The Committee visited Merseyside and Salford on Monday 14 November 2016 to hear from organisations engaged in suicide prevention. The visit included sessions at Goodison Park, where they met representatives from Everton in the Community and State of Mind; Listening Ear, to hear from the Cheshire and Merseyside Suicide Prevention Network and AMPARO, and Salford Royal NHS Foundation Trust, to meet members of the Salford Mental Health Liaison Team.
Committee members present: Dr Sarah Wollaston (Chair); Heidi Alexander; Luciana Berger; Ben Bradshaw; Dr James Davies; and Helen Whately.
The Committee heard presentations from Michael Salla, Director of Health and Sport, Everton in the Community, the official charity of Everton Football Club, and Professor Andy Smith, Professor of Sport and Physical Activity, Edge Hill University, (Edge Hill University is Everton in the Community’s academic partner.)
Everton in the Community’s vision is “to be the most effective charity that uses sport as a tool to identify and support vulnerable people”. The Committee heard about the various projects run by Everton in the Community, including “Tackling the Blues”, a sports based programme targeting children and young people who are experiencing, or are at risk of developing, mental illness and “Active Blues”, which is funded by Sport England to help inactive men aged 35–50 to become active and improve their mental wellbeing. Both of those programmes are delivered in partnership with Edge Hill University. Drawing upon research conducted as part of “Tackling the Blues” at Edge Hill University, Professor Andy Smith told the Committee about the benefits of focusing on a whole school approach to mental health and wellbeing and developing a culture where mental health is a priority.
The Committee also heard from Dave, a military veteran who developed post-traumatic stress disorder after serving in Afghanistan. He told the Committee about his issues with gambling, which led to poor mental health. After participating in Everton in the Community’s ex-military project, his experience then led him to volunteer with Everton in the Community supporting veterans before becoming the Project Coordinator of the ex-military project.
State of Mind describes itself as a charity that harnesses the power of sport to promote positive mental health among sportsmen and women, fans and wider communities to prevent suicide. The Committee heard from Malcolm Rae OBE, Chair of the Board of Trustees, State of Mind Sport, and Dr Phil Cooper, a Nurse Consultant and co-founder of State of Mind.
State of Mind told the Committee about its role in seeking to tackle stigma around suicide and encouraging people who are experiencing mental health problems to seek timely help, particularly those individuals who might be inhibited from engaging with mainstream NHS services. The Committee heard about how rugby players get involved with State of Mind, encouraging individuals to talk about mental health. Danny Sculthorpe, a retired rugby league player, told the Committee about the work he does with State of Mind delivering training programmes, drawing on his own experience of mental health problems following an injury. He contemplated suicide but recovered after talking to his family. He told the Committee that “the biggest thing that saved my life was talking”.
The Committee heard presentations from and held a discussion with various representatives of the Cheshire and Merseyside Suicide Prevention Network: Sue Forster, Chair of the Cheshire and Merseyside Suicide Prevention Network Board and Interim Director of Public Health for St Helens, Jane Boland, Suicide Prevention Clinical Lead, Mersey Care NHS Trust, Audrey Jones, Head of Clinical Governance, Cheshire and Wirral Partnership NHS Foundation Trust, Angela Samata, Project Lead for James’ Place, Dawn Leicester, Director, Champs Public Health Collaborative, Pat Nicholl, Mental Wellbeing Lead, Champs Public Health Collaborative, Ged Flynn, Chief Executive, PAPYRUS, Richard Brown, CEO, Listening Ear, Charley Alvis, AMPARO Case Worker, Listening Ear, Heidi Moulton, AMPARO beneficiary, Katie Donnelly, Health Improvement Specialist, Warrington Borough Council, Steve Gavin, Public Health Project Development Manager, Wirral Borough Council, Christine Hurst, Senior Coroner’s Officer, Cheshire Police, Julie Chadwick, Assistant Director, Integrated Governance, 5 Boroughs Partnership, Cheryl Yeardsley, Project Officer, Champs Support Team, and Suzanne McGuckin, Communications Officer, Champs Support Team.
The Committee heard comprehensive presentations from representatives of the network followed by a wide-ranging discussion. The vision of the network is that “Cheshire and Merseyside is a region where suicides are eliminated, where people do not consider suicide as a solution to the difficulties they face; a region that supports people at a time of personal crisis and builds individual and community resilience for improved lives”. Representatives from the network told the Committee about the structure of the network and its strategic approaches: preventing suicide; transforming services; and post suicide support. The Committee heard about the training that had been made mandatory across all Merseycare staff and the importance of more in depth training for clinicians, including training on confidentiality.
The Committee also heard from AMPARO, which provides support for family members in Merseyside and Cheshire following suicide. AMPARO has been delivered by Listening Ear since April 2015. Support is provided 1:1 and staff can assist with a range of practical matters such as dealing with the police and coroners, helping with any media enquiries, help with overcoming isolation experienced and contacting and signposting to other local support services.
Heidi, a bereaved mother, spoke powerfully about her experience following the death of her son by suicide. She told the Committee that “he wasn’t hard to reach, the services are hard to reach”. Heidi told the Committee about the support provided to her by AMPARO, including crucial practical support with her statement for the coroner.
The Committee heard concerns about funding for services, including precarious funding for AMPARO and SOBS (Survivors of Bereavement by Suicide).
Salford Mental Health Liaison Team offers comprehensive mental health support, available 24 hours a day, 7 days a week to people aged 16 years and over who are inpatients in Salford Royal, Intermediate Care, or have presented in the Emergency Department and are experiencing problems with their mental health. This award winning service has demonstrated improvements in the health and wellbeing outcomes of its service users as well as delivering financial gains for the Trust. The Committee met Dr Ross Overshott, consultant in Liaison Psychiatry, and his team.
The Committee heard about the RAID model of Liaison Mental Health provision. The team described integration of Mental Health Team and Emergency Department working. Mental Health Liaison Service Practitioners take referrals of patients with suspected mental health problems from triage without the requirement for medical clearance by the Emergency Department Team and manage patients jointly with the medical team. Patient notes are shared between the emergency department and the mental health liaison team. It also described regular joint learning between Mental Health Liaison and Emergency Department teams. This would cover analysis of serious incidents, complex case discussion and patient pathway development. The team also described integration with local emergency service providers in the police and fire service. These services form part of their Emergency Village Forum.
The Committee heard about the achievements of the team. Admission rates for patients with mental health problems had halved at Salford Royal from 15.8% to 8.8%. 95.4% of patients were seen and discharged within 4 hours.
Committee members asked about the role of liaison mental health teams in preventing suicide. The Salford Mental Health Liaison Team said suicide was relatively rare so preventing individuals at imminent risk was a small part of their job. A larger part of it they said, is identifying longer-term risk factors for suicide, such as debt and depression, and managing them.
Another question was raised about the impact that the service had had on suicide rates in the area. The Salford Mental Health Team again said that it would be difficult to ascribe any changes in the suicide rate to any one service as this is a multi-pronged approach with community services. Despite this, there was noted to be a small increase in the suicide rate in Greater Manchester area recently, though on root cause analysis, this was thought likely to be a natural variation.