Recommendations

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This guideline should be read in conjunction with Public Health England's Local suicide prevention planning: a practice resource.

1.1 Suicide prevention partnerships

1.1.1 Local authorities should work with local organisations to:

  • Set up a multi-agency partnership for suicide prevention. This could consist of a core group and a wider network of representatives.

  • Identify clear leadership for the partnership.

  • Ensure the partnership has clear terms of reference, based on a shared understanding that suicide can be prevented.

1.1.2 Ensure the partnership has clear governance and accountability structures. Include oversight from local health and care planning groups, for example health and wellbeing boards.

Multi-agency partnerships in the community

1.1.3 Include representatives from the following in the partnership's core group:

  • clinical commissioning groups

  • local public health services

  • healthcare providers

  • social care services

  • voluntary and other third-sector organisations, including those used by people in high-risk groups

  • emergency services

  • criminal justice services

  • police and custody suites

  • people with personal experience of a suicide attempt, suicidal thoughts and feelings, or a suicide bereavement.

Multi-agency partnerships in residential custodial and detention settings

1.1.4 Set up a multi-agency partnership for suicide prevention in residential custodial and detention settings. This could consist of a core group and a wider network of representatives. Ensure the partnership has:

  • clear leadership

  • clear terms of reference, based on a shared understanding that suicide can be prevented

  • clear governance and accountability structures.

1.1.5 Include representatives from the following in the partnership's core group:

  • governors or directors in residential custodial and detention settings

  • healthcare staff in residential custodial and detention settings

  • staff in residential custodial and detention settings

  • pastoral support services

  • voluntary and other third-sector organisations

  • escort custody services

  • liaison and diversion services

  • emergency services

  • offender management and resettlement services

  • people with personal experience of a suicide attempt, suicidal thoughts and feelings, or a suicide bereavement, to be selected according to local protocols.

1.1.6 Link the partnership with other relevant multi-agency partnerships in the community.

To find out why the committee made the recommendations on suicide prevention partnerships and how they might affect practice, see rationale and impact.

1.2 Suicide prevention strategies

1.2.1 Develop a multi-agency strategy based on the principles of the Department of Health and Social Care's suicide prevention strategy for England and other relevant strategies. It should emphasise that suicide is preventable, and it is safe to talk about it.

1.2.2 Identify clear leadership for the multi-agency strategy.

1.2.3 Consider how to measure activities to prevent suicide. Include the introduction of constructive, meaningful preventive activities (for example, education and physical activity) rather than focusing on suicide numbers alone.

1.2.4 Review local and national data on suicide and self-harm to ensure the strategy is as effective as possible. See recommendation 1.4.2.

1.2.5 Assess whether initiatives successfully adopted elsewhere are appropriate locally or can be adapted to local needs, or whether previously successful initiatives can be reintroduced.

1.2.6 Oversee provision and delivery of training and evaluate effectiveness.

Multi-agency partnerships in the community

1.2.7 Consider collaborating with neighbouring local authorities to deliver a single strategy.

1.2.8 Consider advising local institutions and organisations on what to include in their contingency plans for responding to a suicide. This includes: schools, universities, further and higher education institutions, and workplaces.

Multi-agency partnerships in residential custodial and detention settings

1.2.9 Identify and manage risk factors and behaviours that make suicide more likely.

1.2.10 Consider collaborating with neighbouring residential custodial and detention organisations to deliver a single strategy.

To find out why the committee made the recommendations on suicide prevention strategies and how they might affect practice, see rationale and impact.

1.3 Suicide prevention action plans

1.3.1 Develop and implement a plan for suicide prevention and for after a suspected suicide. Ensure the approach can be adapted according to which agencies are likely to spot emerging suicide clusters:

  • Identify clear leadership for the action plan.

  • Interpret data to determine local patterns of suicide and self-harm, particularly among groups at high suicide risk.

  • Compare local patterns with national trends.

  • Prioritise actions based on the joint strategic needs assessment and other local data to ensure the plan is tailored to local needs.

  • Map stakeholders and their suicide prevention activities (including support services for groups at high risk).

  • Share experience and knowledge between stakeholders. Also share data, subject to local information sharing agreements.

  • Keep up-to-date with suicide prevention activities by organisations in neighbouring settings.

  • Oversee local suicide prevention activities, including awareness raising and crisis planning.

  • Review the action plan at a time agreed at the outset by the multi-agency partnership.

Multi-agency partnerships in the community

1.3.2 In addition to recommendation 1.3.1, set out how to:

  • Promote evidence-based best practice with rail, tram and underground train companies.

  • Work with planners who have responsibility for designing bridges, multi-storey car parks and other structures that could potentially pose a suicide risk.

  • Collaborate with coroners to provide a context for local suicide data and help interpret inquest conclusions.

  • Build relationships with the media (including social media, broadcasting and newspapers) to promote best practice when reporting suicides or suspected suicides.

Multi-agency partnerships in residential custodial and detention settings

1.3.3 In addition to recommendation 1.3.1, set out how to:

  • Work with the Prison and Probation Ombudsman and coroners to ensure recommendations from investigations and inquests are implemented.

  • Implement recommendations from internal investigations of instances of self-harm.

  • Assess suicide and self-harm prevention procedures (for example, HM Prison and Probation Service's Assessment Care in Custody and Teamwork and Assessment care-planning system, and the Home Office's Assessment Care in Detention and Teamwork case management systems).

  • Interpret and act on the findings.

  • Ensure systems for identifying risk, information sharing and multidisciplinary working put the emphasis on 'early days' and transitions between estates or into the community.

  • Monitor the impact of restricted regimes on suicide risk.

To find out why the committee made the recommendations on suicide prevention action plans and how they might affect practice, see rationale and impact.

1.4 Gathering and analysing suicide-related information

1.4.1 Use routinely collected data from sources such as Public Health England's Fingertips tool (public health profiles) or HM Prisons and Probation Service.

1.4.2 Collect and analyse local data on suicide and self-harm. This could include data on: method, location, timing, details of individual and local circumstances, demographics, occupation and characteristics protected under the Equality Act 2010. Sources could include reports from:

  • the local ombudsman

  • the Parliamentary and Health Service Ombudsman

  • coroners

  • the Prison and Probation Ombudsman

  • the voluntary sector.

1.4.3 For community settings, also use rapid intelligence gathering (continuous and timely collection of data) to identify suspected suicides, emerging methods and potential suicide clusters. This intelligence could also be used to identify people who need support after such events (see recommendations 1.8.1 and 1.9.1). Collect this local data from a range of sources including:

  • police and transport police

  • prisons

  • immigration removal centres (IRCs)

  • coroners.

1.4.4 For residential custodial and detention settings, also collect data on:

  • sentencing or placement patterns

  • sentence type

  • offence

  • length of detention

  • transition periods (for example, 'early days' and transitions between estates or into the community).

1.4.5 Assess the quality of data from each local source to ensure data collection is robust and consistent.

1.4.6 Ensure staff gathering and analysing this information are given resilience training and other support as needed.

To find out why the committee made the recommendations on gathering and analysing suicide-related information and how they might affect practice, see rationale and impact.

1.5 Awareness raising by suicide prevention partnerships

1.5.1 Consider local activities to:

  • raise community awareness of the scale and impact of suicide and self-harm

  • reduce the stigma around suicide and self-harm

  • address common misconceptions by emphasising that:

    • suicide is not inevitable and can be prevented

    • asking someone about suicidal thoughts does not increase risk

  • make people aware of the support available nationally and locally

  • encourage help-seeking behaviours

  • encourage communities to recognise and respond to a suicide risk.

1.5.2 For residential custodial and detention settings, also consider raising awareness of:

1.5.3 Take into account socioeconomic deprivation, disability, physical and mental health status, and cultural, religious and social norms about suicide and help-seeking behaviour, particularly among groups at high suicide risk.

1.5.4 Ensure the language and content of any awareness-raising materials is:

1.5.5 Coordinate local activities and ensure they are consistent – and coordinated – with national initiatives.

1.5.6 Consider encouraging employers to develop policies to raise suicide awareness and provide support after a suspected suicide. For example, see Public Health England and Business in the Community's toolkits.

To find out why the committee made the recommendations on awareness raising by suicide prevention partnerships and how they might affect practice, see rationale and impact.

1.6 Reducing access to methods of suicide

1.6.1 Use local data including audit, Office for National Statistics and NHS data as well as rapid intelligence gathering to:

  • identify emerging trends in suicide methods and locations

  • understand local characteristics that may influence the methods used

  • determine when to take action to reduce access to the means of suicide.

1.6.2 Ensure local compliance with national guidance to reduce access to methods of suicide:

1.6.3 Reduce the opportunity for suicide in locations where suicide is more likely, for example by erecting physical barriers. Also see Public Health England's Preventing suicide in public places: a practice resource.

1.6.4 Consider other measures to reduce the opportunity for suicide. For example, at locations where suicide is more likely, consider:

  • providing information about how and where people can get help when they feel unable to cope

  • using CCTV or other surveillance to allow staff to monitor when someone may need help

  • increasing the number and visibility of staff, or times when staff are available.

To find out why the committee made the recommendations on how suicide prevention partnerships can reduce access to methods of suicide and how they might affect practice, see rationale and impact.

1.7 Training by suicide prevention partnerships

1.7.1 Ensure training is available for:

1.7.2 Offer training to organisations employing, working with or representing groups at high suicide risk.

1.7.3 Provide generic and specialist training as needed for specialists and non-specialists.

1.7.4 Ensure suicide awareness and prevention training helps people to:

  • understand local suicide incidence and its impact, and know what support services are available

  • encourage others to talk openly about suicidal thoughts and to seek help (this includes providing details of where they can get this help)

  • take into account socioeconomic deprivation, disability, physical and mental health status, and cultural, religious and social norms about suicide and help-seeking behaviour, particularly among groups at high suicide risk.

To find out why the committee made the recommendations on training by suicide prevention partnerships and how they might affect practice, see rationale and impact.

1.8 Supporting people bereaved or affected by a suspected suicide

1.8.1 Use rapid intelligence gathering and data from other sources, such as coroners to identify anyone who may be affected by a suspected suicide or may benefit from bereavement support. Those affected may include relatives, friends, classmates, colleagues, other prisoners or detainees, as well as first responders and other professionals who provided support.

1.8.2 Offer those who are bereaved or affected by a suspected suicide practical information expressed in a sensitive way, such as Public Health England's Help is at hand guide. (This also signposts to other services.) Ask them if they need more help and, if so, offer them tailored support.

1.8.3 Consider:

  • providing support from trained peers who have been bereaved or affected by a suicide or suspected suicide

  • whether any adjustments are needed to working patterns or the regime in residential custodial and detention settings.

See also the National Suicide Prevention Alliance's resources on support after a suicide.

To find out why the committee made the recommendations on how suicide prevention partnerships can support people bereaved or affected by suspected suicide and how they might affect practice, see rationale and impact.

1.9 Preventing and responding to suicide clusters

1.9.1 Use information from the action plan and rapid intelligence gathering to identify and prevent potential suicide clusters (see recommendation 1.3.1).

1.9.2 After a suspected suicide in residential custodial and detention settings, undertake a serious incident review as soon as possible in partnership with the health providers. Identify how:

  • to improve the suicide prevention action plan

  • to help identify emerging clusters

  • others have responded to clusters.

1.9.3 Develop a coordinated approach to reduce the risk of additional suicides.

1.9.4 Develop a standard procedure for reducing – or 'stepping down' – responses to any suspected suicide cluster.

1.9.5 Provide ongoing support for those involved, including people directly bereaved or affected and those who are responding to the situation.

See Public Health England's Identifying and responding to suicide clusters and contagion: a practice resource.

To find out why the committee made the recommendations on preventing and responding to suicide clusters and how they might affect practice, see rationale and impact.

1.10 Reducing the potential harmful effects of media reporting of a suspected suicide

1.10.1 Develop a clear plan for liaising with the media. Identify someone in the multi-agency partnership as the lead.

1.10.2 For community settings, promote guidance on best practice for media reporting of suicide (including providers of social media platforms). Highlight the need to:

1.10.3 For residential custodial and detention settings, where a suspected suicide would be reported via the Ministry of Justice, ensure Ministry of Justice press officers follow good practice in suicide reporting.

1.10.4 Monitor media coverage of suspected suicides locally. If necessary, provide feedback to the journalist or editor in relation to their reporting (see the Samaritans' 'Media guidelines for reporting suicide').

To find out why the committee made the recommendations on reducing the potential harmful effects of media reporting of a suspected suicide and how they might affect practice, see rationale and impact.

Terms used in this guideline

This section defines terms that have been used in a particular way for this guideline. For other definitions see the NICE glossary or, for public health and social care terms, the Think Local, Act Personal Care and Support Jargon Buster.

Gatekeepers

People in groups that have contact, because of their paid or voluntary work, with people at risk of suicide. People in these groups may be trained to identify people at risk of suicide and refer them to treatment or supporting services as appropriate.

They may include: health and social care practitioners, criminal justice and detention settings staff, police and emergency services, people who provide a paid or voluntary service for the public, faith leaders, railway and underground station staff, and staff in educational institutions.

High suicide risk

High suicide risk means that the rate of suicide in a group or setting is higher than the expected rate based on the general population in England. Groups at high risk can include: young and middle-aged men, people who self-harm, people in care of mental health services, family and friends of those who have died by suicide, people who misuse drugs or alcohol, people with a physical illness, particularly older adults, people in the LGBT community, people with autism, people in contact with the criminal justice system, particularly those in prisons, people in detention settings, including immigration detention settings, and specific occupation groups (see Suicide by occupation, England: 2011 to 2015 Office for National Statistics).

Locations where suicide is more likely

These include high buildings such as multi-storey car parks, railways and bridges and places where other means of suicide are accessible, such as medical, veterinary or agricultural settings where human or animal drugs may be readily available. See Public Health England's Preventing suicides in public places: a practice resource.

Restricted regimes

Reduced access to time out of cell and purposeful activity, usually as a result of short staffing or serious incidents.

Suicide clusters

A series of 3 or more closely grouped deaths linked by space or social relationships. In the absence of transparent social connectedness, evidence of space and time linkages are needed to define a cluster. In the presence of a strong demonstrated social connection, only temporal significance is needed. (Adapted from Public Health England's Identifying and responding to suicide clusters and contagion: a practice resource.)

  • Public Health England
  • National Institute for Health and Care Excellence (NICE)