Conclusions and recommendations
Implementation
1.The refreshed suicide prevention strategy must be underpinned by a clear implementation strategy, with strong national leadership, clear accountability, and regular and transparent external scrutiny. In the words of a bereaved parent, “we cannot allow more lives to be lost because we do not have effective governance and implementation”. (Paragraph 11)
2.We recommend that the Government’s updated strategy should include a clear implementation programme, with strong external scrutiny of local authority plans and progress. Local areas also need a clear message from the top that suicide prevention plans are mandatory. (Paragraph 12)
Services to support people who are vulnerable to suicide
3.Our evidence suggests that there are three distinct groups of people at risk from suicide, and different approaches are needed for each:
- For people not in contact with any service, we support greater emphasis on public mental health and wellbeing as well as ongoing efforts to reduce stigma. We recommend that the suicide prevention strategy should include measures to improve the identification of those at risk of suicide within local communities and the provision of accessible support, including within non-traditional settings and recognising the important role of the voluntary sector. Renewed focus should be given to providing mental health training for staff in public facing roles, especially in higher risk situations, and to providing practical support for those experiencing adversity which may lead to a crisis, including bereavement and financial distress.
- To help people who are in contact with primary care services, GPs need better training in suicide risk. NICE guidelines should be promoted and implemented across primary care.
- We recommend that all patients being discharged from inpatient care should receive follow up support within three days of discharge, rather than the current standard of seven days. The deadline for establishing liaison psychiatry services in every hospital should be brought forward from 2020 to 2017. (Paragraph 22)
4.We recommend that all suicide prevention plans should include mandatory provision of support services for families who have been bereaved by suicide. (Paragraph 23)
Consensus statement on sharing information with families
5.Although a patient’s right to confidentiality is paramount, there are instances where professionals sharing information—with consent—with a person’s trusted family or friends could save their life. Stronger action needs to be taken to raise awareness of the Consensus Statement, to train staff in this area (including training on how to seek consent), and to engender a culture shift away from the current presumption that suicidal patients will not want their family or friends to be involved in their recovery. (Paragraph 26)
Data
6.Our evidence suggests the need for a more rapid provisional notification of suicide at the time when a suspected death by suicide occurs. We recommend that the Government take action to improve consistency between coroners and to make routine the use of provisional notifications of suicide. Furthermore, 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 31)
Media
7.We recommend that the suicide prevention strategy should review the accountability and responsibility for the adherence to media guidelines. The guidelines must have teeth and the refreshed suicide prevention strategy must make clear who is responsible for dealing with breaches by the media, at national and local level. We recommend that the refreshed suicide prevention strategy should include a commitment by the Government to work with internet providers and social media platforms to consider what changes should be made to restrict access to sites which encourage self harm or give detailed advice on suicide methods. (Paragraph 36)
15 December 2016