Report of The Director of Population Health, Nursing and Safeguarding, Manchester Health and Care Commissioning

This report provides the Committee with an update on the paper on suicide prevention submitted in December 2017 and specifically reports progress on the delivery of the local suicide prevention plan (2017 - 2019) and on the development of a refreshed plan for 2020 – 2025.

The Committee considered the report of the Director of Population Health, Nursing and Safeguarding, Manchester Health and Care Commissioning that provided Members with an update on the paper on suicide prevention submitted in December 2017 and specifically reported progress on the delivery of the local suicide prevention plan (2017 - 2019) and on the development of a refreshed plan for 2020 – 2025.

The Director of Population Health referred to the main points of the report which were: -

·                The national and local strategic context of suicide prevention;

·                Key trends, facts, figures and risk factors relating to suicides in Manchester;

·                A summary of key areas of activity contributing to suicide prevention;

·                Progress on delivery of specific actions within the local plan; and

·                Development of a refreshed plan for 2020 – 2025.

The Committee then heard from Prof Navneet Kapur, Head of Research at the Centre for Suicide Prevention, University of Manchester. He informed the Members that the issue of suicide prevention had begun to take a more prominent role both locally and nationally, commenting that a Minister for Suicide Prevention had been appointed. He stated that nationally, NICE (National Institute for Health and Care Excellence) guidance had been refreshed and published in relation to both suicide prevention and self-harm. Locally he described the work undertaken to raise awareness of this issue and described the work of the Greater Manchester Shine a Light campaign delivered to coincide with World Suicide Prevention Day, and the powerful Exhibition of Hope delivered in the Town Hall that had been designed and coproduced with people who had experience of suicide. He further described the establishment of a dedicated Bereavement Service, to support people affected by suicide.

Prof Kapur further described recent changes to the legal recording of suicides. He stated that previously a coroner had to apply the criminal test of ‘beyond reasonable doubt’ when determining cause of death. He said that this had changed and the test now was ‘balance of probability’. He stated that this had the potential to increase the number of recorded deaths by suicide, and in response to a question from a Member he advised that consideration would be given to how this data was used to understand comparative information to reflect this change.

The Committee then heard from Cllr Midgley, Mental Health Champion who described the work of the Manchester Suicide Prevention Partnership. She informed Members that the partnership steering group met regularly and oversaw the operational delivery of the local suicide prevention plan and shaped the strategic direction of this work. She described that the Partnership was comprised of a range of stakeholders and they were all committed to working together. She further described examples of this and the positive outcomes achieved by adopting this approach. She stated that the Partnership was working to deliver awareness training around this issue to frontline workers, including staff working within housing providers and school nurses. She described that demand for this training was very high and they were continuing to review this and identify areas that would benefit from this training so as to help support people to engage in this subject. Cllr Midgley concluded by paying tribute to all of the staff working within the Public Health team for their dedication, hard work and support for this important area of work. 

Members commented that it was important to always acknowledge that suicide was a tragic event for the individual, their families, friends and all those affected. In response to a question asked by a Member regarding the figure quoted within the report that the estimated cost of a completed suicide was £1.67m, Prof Kapur advised that information on how this figure was calculated would be provided to the Committee following the meeting.  

Members noted the statistical information and commented that a link could be identified between the onset of economic recession and austerity and a rise in the numbers of recorded suicides.  Prof Kapur responded by informing the Committee that studies across both Europe and the United States had demonstrated that there was a link between economic down turn, austerity and suicide.

A Member commented on the list provided of groups identified as being at risk of suicide and enquired if Looked After Children should have been included. Prof Kapur commented that it was recognised that this was a group at risk and would be included.

Members then discussed their concern regarding suicide being the leading cause of death in the UK for 10-19 year olds. The Deputy Director of Commissioning, MHCC acknowledged this concern and informed the Committee that work was being developed and coordinated across Greater Manchester to respond to this. She stated that dedicated commissioned crisis services for young people were at different stages of development and implementation, commenting that part of this response was the intention to further roll out the CAHMS (Child and Adolescent Mental Health Service) provided in North Manchester. She further stated that the real time data provided by the Coroner’s office would be used to help identify trends and emerging issues, both at a local and national level and that would inform appropriate interventions and responses and inform safeguarding work and practices.

The Deputy Director of Commissioning, MHCC stated that Adult Mental Health Services continued to be improved, noting the increase in Home Based Treatment; improved Mental Health liaison with Accident and Emergency Departments and improving mental health care pathways. She further informed the Committee that it was the intention to commission Crisis Cafes in the city to offer face to face appointments and offer peer support. She further described that work was ongoing to align services, such as Improving Access to Psychological Therapies (IAPT) within the Neighbourhood models of service delivery. The Chair commented that the Committee would be interested in learning more of these developments and a report would be scheduled into the Committee’s Work Programme. 

Members discussed the impact of social media and the negative impact this could have on young people, especially in relation to bullying and issues of self-esteem.     Professor Kapur noted this comment and acknowledged that this was an issue but added that not all social media was negative and that it was a useful medium to offer advice and promote services to support young people experiencing crisis. He further commented that social media needed to be used responsibly and appropriately regulated to avoid harm. He commented that research was underway to understand the factors for the reported increased levels of anxiety amongst young people. He further stated that the ambition was to have a mental health provision in every school to help identify and support those young people at risk of self-harm.

Members then discussed the issue of employment and the prevalence of zero hour contracts and unsecure contracts of employment and the impact of this on mental health. A Member commented that a company might have all of the correct written procedures in place regarding staff welfare, however the nature of the terms of employment could result in pressures for individuals and their families. Members commented that other factors such as concerns over climate change and current economic uncertainty could also contribute to levels of anxiety experienced across the general population.

Members stated that work needed to be done to raise awareness of the issue of suicide prevention with all employers, including those in the private sector and Trade Unions. Cllr Midgley responded that she would look at what could be done to engage with Trade Unions around this issue.

In response to a question posed by a Member regarding how to reach those males who were reported as being three times more likely to die by suicide than females and who might not be known to any service or health professional, Prof Kapur advised that a number of innovative interventions had been developed. He said that these included reaching out and providing a presence in those places where men go, including sports events and public houses.

Decisions

The Committee: -

1. Note the report.

2. Recommend that the research relating to the economic impact of suicide be circulated to the Committee.

3. Recommend that a report on the provision of Mental Health Services in Manchester be included on the Committee’s Work Programme to be considered at an appropriate time.