This week’s Leadership Message comes from Mike Doyle and Lin Harrison

We have been working together to reduce suicide across West Yorkshire and Harrogate since 2016/17 and that ambitious work has gathered pace in this last year. As with all of our work across the Partnership, COVID-19 has brought new challenges and we and our many colleagues and partners have worked hard to adjust and adapt.

In last week’s blog Alistair and Justin wrote about an ‘accelerated evolution’ of Partnership wide changes made at pace in our response to COVID. Alistair gave an example of an initial 1000% increase in online consultations in his practice that has continued to rise. We are aware of many similar examples of rapid and innovative changes to the delivery of care within our own Trust (South West Yorkshire Partnership NHS Foundation Trust) as teams have adapted and adjusted, working in new ways. For both of us, MS Teams meetings and webinars have quickly become the norm and the constant demand to be online needs careful monitoring. At the same time national and regional webinars have supported us in adjusting suicide prevention work during lockdown, allowing for the sharing of ideas, IT solutions and support. Whilst this level of innovation and creative problem solving develops, we need to remember the suicide prevention aspect of all of this, both for those that use our services, those that crucially don’t and might need to and also for us as a workforce. 

We need to be mindful of varying degrees of digital literacy and digital exclusion, of the unintended potential to widen the health inequalities that can increase vulnerabilities to both COVID-19 and suicidality for some in our communities as we adjust our service offers. We need to stay alert to the pressure felt by particular groups at this time, our children and young people anxious about their futures, those from BAME and LGBTQ+ communities, staff throughout our partnership who feel fatigued, and need support themselves and our many voluntary and community colleagues who are perhaps seeing those people who have not been engaging with health and care services throughout the pandemic. This week saw the publication of the NHS People Plan, and within it 'Our NHS People Promise' challenges us all to make the NHS a better place to work. This must be true throughout our Partnership. It needs to be safe enough too. So we know for instance that female nurses are at heightened risk of suicide, and are also in the frontline of a possible ‘second wave’ (Nursing Times, 2019).

This next phase of our response to COVID-19 is often referred to as stabilisation and reset, language that may feel decidedly neater than the reality for many in our communities facing uncertain futures. Again, our minds turn to how this affects vulnerability to self-harm and suicide particularly. If we are able to consider the risks we can move to how we work strategically to mitigate them. COVID-19 may be a new and bewildering situation, but there are known and well researched aspects to the challenges it brings that can guide us.

At our recent suicide prevention advisory network meeting, Professor Louis Appleby reminded us that though we may not have direct evidence of how this novel pandemic will affect suicide rates, there’s a research base we can draw on to mitigate possible risks. We know that those at greatest risks are people with mental health problems, children and young people, those who are economically vulnerable, those bereaved or traumatised and we also know that heath inequalities will exacerbate risks. This knowledge must inform our suicide prevention work going forward as we work strategically to mitigate risks; one example might be targeted work for those most impacted by the economic downturn in the economy and the long term recession to come.

Increased funding for Suicide Prevention work in West Yorkshire and Harrogate

We have successfully secured national funding from NHS England/NHS Improvement for several key programmes to take suicide prevention work forward across our communities.

Trailblazer funding has enabled us to employ two pathfinder support workers whose ambition is to reach men in our communities, vulnerable to suicide risk, through our ‘Great Minds’ project work. These workers are mapping out and linking up sources of support across WY&H so that men can get the help they need, when they need it. They will also be offering groups to teach mental fitness for up to 600 men in our communities, working closely with our colleagues in State of Mind Sport who draw on their own lived experiences. This work will now take place online, we have produced some great promotional films to promote the ‘Great Minds’ project and our workers are also providing online network groups for local support services to connect with each other during lockdown.

Work on postvention, or suicide bereavement support, is also a key objective of our work. Despite our ambition to reduce suicide rates, we know that some people in our communities will sadly go on to take their own lives. The impact of this loss on those left behind is enormous, in fact research studies highlight an increased risk of suicide attempts in those bereaved by suicide, and also found that those affected were more likely to drop out of education or work. Many of us are affected when someone takes their own life; for some this may be the loss of a family member, a friend, colleague, someone who you cared for in the course of your work or even a stranger whose death you may have witnessed and support options are needed for all. The West Yorkshire Suicide Bereavement Service, run by our key partners at Leeds Mind, launched in December 2019 with the aim of offering support to 140 people in the first year. In the 8 months since we opened project staff have already received and responded to 114 referrals and this continues. These referrals have been directly responded to on average within less than 1 day of and the service has been accessed by people right across West Yorkshire and Harrogate. This service builds on the well-established and evaluated peer-led service offered in Leeds for the last four years. All project staff are themselves bereaved by suicide and so best placed to offer a range of support grounded in lived experience. Funding has now been secured to continue this valuable work for another year. Again, the team have adjusted the service offer due to lockdown and continue to find ways of providing this valuable support to those bereaved by suicide with more telephone sessions, online peer groups, the ‘Living with my loss’ course and virtual coffee mornings.

We have also recently secured three years of Wave funding, totalling over £1.5million, which will allow us to undertake more locally targeted work in each of our places; to reduce suicide within acute hospitals and mental health services by improving how we address risk factors such as self-harm; an increased focus on improving our understanding on people’s experiences of self-harm to further inform our work; and the provision of more suicide prevention and alertness training. We will also work closely with the Police to continue the development of a system called Real Time Surveillance, which allows us to be informed as soon as possible following a suspected suicide. This means support can be offered to those affected immediately and helps us plan further suicide prevention work.

The local place based funding allocated (Bradford district and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield) through the wave money will support a wide variety of suicide prevention work, including more training on self-harm, small grants schemes for grassroots projects, local suicide awareness campaigns and mental fitness sessions offered in the workplace with some of our region’s biggest employers. We know that people who are struggling with thoughts of suicide can really struggle to reach out for help for a whole variety of reasons. It’s no surprise then that many of our workplans involve taking an initiative to people where they are, where they work being a great example.

We are also committed to supporting research and innovation to help deliver our suicide prevention strategy. The Partnership recently funded phase two of a pioneering study led jointly by South West Yorkshire Partnership NHS Trust and the University of Huddersfield investigating how machine learning and artificial intelligence might help to prevent suicides.  Early days for this novel approach but phase one of this works has already been published[1]. This approach supports working with public health colleagues to create a high-risk decision support tool for primary care and non-mental health services to identify people at risk of suicide so we can better target support.

Every death by suicide means the loss of someone’s friend or family member, and even the deaths by suicide of people we don’t know can sadden us - we’ve heard many people speak of how the death of the television presenter Caroline Flack affected them, despite not knowing her personally, as Mel Pickup did in her recent leadership message. One research study estimates that each death by suicide affects more than 130 people and when someone with a high public profile, or in a community such as a school or workplace, takes their life this impact can be hugely magnified. In truth we can never really calculate the extent of these losses; death by suicide impacts us as individuals, on our communities, faith groups, families and on our wider society. On a personal level, Lin overheard staff in her local fruit and veg shop talking about their shock following the suspected suicide of a local young man just last week. They had all known him and his family since he was a young boy and just didn’t know how to make sense of this. She took the opportunity to talk to them about what support might be needed for them, the young man’s family and friends and dropped off some copies of the booklet ‘Help is at Hand’ and information about their local postvention service. Daring to speak about suicide and reaching out is so important, it can be lifesaving.

Across the Partnership we know the added value of working at scale, developing strong alliances and linking communities in our shared endeavours. Nowhere is this more needed than in suicide prevention and it takes a connected, vibrant network of diverse and collaborative partners to build suicide safer communities – that means all of us.

This focussed work is a key priority in the West Yorkshire and Harrogate Health and Care Partnership Mental Health, Learning Disability and Autism five year strategy (2019-2024). We intend to reduce death by suicide by 10% overall and 75% in targeted areas (such as mental health services, custody suites and frequently used locations). Achieving this target is a huge challenge, particularly in light of the Office of National Statistics data showing a significant rise in rates.

We need to work together, drawing on good practice whilst at the same time developing innovative approaches. We have adopted a ‘Zero Suicide’ philosophy across West Yorkshire and Harrogate, where every death by suicide is seen as preventable, not inevitable.

Our Trusts are members of the Zero Suicide Alliance and have committed to implementing the ‘10 ways to improve safety’ recommendations and to developing Zero Suicide action plans. It’s likely that these efforts have resulted in the fall we have seen in suicide rates for mental health patients in our care, a downward trend that has continued for several years now. This is encouraging news and shows the impact we can make when we work together strategically and share best practice.

We’ve been working collaboratively with partner agencies in recent years to deliver suicide prevention training in our communities; training firefighters to themselves train as trainers and deliver these courses directly; developing data-sharing arrangements with West Yorkshire Police to share information in a timely manner so we can respond as effectively as possible to a suspected suicide; working with Highways England to restrict access to means in public places; developing guidance for the media on sensitive reporting of suicide and much more besides.

This next phase of work in West Yorkshire and Harrogate promises to bring new challenges and opportunities.

We wanted to sign off by leaving you with a challenge, which may be different for each of us, us included! You might want to join one of our Suicide Prevention Advisory Network (SPAN) meetings (all are welcome, just get in touch and let us know); maybe even sign up to join a working group; sign up for Applied Suicide Intervention Skills (ASIST) or SafeTalk Training; complete the easily accessible ‘20 minutes to save a life’ online training here; access our bereavement service for support; spread the word about a mental health resilience course for men; tweet about suicide prevention or numerous other things.

Suicide prevention is all of our business and we need to work together to make a difference. Our fabulous ‘Looking out for our neighbours’ campaign has really demonstrated the difference we can make when we reach out and connect. This is how we build communities, combat isolation and instil hope. Thanks for taking the time to read this, and for all that you already do to build suicide safer communities. Finally don’t forget there is some really helpful support available also from the Samaritans and / or Papyrus for you or anyone you know who may need it. Please do reach out for support if you need to and spread the word.

Thanks for reading and take care,
Mike and Lin

[1] Adamou, M., Antoniou, G., Greasidou, E., Lagani, V, Charonyktakis, P., Tsamardinos, I. and Doyle, M. (2018). Toward Automatic Risk Assessment to Support Suicide Prevention. Crisis. https://doi.org/10.1027/0227-5910/a000561