Welcome Suicide Prevention Pilot Workshop 31 st January 2020 Points - - PowerPoint PPT Presentation

Welcome

Suicide Prevention Pilot Workshop

31st 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

• ur 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!

Nattalie Kennedy Public Health Programmes and Commissioning Manager Public Health St Helens Council

31/1/20

Primary Care Pilot

Progress update from St Helens

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

• ur 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

Patients

Prevention Advertise Proactive Follow up Data , IT Systems Safe

prescribing

Dedicated Appt slots

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)

Coroners reports

 Themes

 ALL patients had mental health problems  3 of 4 patients were misusing alcohol +/- drugs

 Concerns

 No training  Non NHS work  Time consuming  Emotive

Audit – based on criteria

Suicidality When? Last Appt Med Rv MH service LTC Pain Admission Support service 1 Y 9.19 12.19 N 11.19 D N N 2017 Y 2 Y 12.18 7.19 N 12.18 D N N 2018/19 N 3 N 5.19 IAPT N N N Y 4 Y 6.19 8.19 6.19 Y N N N N 5 Y 3.19 8.19 6.19 Y Y N 2019 (a) Y 6 N 11.19 11.19 REFERED N N 2018 DNA 7 N 11.19 5.19 Y PTSD N 2019(a) N

Data drives decisions

No current data collection has our MH DNA rate improved? reduced our population self-harm/suicide rate? No qualitative information how do staff feel about pilot how do clinicians feels about pilot/resources/managing cases any change in their confidence are the patients satisfied with appointments available No extra formal training Protocols /policies not yet in place “trying things out”

Also – Primary Care Networks

 Mental Health is a priority  Employment of Mental Health Practitioners e.g.

 RMN  Mindfulness practitioners  CBT therapists

Next Steps?

 Review  PDSA cycle?  Repeat team brief  Review audit and our data collection tool  Named ‘champion’ to support resources  Engagement, continue, quality improvement  Perhaps we will find out ..... Workshop!

Training Packages Steve Gowland, Public Health Lead (Wellness and Mental Health) Sefton Council

Suicide Prevention Training

Steve Gowland – Public Health Lead (Mental Health)

The Sefton Story since 2015

• 86 people died
• 60-70% male
• Majority white, heterosexual
• Most live alone
• Majority of deaths take place in own home
• Most have never attempted suicide before
• Most known to mental health services.
• Most deaths in May and June
• Most common antecedences/circumstances
• Job loss
• Relationship breakdown
• Significant life event

Source: Sefton Suicide Audits 2016-2018

Median 12 80 45 Male - Median 12 80 47 Female Median 15 68 44 Combined Age Range Male - Age Range Female - Age Range

Self poisoning Hanging/strangulation

Sefton rates of death by suicide 2001/2019

Source: Public Health England, Fingertips, 2019

Preventing Suicide in England

Key areas for action: 1. To reduce the risk of suicide in key high risk groups (middle aged men, mental health, self harm, LGBTQ+, criminal justice, occupations – teachers, nurses, agriculture, carers) 2. Tailor approaches to improve mental health in specific groups 3. Reduce access to the means of suicide 4. Provide better information and support to those bereaved or affected by a suicide 5. Support the media in delivering sensible and sensitive approaches to suicide and suicidal behaviour 6. Support research data collection and monitoring

Source: (From Preventing Suicide in England, A Cross-Government Outcomes Strategy to Save Lives” (2012)

Community Gatekeeper – Wirral Mind

Training objectives

• Be able to identify signs that might suggest someone is thinking about

suicide

• Be able to recognise risk and identify key risk factors
• Have increased confidence to ask direct questions about suicide
• Be able to list key support services for people who feel suicidal
• Outlined local service offer for under and over 18s
• *Included scene setting and elements of role play*

Did not cover

• Offer skills to manage long-term intervention with an individual
• Offer counselling or therapy skills
• Cover the issue of assisted suicide

Community Gatekeeper Based on feedback from sessions:

What worked well  Positively received  Content localised  3 hours sessions  Very in-depth  Covered wide range of subject areas: risk factors, protective factors, sign of stress/anxiety, suicidal behaviours  Group discussions and exercises  Able to discuss difficult issues together  Raised importance of language  Felt empowered to act What worked less well

• 3 hours sessions
• Too in-depth
• Raised apprehension in some

learners

• Difficult to get time put aside
• Logistically challenging
• Roll out of the Trainer the Trainer

model was an issue

• Rigid structure and core content
• Since 2017 = 15 sessions carried out training 203 people: Police Officers, Social

Care, Libraries, Early Help and Localities staff and people in community

Zero Suicide Alliance

Training content

• Provided subject context and overview
• Be empowered to act – See, Say, Signpost
• Practice in handling difficult situations
• Be able to recognise risk and identify key risk factors
• Have increased confidence to prepare & ask direct questions about suicide
• 3 scenarios – work, stranger, family
• National services able to help

Did not cover

• Local services offer
• Offer skills to manage long-term intervention with an individual
• Offer counselling or therapy skills
• Cover the issue of assisted suicide or self harm

Zero Suicide Alliance Based on feedback from learners:

What worked well  Positively received  20 minute session  Covered wide range of factors  Online - flexible  Covered wide range of subject areas: risk factors, protective factors, sign of stress/anxiety, suicidal behaviours  3 x scenarios  Raised importance of language What worked less well

• Only 20 minutes
• Not in-depth enough
• Liked opportunity to discuss some

elements

• No information local content
• Can be hard to keep track of numbers
• Since August 2019 = 580+ people completed the course; Council, CCG, Sefton

CVS, community

Other training offers:

• SP-OT Suicide Prevention-Overview Training (90 minutes) the focus of this

training is on what EVERYONE needs to know.

• SP-EAK Suicide Prevention – Explore, Ask, Keep-Safe (3.5hrs): The workshop

aims to prepare participants to identify those with thoughts of suicide, respond effectively and connect them with support.

• ASIST Applied Suicide Intervention Skills Training (2 days): A skills building

workshop that prepares caregivers to provide suicide first aid interventions

Other training offers:

Suicide Alertness For Everyone (safeTALK) is a suicide alertness programme that teaches participants to recognise persons with thoughts of suicide and connect them to intervention resources. Delivered as a half-day course, safeTALK trains suicide alert ʻhelpersʼ to:

• be aware that opportunities to help a person with thoughts of suicide are

sometimes missed, dismissed or

• recognise when someone might be having thoughts of suicide
• feel confident in listening to the personʼs feelings and talk with them in an

honest and direct way

• know what the local suicide intervention resources are
• act quickly to connect a person with thoughts of suicide to someone trained

in suicide intervention.

Other training offers:

Role: Intervention provider Course length: 2 days Key features:

• Comprehensive
• Interactive
• Improves suicide alertness
• Minimises risk and maximises safety
• Examines barriers to seeking help
• Practical and robust model of suicide intervention
• Evidence based and scientifically proven
• Recognised by the World Health Organisation (WHO)

Other training offers:

Launched in May 2018, 4 course levels to choose from: Basic, Level 1, Level 2 & Level 3. Each level includes content covering:

• Skills Training in Suicide Prevention (Adults)
• Skills Training in Suicide Prevention (Children and Young Adults)
• Skills Training in Suicide Prevention and Self-harm Mitigation (Adults)
• Skills Training in Suicide Prevention and Self-harm Mitigation (Children and

Young Adults) These courses have been designed to accommodate the needs of frontline staff with differing levels of engagement and responsibility for safety planning.

Conclusions

There IS a demand for suicide prevention training from partners, organisations, community and the public. Ideal training package:

• Flexible
• Detailed
• Direct
• Group learning
• Discussion opportunity
• 1-2 hours in length
• Supporting materials/resources

Challenges

• Need for consistency of approach
• Sustainable
• Cost
• Need to get it right & embed it

Refreshment break

Introduction to the workshop Rory McGill, Public Health Specialty Registrar and Nicola Harris, Programme Manager Suicide Prevention Champs Public Health Collaborative

Introduction to the Primary Care Pilot workshop

Rory McGill, Public health Specialty Registrar Nicola Harris, Programme Manager Suicide Prevention, Champs Public Health Collaborative

Vs.

Project Aim - feasibility of finding patients who have potentially a higher risk of suicide.

• 1. Who and How we will use the information?
• 2. What are the benefits of identifying this group?

In Groups discuss:

• 3. How do we measure the success of this, both in

terms of usefulness to GPs and ultimately in terms of reducing suicides. Workshop - Part 1

Workshop - Part 2 Scoping the next phase

• 1. Does the criteria from the current pilot work for

us?

• 2. Are there other actions arising from part one

that need to be implemented?

• 3. Agree the scope of the project
• 4. Agree leads for the next phase

Workshop facilitated by Justine Maher, ZSA Programme Manager, Zero Suicide Alliance and Rebekah Shaw, Business Change Manager, Zero Suicide Alliance

Chairs closing remarks and next steps

Thank you for attending

Please complete your evaluation form

The presentations can be accessed following the event via www.champspublichealth.com