Next Steps

As an active member of both the SPAN and FONT, the Trust will continue to work on the actions within the West Yorkshire strategy with partners and continue to be involved in the training development, development of the postvention service and initiation of both the military veterans campaign and the targeted pathway for men.

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Real Time Surveillance system - The SPAN, during 2019/20 are continuing the work set out in the WY&H strategy and will have a specific focus on not only the afore mention projects but to further develop real time surveillance where there will be a monthly release to each local authority via a secure sharing system of all suspected suicides. This information will help to support the directions in each local authority for suicide prevention and potentially allow early intervention to learn lessons and support those bereaved by suicide.

BDCFT are working alongside the Local Authority and the review of the current strategy and action plan for Bradford of which the local authority leads. We will continue to be a key member of this group.

The clinical risk assessment process will be reviewed across quarter 3 of 2019, exploring appropriate processes and tools, quality and provision of training and effective oversite of clinical risk management. This is also linked to an action designed in response to the recent care quality commission inspection.

The Trust has now developed a patient safety lead and Head of Nursing in Mental Health role that will lead on the suicide prevention strategy and work for the Trust alongside partners within the Local Authority, FONT and the SPAN.

The Trust’s Suicide Reduction Steering group will continue to monitor and steer progress on suicide reduction within the Trust. There are now several action plans that either relate to or are connected with suicide prevention in the Trust and it is the intention of the suicide reduction steering group to create an overarching action plan specifically for suicide prevention that will allow simplified monitoring and consequent accountability to be identified.

Appendix one

Appendix two

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