Suicide Prevention in Gloucestershire

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Suicide Prevention in Gloucestershire

• Sola Aruna
• 30.06.10

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Policy Context

• NSF for Mental Health 7 standards
• 7th standard (Preventing Suicide) which depends
  on the other six standards
• 1 Mental Health Promotion
• 2 3 Primary care access to services
• 4 5 Effective services for people with severe
  mental illness
• 6 Caring about carers
• And
• Preventing suicide in prisoners
• Competence in assessing risk of suicide
• Local systems for suicide audits
• New Horizons towards a shared vision for mental
  health
• Improve mental health well being of population
• Improve quality accessibility of services for
  people with poor mental health
• Lifespan approach

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Suicide in Gloucestershire
Mortality from Suicides and Undetermined Injury.
DSR for al lAges, 2006-08
Source NCHOD
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Suicide reduction target

• 2010 reduction target of 20 from 1995-97
  baseline 6.56 per 100,000 population
• With current trend 7.90
• SW target of 7/100,000 by 2013

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Suicide Audits

• Population-based
• ONS, Coroner, GHT, 2FT, Primary Care
• Identification of trends/local risks
• Informs preventive activities
• Learning
• Broad-based including primary care level
• Recommendations
• Broad-based including primary care level
• Gaps data on sexual orientation, ethnicity

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Suicide patterns in Gloucestershire
Method of suicide
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Why do people take their lives?

• Reasons very complex
• Risk/protective factors
• Different levels individual, social,
  contextual
• Modifiable/non-modifiable
• Relationship not a straight forward one
• Individual, social, contextual

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Risk and Protective Factors for Suicide
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How can knowledge of risk factors help prevent
suicide?

• Identification of
• existing risk factors present for
  individual/group
• individuals most likely to be badly
  affected/resilient
• modifiable factors (to reduce risk)
• Focus on specific groups/populations at risk
  rather than individuals
• Focus on groups of risk/protective factors

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Protective factors

• Research into this not as long standing as those
  that increase vulnerability or exposure to
  suicidal thinking
• Recent research on what builds resilience and the
  ability to cope with adverse life events
• (Beautrais, 2006 Beautrais et al. 2005, 2007
  Brent Mann, 2006 Bridge, 2006 Knox et al.
  2003 Mann et al. 2005 Page et al. 2006a Qin et
  al. 2002b Robinson et al. 2006 Rehkopf Buka,
  2006 WHO, 2002).
• Many theories on what gives an individual the
  resilience to cope with and bounce back from
  adverse life events
• Individuals will respond to potentially traumatic
  events in four different ways
• resilience accompanied by mild disruption ( 60
  of people)
• initial shock followed by recovery over time (
  20 of people)
• delayed intense emotional reaction ( 10 of
  people)
• chronic disruption and ongoing mental disorder (
  10 of people) - Bonanno, 2004

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Health and Well being Suicide Prevention

• Individuals develop sense of self way of coping
  with life from birth
• Factors that influence resilience include
• Individual health well being (see next slide)
• Predisposing/individual factors - genes gender
  and gender identity personality
  ethnicity/culture socioeconomic background and
  social/ geographic inclusion or isolation
• Life history experience - Family history and
  context previous physical and mental health
  exposure to trauma past social and cultural
  experiences and history of coping
• Social community support - Support and
  understanding from family, friends, local doctor,
  local community, school level of connectedness
  safe and secure support environments and
  availability of sensitive professionals/carers
  and mental health practitioners (Beautrais, 1998
  Kumpfer, 1999 Maslow, 1943 Rudd, 2000)

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Health and Well being Suicide Prevention

• Strengthened health well being depends on
• Sense of self self-esteem secure identity
  ability to cope and mental health and wellbeing
• Social skills life skills communication
  flexibility and caring.
• Sense of purpose motivation purpose in life
  spirituality beliefs and meaning
• Emotional stability emotional skills humour
  and empathy
• Problem-solving skills planning problem
  solving help-seeking and critical and creative
  thinking
• Physical health health physical energy and
  physical capacity

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Mental illness Suicide

• Strong relationship with suicidal behaviour
  (Taylor et al. 2005) BUT only 25 not
  everyone who takes own life has mental/emotional
  illness/problems
• There may be a strong link between mental
  illness, genetic factors and life events (Caspi
  et al. 2003 Rutter et al. 2006) - ? depression
  due to acculated stressful life events involving
  threat, loss, humiliation, personal defeat
• Complex circular relationship between mental
  health, other risk factors and suicide e.g.
  having a mental illness may give rise to events
  that exacerbates suicidal thoughts mania ?
  reckless decisions ? unbearable stress ? suicidal
  thoughts
• Some mental illnesses are associated with suicide
  related behaviours and/or suicide clinical
  depression, bipolar disorder, schizophrenia,
  alcohol or other drug abuse, borderline
  personality disorder, behavioural disorders

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Mental illness Suicide

• Suicide
• Commoner cause of death in people with
  Schizophrenia and mood disorders
• Higher risk in psychiatric in-patients
  (especially immediatly after discharge from
  hospital or AE)
• Higher risk (acting on suicidal thoughts) in
  people in early recovery phase of depression
  delayed response to treatment
• Treating 50 of the people with 3 most relevant
  mental disorders (depression, alcohol/drug/substan
  ce abuse disorders and schizophrenia) will reduce
  suicides by 20 (Bertolote et al. 2004)
• Treatment plus providing a sense of caring,
  better social connectedness and creating a
  secure, safe and empathetic environment

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Personal factors/Live events Suicide
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Personal factors/Live events Suicide
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Precipitating events
Warning signs
Tipping point
Imminent risk
Risk factors
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Prevention

• Focus on
• Individual health well being
• Suicide-specific person-centred approach
• Universal interventions
• Selective interventions specific at-risk
  population
• Indicated interventions specific high-risk
  individuals showing early signs of suicidality
• Limited evidence of effectiveness of
  interventions
• Symptom identification
• Care support
• Early intervention
• Standard treatment
• Longer term treatment support
• On-going care support

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Evaluation

• Very few interventions have been evaluated fro
  effective and impact
• Challenges with choice of appropriate measure
  rare event needing huge sample size if reduction
  in suicide rate is to be measured (15 reduction
  in national rate will need 13 million sample
  (Gunnell Frankel, 1994).
• Measures used should include
• the prevalence of suicide attempts
• suicide-related behaviours thinking or
  communication
• changes in predisposing vulnerabilities and
  protective factors (Beautrais et al. 2007 Headey
  et al. 2006 Mann et al. 2005 Maris et al.
  2000).
• Evaluation important - suicide prevention is
  inexact process based on limited evidence (De
  Leo, 2002)

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So.

• Interventions should be multi-modal and
  complementary, targeting a wide range of high
  risk groups.
• WHY
• there is no single, readily identifiable,
  high-risk population that constitutes a sizeable
  proportion of overall suicides and yet is small
  enough to target easily and have an effect
  (Gunnel Frankel, 1994