Published: 03/06/2004, Volume II4, No. 5908 Page 33

Lynne Greenwood on a multi-agency approach to suicide prevention

When national statistics reveal that three out of four people who commit suicide are not in contact with mental health services, it takes only the smallest step to accept that many other agencies must be involved in its prevention.

According to many working in the field, these should include not only health organisations but schools, youth groups, police, housing, community and voluntary agencies, any of whom may touch the lives of those vulnerable to suicide.

The national suicide prevention strategy, launched in 2002 to reduce suicides by 20 per cent by 2010 - from a baseline figure of 9.2 per 100,000 of population in 1997 to 7.4 - reports some progress. New initiatives include targeting suicide hotspots, reducing railway deaths, pilot schemes aimed specifically at young men and work with the Committee on Safety of Medicines to reduce deaths from overdoses of Co-proxamol, the prescription-only painkiller.

But some trusts have already devised local plans to the prevention strategy. These involve a wide group of organisations that may have contact with people with the potential to commit suicide in later life.

The first year of County Durham and Darlington Priority Services trust's plan for suicide prevention is being evaluated.

The strategy was devised after a county-wide suicide audit revealed some similarities to the national picture - high numbers of deaths from poisoning and hanging - and some differences, including a low number of deaths from carbon monoxide poisoning.More importantly, it exposed patterns specific to particular local areas.

Statistics in the trust-wide audit showed that 20 per cent of individuals who committed suicide had reported a crime within a year of their death, and 20 per cent had been arrested in the previous year. The most common crimes in both categories were criminal damage, arson and theft.

It also showed that many had visited their GPs on a regular basis with non-mental health conditions, including muscularskeletal and lower back pain and insomnia. Research also uncovered a high number of illicit drug-related deaths and many individuals with a history of homelessness, particularly in the Darlington area.

Similar audits were conducted within each primary care trust boundary and all trusts are now developing their own local plans as a result.

More than 300 GPs across the two counties have been provided with up-to-date information on the prescribing of antidepressants and analgesics. And the first 25 mental health and multi-agency professionals have just completed a specially devised 15-week part-time course, including three full intensive days of study, in awareness and management of risks, delivered by Teesside University.

Project manager Neil Johnson says: 'One of the key starting points is to bring together a group of champions from all relevant agencies with knowledge ofsuicide prevention and mental health promotion, to take forward this important agenda.

'In particular we need to target those individuals who are socially isolated, who never come into contact with any services.'

Year two of the suicide prevention plan will run from 2004-07 and year three to 2010.

Coventry PCT nurse consultant Jenny Cook co-ordinated a networking exercise 'trawling round the city meeting a lot of people we do not usually encounter'.

She says: 'Voluntary agencies, housing associations, personal and social development teachers in schools, the police, the young person's arm of MIND are all involved with people who have the potential to be at risk from suicide in later life, but are without the means to help them. If we are able to look at their needs now, it could go some way to reducing suicide in the whole population.'

Her research revealed some individual projects aimed at specific groups -counselling organisation Relate had carried out good work in schools, using a 'Time For Me' learning exercise - but initiatives were very fragmented.

Ms Cook, who has worked closely with the West Midlands division of the National Institute for Mental Health in England, invited agencies to an awarenessraising day at which training needs for individual organisations were identified.

'We think this approach has the potential to provide a more effective way of reaching out before people come into contact with mental health services, ' she says.

The trust is making links with alcohol and drug abuse teams in the community, aiming for more open and seamless communication. But the dilemma, adds Ms Cook, is in how to prioritise, as the project is both time and resource-intensive.

'We have to make clear the message that suicide and suicide prevention is not just the concern of people in mental health.'

The strategy has been divided into two strands: primary prevention, for people not in contact with mental health services, and secondary prevention, for those who are.

NIMH West Midlands programme lead for suicide prevention Nick Adams says: 'People already make connections between suicide prevention and mental health promotion and we want to strengthen those connections.

'Although many may have made a conceptual link between suicide prevention and those not involved with mental health services, we now need to produce practical guidance for such a combined approach.'

He expects the work in Coventry to lead to practical guidelines for other trusts and agencies for taking a combined approach to suicide prevention.

Ms Cook is keenly aware of the effects on staff of involvement with suicide issues. 'The work we do has the capacity to draw us in and is very meaningful, ' she says.

'I never fail to be touched by the aftermath and chaos of a suicide.'

Further information

DoH suicide prevention strategy.www. publications. doh. gov. uk/ mentalhealth/suicideprevention. htm

For information on contributing to HSJ's fortnightly mental health page, e-mail emma. forrest@emap. com