Preventing suicide in community and custodial settings

Resource impact statement

Background

People at risk of dying by suicide may come into contact with a wide range of professionals and others. The Department of Health and Social Care's suicide prevention strategy for England and the Commons Health Committee's report on the government's suicide prevention strategy highlights the potential role of the community in preventing suicide. For example, people can make contact with suicide prevention services through helplines and support groups (offered by charities such as Samaritans), or they can speak to a GP.

The risk of suicide in the UK prison population is considerably higher than among the general population. The 3-year average rate of self-inflicted deaths by people in prison in England was 69 per 100,000 between 2009 and 2011; approximately 80% received a suicide or open verdict at inquest. There were 62 ‘apparent suicides following police custody’ during 2013/14 in England and 119 deaths by suicide in prison in England and Wales in 2016. 

Suicide and self-harm are major public health problems, with someone who self-harms being at increased risk of suicide (The Chief Medical Officer annual report: public mental health – investing in the evidence, Department of Health).

The guideline covers people of all ages but focuses particularly on groups with high suicide risk.

It also looks at interventions for people who are, or have been in custodial settings, and those in contact with any branch of the criminal justice system.

Suicide prevention in mental health settings is not covered by this guideline. For further information on preventing suicide in mental health services see the National Confidential Inquiry into Suicide Reports.

The House of Commons Health Committee report on Suicide prevention (March 2017) highlighted that there was inadequate implementation of the national suicide prevention strategy. The NICE guideline has been produced to help address this poor implementation and move towards full implementation of the strategy.

Current position

In Great Britain in 2016 there were 5,668 recorded suicides which represented a slight fall since 2015 and the lowest overall number since 2010. However, further progress is required if the government strategy – Preventing Suicide in England: a cross-government outcomes strategy to save lives – whose aim, principally, is to prevent people from taking their own lives, is to be achieved. Since 2017 the strategy has included a commitment to reduce the rate of suicides by 10% in 2020/21 nationally, as compared to 2016/17 levels.

The guideline highlights the overall financial cost of someone of working age dying by suicide in the UK is more than £1.6 million (Evaluation of the first phase of Choose Life: the national strategy and action plan to prevent suicide in Scotland Scottish Executive Social Research).

Future position

The area of concerns from The House of Commons Health Committee report on Suicide prevention (March 2017) are set out in column 1 of table 1 below. Column 2 of table 1 set out links to the relevant parts of guideline which help to address these concerns.

Table 1 Areas where current policies have yet to be fully implemented and links to relevant section of the guideline which help support implementation

Resource impact

The resource impact should be considered at a local level. The resource impact will vary at a local level according to current progress made towards implementing existing policies and strategies.

The guideline may help to implement gaps in current policy implementation and support the policy aim of to prevent people from taking their own lives and to achieve the target to reduce the rate of suicides by 10% in 2020/21 nationally, as compared to 2016/17 levels.

Services are commissioned by local authorities, clinical commissioning groups, NHS England and the criminal justice system. Providers are NHS primary care and secondary care providers, community providers, voluntary agencies, employers, schools, colleges and universities, the police, transport services, prisons and others.

The guideline highlights the need for multi-agency partnership working to effectively implement the guideline. A multi-agency partnership approach is discussed in the following sections of the guideline:

• 2 Suicide prevention strategies
• 3 Suicide prevention action plans
• 5 Awareness raising by suicide prevention partnerships
• 6 How suicide prevention partnerships can reduce access to methods of suicide
• 7 Training by suicide prevention partnerships
• 8 How suicide prevention partnerships can support people bereaved or affected by a suspected suicide
• 10 Reducing the potential harmful effects of media reporting of a suspected suicide 

Section 1.1 Suicide prevention partnerships discusses specific responsibilities for local authorities and their work with other local organisations.