Welcome Suicide Prevention Pilot Workshop 31 st January 2020
Points to note… • Fire exits • Toilets • No fire alarms planned • Phones on silent • Photos will be taken • Wifi Code SMBC-Guest-SSID has been changed to :- • 67MP*K#2
Welcome, Introductions and Scene Setting Sue Forster, Director of Public Health, St Helens Council
Welcome and Introduction to the Suicide Prevention via Primary Care Pilot in St Helens & Sefton Sue Forster Director of Public Health; St Helens
The Champs Public Health Collaborative • An outcome focused model that delivers a number of local priorities • Coordinates the joint actions for Cheshire & Merseyside to prevent suicide through the NO MORE Suicide Strategy VISION: “Cheshire & 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”
Background • Suicide is a major public health problem • Trend indicates this is significantly increasing nationally • Around 6,000 people die by suicide every year in the UK, with someone taking their own life every 90 minutes • We know that those who die by suicide visit their GP in the months preceding their death
Some facts about suicide • Suicide cannot be “screened” for • Very complex issue with multiple interconnected factors • Can only identify some associated variables which may make someone more likely to complete suicide e.g. Middle aged men Veterans Previous attempts Chronic conditions Social isolation • Talking to a patient about suicide does not trigger an attempt
Why St Helens & Sefton? • Most recent data available from PHE shows both areas have significantly higher rates than the rest of England, with St Helens having the highest rate
Why now? • We know the contextual role primary care has in terms of potential to engage with those most at risk • Work has been started elsewhere in the country but for local reasons were not implemented • Potential to be the national lead in this field and showcase both areas primary care and public health collaborative actions
Aims of the pilot • Primary aim: to show the feasibility of proactively identifying patients who are at rising risk of suicide and in contact with primary care (who do not already have services wrapped around them) • Secondary aims • to provide insight into how this could be developed and rolled out as best practice regionally and nationally • Create a culture of normalising conversations around suicidality
What the pilot may look like • Targeted searches in EMIS to identify those who may be at risk (similar to sepsis red flag system) • Training for everyone who works in GP practices to raise awareness of those they come into contact with • This is not set in stone and can be adapted/changed based on our conversation today
Support • This is a collaborative endeavour with central support from Champs and local authority public health • St Helens: Nattalie Kennedy & Nicola Harris • Sefton: Steve Gowland & Rory McGill • Reminder this is a pilot to show feasibility • Evaluation – Interviews with staff to assess how it is going (linked to CQC audit criteria)
The ask of today • Some ideas have been pursued both regionally and locally which need to be refined/discussed: • Use of EMIS system to flag those most at risk • Training for all practice staff to increase awareness, vigilance and change the culture • Main outcome of today is a shared vision and some key deliverables identified so the project can be defined and begin running in both sites • Thank you in advance for your input!
Primary Care Pilot Progress update from St Helens Nattalie Kennedy Public Health Programmes and Commissioning Manager Public Health St Helens Council 31/1/20
What we did at St Helens First steps • Identified a small project team (October 2018), GP champion, Champs, PHE, Public Health (St Helens and Sefton) and St Helens CCG Business Intelligence • Review national (ONS) and local (suicide audit) data to identify key suicide-risk factors • Link suicide-risk factors to “diagnosis” READ codes • Test the system • Produce guidance notes Next steps Get Primary Care interested and involved to pilot the system and ultimately trained in both the process and suicide prevention
What we did at St Helens In June 2019 Public Health and Papyrus jointly presented at the St Helens PLT. The presentation covered the current situation with regard suicide in St Helens alongside an overview of the primary care pilot. Papyrus presented their current training offer. At the event there was an “ASK” of all GP surgeries to pledge* – 1. To complete the e-training (i.e. Zero Alliance and RGCP e- training) and download the StayAlive app; 2. To promote alternative sources of support via social prescribing; 3. To invest in suicide intervention skills training via Papyrus; 4. To volunteer to be part of the suicide prevention pilot in primary care. * this is a physical sign up form at the exit of the event
How the criteria was developed Stage 1 2018 - NHS Oldham CCG had already started work on this and kindly shared their Criteria for the searches designed to find patients with Risks associated with suicide. These were ran at CCG Level to look at the number of assessments which would be required. They were then given to some of the GP Practices who were asked to review the patients found and feedback Feedback was that there were too many patients to clinically review.
How the criteria was developed Stage 2 The searches were condensed, to only list the Patients who had multiple Risk Factors – just 8 searches for the GP Practice staff to look at. GP’s felt that they were much more manageable numbers of Patients to review, but gave feedback that extra criteria were needed. Therefore they have since developed with input from local GPs and academic research to attempt to assist Primary Care to identify patients that may need help.
How the criteria was developed Stage 3 For example, one GP found a patient he was really concerned about was not included in any of the lists, he had PTSD only, so an extra search was added just to find patients with PTSD or who were a Veteran Another GP suggested being prescribed Opioids and Psychotropic drugs as being risks Another coded if they were Maintaining good Eye Contact Academic criteria from National confidential enquiry (2014) i.e. frequency of Primary Care appointments
Any questions?
Case Study – How we made our GP Practice Suicide Aware Dr Pogue, GP, Patterdale Lodge Medical Centre
12,600 patients 4 partners, 3 salaried GPs, 2 pharmacists 2 ANP, 3 nurses, 2 HCA, 1 physician assistant 3 managers Reception staff Lots of regular locums Lots of Mental Health
Risk and support in General Practice Alys Cole-King Trusted GP often best placed to support Patient-professional relationship protective 15% consult in week prior, 33% in previous month 60% have physical health problem Opioids + in 30%
Missed appointments and risk (Glasgow study 2013-2016 274,000 patients) MH patient who miss 2 or more appts in 12months: 8x more likely to die in next 18months vs those who missed none 32% of those missing appts : alcohol/drug addiction Prof Helen Stokes-Lampard, Chair RCGP "People miss appointments for a range of reasons but this study highlights why it's more important to show compassion to people who fail to attend, rather than punishing them.”
Risk & antidepressants Increase risk of suicide & self harm in young people taking A/D Meta analysis RCT <25 Stone, Laughren, Jones BMJ 2009 Friedman, Leon N Eng J Med 2007 Cohort study >288,000 BMJ 2015 Mirtazapine, Venlfaxaine, Trazodone risk incr Higher when started or stopped Recommendation provide review on stopping
So what are we doing? For Professionals Dedicated Mental Health ‘slots’ appointment system Team briefing Attended by 17 staff (out of total possible 20 on the day) Professional support with cards/handouts In 2 number of consulting rooms (out of 10 at main) Zero suicide alliance training Completed by 15 number of staff
So what are we doing? For Patients Prevention Advertise Dedicated Proactive Follow up Appt slots Patients Data , IT Safe Systems prescribing
So what are we doing? For Patients Positive advertising re: prevention Dedicated appointment slots for Mental Health On the day Book ahead New allied Health professionals Proactive follow up for Overdose Self harm Safe Prescribing Weeklies where appropriate Reducing opiates Data and IT systems Accurate coding of data Alerts
Also – Primary Care Networks Mental Health is a priority Employment of Mental Health Practitioners e.g. RMN Mindfulness practitioners CBT therapists
Coroners reports Rise of request in past 6M Total of 4 requested for completion 1 definite confirmed suicide 3 likely 1 suicide >12M ago (no coroners report requested)
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