Conclusions and recommendations
Implementation
1.We welcome the Secretary of State’s promise that the Government “will put in place a more robust implementation programme to deliver the aims of the National Strategy as recommended by the HSC [Health Select Committee]” and we urge him to publish details of the implementation programme as soon as possible.
(Paragraph 17)
Quality of local authorities’ plans
2.We welcome the fact that 95 per cent of local authorities have a suicide prevention plan in place or in development. However we are concerned that there is currently no detail about the quality of those plans. It is not enough simply to count the number of local authorities which report that they have a plan in place. (Paragraph 21)
3.It is essential that there is a strong and clear quality assurance process to ensure that local authorities’ plans meet quality standards. This will also enable more support to be provided to local authorities where it is needed. In its response to this report, the Government should set out how the quality assurance process will work; who will be responsible for it; how it will report; how often it will be carried out; and when it will start. (Paragraph 22)
4.We recommend that Public Health England’s suicide prevention planning guidance for local authorities should be developed into quality standards against which local authorities’ suicide prevention plans should be assessed. (Paragraph 23)
5.We consider that oversight of nationwide implementation [of local authorities’ plans] could usefully be carried out by an implementation board, as recommended by Samaritans and Hamish Elvidge (Chair of the Matthew Elvidge Trust (a trust aiming to tackle the issue of depression in young people) and the Support after Suicide Partnership). As well as ensuring implementation of local authorities’ plans, the implementation board should have responsibility for overseeing the implementation of the other aspects of the Government’s suicide prevention strategy. (Paragraph 27)
6.We recommend that health overview and scrutiny committees should also be involved in ensuring effective implementation of local authorities’ plans. This should be established as a key role of these committees. Effective local scrutiny of a local authority’s suicide prevention plan should reduce or eliminate the need for intervention by the national implementation board. (Paragraph 28)
7.The Government should consult the National Suicide Prevention Strategy Advisory Group on whether the implementation board should also be responsible for the quality assurance process of local authorities’ plans, or whether that responsibility should rest with another body. (Paragraph 30)
Funding
8.We welcome the provision of funding for suicide prevention guaranteed for 2018/19–2020/21. However, unless it is supported by other funding already committed by the Government to mental health, and unless that funding actually reaches the front line, we are concerned that it will not be sufficient to fund the suicide prevention activity required both to meet the Government’s target of a 10 per cent reduction in suicides and to implement the strategy. (Paragraph 38)
9.We note that there are currently important steps which could be taken to reduce suicide but which cannot be acted upon due to the lack of significant additional resource. The Government should make a clear commitment to assuring the funding for every action outlined in the suicide prevention strategy. In order to demonstrate this commitment, the Government should make an estimate of the cost of each activity referred to in the strategy, and indicate what funding is currently allocated to each. This will allow the funding gaps to be identified and addressed.
(Paragraph 39)
10.The Government must make clear who has overall responsibility in each area (whether that is the CCG, the director of public health, or another body) to ensure that the money is allocated in the right places within the area to fund both NHS initiatives and public health activity. The Government should set out how the additional funding will be distributed and accounted for so that local authorities and CCGs can plan their suicide prevention work effectively. If there is insufficient funding, the Government should be realistic about what is achievable on existing resources and set out the evidence on prioritising resources. (Paragraph 40)
Services to support people vulnerable to suicide
People not in contact with any health services
11.We recommend that local authorities keep and maintain a record of services of a suitable standard (both in the voluntary sector and commissioned services) to which individuals can be signposted for both practical and emotional support. Part of the work of health overview and scrutiny committees in scrutinising local authorities’ suicide prevention plans should be ensuring that these records are created and maintained. There should also be an annual review of the impact of any loss of these services. (Paragraph 47)
12.Local authorities should promote a joined-up, multi-agency collaborative approach to suicide prevention to improve data sharing and knowledge between different sectors which will ultimately lead to more efficient and effective action on preventing suicide. (Paragraph 51)
13.We recommend that organisations and services at high risk locations, including the police and Network Rail (as well as other organisations such as the RNLI where appropriate), should be involved in the development and implementation of local authorities’ suicide prevention plans. (Paragraph 52)
14.We recommend that local authorities should include in suicide prevention plans a strategy for how those who are at risk of suicide but are unlikely to access traditional services will be reached. This should include up-to-date knowledge about what services are available in the voluntary sector. (Paragraph 56)
People in contact with primary care services
15.We recommend that the GMC should ensure that all undergraduate medical students receive training in the assessment of suicide risk as well as depression. We also recommend that the Royal College of General Practitioners and Health Education England should include the assessment of depression and suicide risk in the training and examinations for GPs. The Government should monitor progress on the addition of these competencies to medical school and Royal College exams. (Paragraph 61)
16.Strong and coordinated national leadership is required to ensure that GPs and primary care nurses receive adequate ongoing training in detecting suicide risk. We recommend that NICE guidelines and other training resources should be promoted and made readily available for practitioners by Public Health England and Health Education England. There should be national oversight by Public Health England to ensure that all practitioners involved in the assessment of those who could be at risk of suicide are accessing this training. (Paragraph 65)
Drug treatments and suicide
17.We urge the Government to ensure that NICE guidelines on the appropriate use of drug treatments for depression are promoted and implemented by clinicians. (Paragraph 66)
People under the care of specialist mental health services
18.We repeat our recommendation that all patients being discharged from inpatient care should receive high quality follow up support within three days of discharge. We recommend that this should be in addition to a further instance of follow up support within the first week post-discharge. The Government must ensure sufficient funding for crisis resolution home treatment teams to ensure that they have enough resource to provide adequate support. (Paragraph 71)
19.We urge the Government to ensure that there are enough trained staff to establish and sustain liaison psychiatry services in every acute hospital. (Paragraph 75)
20.More broadly, the Health Education England Mental Health workforce strategy must set out what the Government is going to do to ensure that there are enough trained staff to implement the Mental Health Taskforce recommendations. (Paragraph 76)
21.We welcome the Government’s expansion of the Improving Access to Psychological Therapies (IAPT) programme. However we urge the Government to ensure that it is properly integrated into mental health teams supporting people with complex mental health conditions, to ensure that patients being supported by the IAPT programme who experience suicidal ideation can be supported effectively and quickly. (Paragraph 79)
Self-harm
22.All patients who present with self-harm must receive a psychosocial assessment in accordance with NICE guidelines. Patients who present at A&E with self-harm should have a safety plan, co-produced by the patient and clinician, and properly communicated and followed up. We urge the Government to set out its plans for ensuring that the workforce is sufficient to meet these objectives. (Paragraph 92)
Confidentiality and consent
23.We are disappointed that the Government has not included any proposals for action on the Consensus Statement in its report on the strategy. We recommend that there should be a named responsible individual within Government to support the NSPSAG in discussions with the Royal Colleges and to ensure progress in raising awareness of the Consensus Statement and training of staff in this area (including training on how to seek consent). (Paragraph 100)
24.We recommend that further discussions between the NSPSAG and the Royal Colleges on the Consensus Statement should involve representatives from trust legal departments, legal authorities and defence unions, in order to ensure consistent guidance. (Paragraph 105)
25.Training for medical staff on the Consensus Statement and on how to seek consent should include educating medical professionals on the importance of action when a patient has given consent for information to be shared with a friend or family member. (Paragraph 107)
Support for those bereaved by suicide
26.We recommend that ensuring high quality support for all those bereaved by suicide should be included in all local authorities’ suicide prevention plans. Bereavement support should be a key criterion on which local authorities’ plans are quality assured. (Paragraph 114)
27.We recommend that those bereaved by suicide should receive a copy of ‘Help is at Hand’ within a maximum of 48 hours, but where possible when contact is first made with the family/friends of the deceased individual. Further support, including information about counselling but also support for the practical problems that bereaved individuals will face (including coroners’ inquests and incident reviews), should be offered as soon as is practicable. The next of kin should have access to a victim liaison officer to support them through the inquest. (Paragraph 115)
Media
Guidelines for responsible reporting of suicide
28.We note the lack of detail [in the third progress report] on the action that may be taken if concerns [about irresponsible media reporting of suicide] are escalated to PHE and we recommend that PHE should include options for action in its partnership agreement with Samaritans. (Paragraph 123)
29.We urge the Department of Health and Public Health England to be vocal and proactive in their support for the work ensuring responsible reporting of suicide. We recommend that there should be a nominated person within the Government/Public Health England who is ultimately responsible for ensuring that the Government has a firm grasp of the current media situation and for supporting Samaritans and other organisations and individuals in their work with the media. (Paragraph 124)
30.A clear message must be sent to the media that the Government supports Samaritans’ media guidelines and the work that Samaritans do in helping journalists report suicide responsibly. (Paragraph 125)
Local media
31.We recommend that when producing and updating suicide prevention plans, local authorities should include work with local media to ensure good practice in local media sources and to ensure timely follow-up discussions when a guideline has not been followed. (Paragraph 127)
Regulation
32.We recommend a change to the IPSO Editors’ Code of Practice to replace the term “excessive detail” with “unnecessary detail”. (Paragraph 131)
33.We recommend that the Ofcom Broadcasting Code should be strengthened to ensure that detailed description or portrayal of suicide methods, including particular locations where suicide could be easily imitated, are not permissible.
(Paragraph 133)
Social media and the internet
34.We recommend that the Government should clearly set out its expectations of social media companies and relevant stakeholders relating to processes for dealing with harmful content on social media. There should be responsibility within Government for ensuring that these organisations have robust processes in place and for monitoring adherence to the processes. (Paragraph 138)
35.We note the research projects relating to the online environment, in which Samaritans are involved. We urge the Government to closely examine the findings of that research and to report back to us on the action that it proposes to take as a result. (Paragraph 141)
Data
Standard of proof
36.We recommend that the standard of proof for conclusions of death by suicide should be changed to the balance of probabilities rather than beyond reasonable doubt. (Paragraph 151)
Coroners’ conclusions
37.We recommend that the Chief Coroner should be given adequate resourcing to allow clear oversight of the variation in the recording of suicide. We also recommend mandatory training for all coroners, both those already in post and newly appointed, on the use of short form and narrative conclusions, to ensure consistency across England and Wales. (Paragraph 161)
38.We suggest that the Government should explore whether information about lethal methods of suicide could be made available to statistical agencies and public health teams, but withheld from public view. (Paragraph 163)
39.We recommend that training for coroners on suicide should include the importance of including sufficient detail in a narrative conclusion about the deceased individual’s intent and method used in order to minimise the number of hard-to-code narrative conclusions. Accurate data is crucial to the understanding of what approaches work best in reducing suicide. We suggest that this training could be given by experts in the field of data and suicide prevention. (Paragraph 164)
40.We recommend that training and guidance for coroners should include material about the importance of timely information sharing with public health and mental health teams where appropriate in order to identify possible clusters and the proliferation of emerging new methods of suicide. (Paragraph 166)
Conclusion
41.We intend to hold a follow-up hearing after there has been opportunity for the Government and other relevant stakeholders to implement the measures set out in the latest progress report. We urge the Government to take forward the recommendations we make in this report. (Paragraph 169)
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