Self-harm and suicide


 

Last updated: 2020-02-03 15:05:04
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1. Summary

Last updated: 03/02/20

2. Introduction

Suicide

Suicide has been defined by the Office for National Statistics as “a death with an underlying cause of intentional self-harm or an injury or poisoning of undetermined intent”. There are approximately 6,000 suicides per year registered in the UK.

There is no simple explanation for why someone chooses to die by suicide and it is rarely due to one particular factor.  Factors that lead to suicide are complex but nonetheless preventable. Mental health problems are important influences, as well as alcohol and substance misuse, the current economic climate and welfare reforms, feeling desperate, helpless or without hope.

Following a suicide there is an impact across the community which has been affected by this. For each suicide it has been found that it directly affects at least 10 people, but other estimates by Public Health England (PHE) suggest that around 50 people are affected by a suicide.

For each person who dies by suicide it costs the economy an estimated £1.67 million (2009 figures). Which further shows the need for Public Health to address suicide prevention as a key priority.

Self-harm

Self-harm is defined as ‘self-poisoning or self-injury, irrespective of the apparent purpose of the act’. Self-harming can take many forms such as cutting/scratching, burning, scalding, hair pulling and ingesting toxic substances or objects. 

Current estimates suggest that around 1 in 10 young people have engaged in self-harm behaviours. Across the whole UK population it is estimated that 400 in 100,000 people self-harm.

There are many reasons why a person may self-harm including feeling isolated, academic pressures, suicide or self-harm by someone close to them, low self-esteem or poor body image, bullying and difficult personal relationships including family issues, trauma, depression or anxiety.  In addition, there are a range of risk factors that can impact generally on mental health including deprivation, parental factors, domestic abuse and school factors.

People who have self-harmed or made a serious attempt at suicide in the past are more likely to do so again, and are therefore at much greater risk of dying by suicide in the future.

Other JSNA topics this topic closely linked to:

Mental wellbeing

Armed forces community

Offenders

Alcohol misuse

Domestic abuse victims

Illicit drug use

Poverty

Employment

 

 

Last updated: 03/02/20

3. Data and Intelligence

Suicide

In England and Wales, all suicides are certified by a HM Coroner following an inquest. The death cannot be registered until the inquest is completed, which can take months and sometimes years, therefore providing a delay on the information.

Due to this delay the suicide figures are representative of the year in which the death was registered, not necessarily the year in which the death took place.

Where there is insufficient evidence to suggest that an individual did die by suicide an open or narrative verdict is given by HM Coroner. This therefore means that often there is an under reporting of the actual number of suicides that happen within the UK each year.

In 2018 there was a ruling that the standard of proof for recording a suicide would change from the Criminal Standard to the Civil Standard, which aims to address the under reporting of suicide nationally.

In 2015-17, the suicide rate in Stockton-on-Tees (9.2 per 100,000 population) was statistically similar to the national average (9.6 per 100,000 population).

From 2013-16 the rate was statistically significantly higher than the national rate, however, this is likely due to a new coroner being employed across the Tees area looking at a backlog of coroner cases awaiting an inquest. It is expected that the suicide rate locally will continue to be at a similar rate to the national average.

Tees audit

In 2017, an audit was conducted using coroner records to gather information regarding local suicide data for the full years of 2015 and 2016 across Teesside. Data from ONS informs that there were 37 recorded suicides in Stockton-on-Tees for this two-year time period. The purpose of the audit was to provide medium term planning to prevent suicides by providing an in depth look at local cases.

The below chart shows that in Stockton-on-Tees, the suicide rate for males is twice as high as the suicide rate for females.

The below chart shows that only 1-in-6 individuals who took their own life were engaging with a mental health service at time of death.

During the audit process wider themes are investigated as possible contributory factors as to why potentially that person took their own life. Suicide is multi-faceted there is never one single factor which leads to suicide, often there are many different issues ongoing.

The following themes were identified as recorded contributory factors. In 60% of cases 2 or more of these themes were recorded:

  •  Poor mental health
  • Bereavement
  • Financial issues
  • Relationship issues/breakdown
  • Recent involvement with the criminal justice system

From the coroner data it was also found that:

  • 77% of deaths were within the home
  • 20% of the deaths were on private property
  • 3% of the deaths were in a public space

This highlights the need for agencies to work together on this key issue to provide points of potential intervention at an earlier stage to identify suicidal ideation as still most deaths occur in a place where there is minimal opportunity for intervention.

Self-harm

The rate of hospital admissions as a result of self-harm (10-24 years) in Stockton-on-Tees is generally statistically significantly higher than the national average, however, on 2016/17, the rate reduced and was similar to the England rate. 

The rate of hospital admissions as a result of self-harm (20-24 years) in Stockton-on-Tees is statistically significantly higher than the national average This has been the case for a number of years. 

The rate of hospital episodes for intentional self-poisoning by exposure to alcohol in Stockton-on-Tees is generally statistically significantly higher than the national average. 

The rate of emergency hospital admissions for intentional self-harm in Stockton-on-Tees is statistically significantly higher than the national average This has been the case for a number of years. 

Emergency hospital admissions for intentional self-harm is prevalent across all age groups and genders in Stockton-on-Tees, however, the rates are highest for females who are 15-24 years old. 

Females under 14 years old are much more likely to have an emergency hospital admissions for intentional self-harm than males of a similar age. 

Investigating further in to the 15-to-24 age group, emergency hospital admissions for intentional self-harm in Stockton-on-Tees are highest for teenage females, particularly 15-year-olds.

Tees audit

The Tees suicide audit found that 1-in-6 of the Stockton-on-Tees residents whose death was recorded as suicide had previously self-harmed.

A&E and primary care data quality

There are currently data quality issues with A&E data relating to self-harm, therefore, we do not fully understand the true extent of self-harm as many A&E attendances for self-harm will not result in an admission.

Self-harm incidents are rarely presented directly to primary care as an acute event, it’s much more often that self-harm is disclosed during a conversation regarding a mental health condition (e.g. depression) and would therefore not be coded on primary care systems as self-harm. 

Last updated: 03/02/20

4. Which population groups are at risk and why?

Last updated: 03/02/20

5. Consultation and engagement

Last updated: 03/02/20

6. Strategic issues

Last updated: 03/02/20

7. Evidence base

Issue number

1 = highest priority

 

1

Source

Public Health England (PHE)

 

National Institute for Health and Care Excellence (NICE)

 

Government Office for Health & Social Care

 

Samaritans

All Party Parliamentary Group (APPG)

Office for National Statistics (ONS)

Title incl. web links

Local Suicide Prevention Planning: a practice resource

Preventing suicide in community and custodial settings

Preventing suicide in England: Third progress report of the cross government outcomes strategy to save lives

Socioeconomic disadvantage and suicidal behaviour

Inquiry into local suicide prevention plans in England

Suicides in the United Kingdom

Summary

PHE: A resource to support local authority public health teams to work with a range of partners to develop or update local suicide prevention plans to ensure that they review the whole system approach, this includes a section to review the male at risk population group.

NICE: A resource to review local plans to ensure that there is preventative work ongoing within both communities and custodial settings.

GOV: cross-government strategy to review the whole system approach to prevent suicides including males as an at-risk population group.

SAMARITANS: National guidance on suicidal behaviour and the role of local authorities in preventing suicides.

APPG: Findings and recommendations regarding suicide prevention plans in England.  Incorporating the work of the whole system to reduce suicides.

ONS: 2017 registrations of death by suicide, this shows the rates of males compared to the rates of females.

2

Source

National Institute for Health & Clinical Excellence (NIHCE)

Mental Health Foundation (MHF)

National Institute for Health & Clinical Excellence (NIHCE)

Title incl. web links

Self-harm: The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care

Truth hurts- report of the National Inquiry into self-harm among young people.

Self-harm in over 8s: long-term management

Summary

NIHCE: Multi-disciplinary guidelines to advise on the prevention of self-harm in primary and secondary care.

MHF: An overview of evidence regarding what self-harm is, how to respond to self-harm and plans which can be put in place to prevent this.

NIHCE: Reviewing the role of a range of different organisations, those who self-harm and their carers to prevent self-harm.

 

Last updated: 03/02/20

8. What needs to be done and why?

Community

  • Teesside Samaritans – providing 24/7 support to those in distress, working with schools and business to provide training and support for both suicide prevention and postvention.
  • A wide range of voluntary and community sector (VCS) organisations that support individuals to improve emotional wellbeing and mental health
  • Job Centre Plus – each site has a ‘Complex Needs plan’ which is accessible to all work coaches. The plans varies by site depending on what local resources are available. The plan has information to signpost and support our most vulnerable customers including Mental Health, Homelessness, Disability, Forces Community, Addictions, Debt, feeling Suicidal/Self harm, ex offender etc. Each JCP work coach working with customers in front facing roles have attended a two day Mental Health awareness training. Throughout DWP a further 2000 staff are to be trained to be Mental Health First Aiders. JCP have a number of outreach programs which include Prison Work Coaches, Troubled Family Employment Advisors co located with Stockton Borough Council, patient Advisory Support teams and school advisors.
  • Citizens Advice- Help Through Crisis scheme supporting those going through financial crisis to support their emotional wellbeing
  • CRUSE – bereavement service including specialist suicide bereavement support and postvention
  • Stockton Information Directory (SID) – an online directory of services for Stockton residents
  • Stockton Welfare Advice Network (SWAN)- providing free information and resources on a range of issues affecting people living in Stockton.

Workplaces

The Better Health at Work Award Programme promotes good emotional wellbeing and mental health within the standards of the award.

Mental health

As part of the cross-government report it was recommended that all local authorities had a suicide prevention plan in place. This led to the development of the Tees Suicide Prevention Action & Implementation plan. Within this is 6 strands:

  • To support those high risk groups
  • High risk locations – reducing access to means of suicide
  • Comms/media engagement to report sensitively around suspected or confirmed death by suicide
  • Commissioned CRUSE Bereavement Care to provide specialist suicide bereavement counselling and postvention
  • Tees Suicide Prevention Taskforce – multiagency working group to address ways of joint working to reduce suicides.
  • Tees Training Hub – providing mental health training, such as; ASIST (Suicide Prevention Training), Mental Health First Aid & A life worth living
  • Tees Crisis Care Concordat with an identified work stream being the Prevention Concordat for Better Mental Health.

Primary care:

  • Improving Access to Psychological Therapies
  • GP practice assessment, support and treatment.

Secondary care & specialist services:

  • Tees Esk & Wear Valley Mental Health Foundation Trust
  • Community Mental Health Services
  • Criminal Justice Services
  • NHS Acute Hospitals
  • Child & Adolescent Mental Health Services (CAMHS)
  • Crisis Assessment Suit & Crisis Intervention
  • Liaison Psychiatry
  • Substance Misuse Services 
Last updated: 03/02/20

9. What needs are unmet?

Last updated: 03/02/20

10. What needs to be done and why?

Last updated: 03/02/20

11. What additional needs assessment is required?

Further engagement and consultation with service users and other interested stakeholders in Stockton-on-Tees is required to gather further service level data relating to the prevention of suicide and self-harm.

Qualitative information from those who attempted suicide but did not complete to understand the key differences between those who attempt and those who complete, including protected characteristics.

Work with providers to gather data and intelligence regarding engagement with other services, e.g. social care, job centres, Citizens Advice Bureau but also more data around self-harm that is reported through other settings, not A&E including the method of self-harm.

Wider demographic data that is not recorded through coroner records; e.g. ethnicity and sexual orientation to understand any further work. 

Last updated: 03/02/20

12. Key contact

Name:   Mandy Mackinnon

Job title:    Strategic Health & Wellbeing Manager (Adults)

Organisation:  Stockton-on-Tees Borough Council - Public Health

Phone number:  01642 528478

Contributor/s:  

James O'Donnell (SBC)

Katie Bannister (Tees Suicide Prevention Coordinator)

Last updated: 03/02/20

E-mail: mandy.mackinnon@stockton.gov.uk