Agenda item

·         Draft Action Plan 2019-20

·         Report

The Chairman invited the following to the table:

• Dr Jeff Lake - Consultant in Public Health, LB Barnet
• Dr. Patricia McHugh - Barnet, Enfield and Haringey Mental Health Trust
• Professor Liza Marzano – Associate Professor in Psychology, Middlesex University
• PC Carl Ford -  Mental Health Police Liaison Officer, Metropolitan Police
• Ms Sharon Thompson – Community Services Manager, Barnet, Enfield and Haringey Mental Health Trust
• Ms Seher Kayikci – Senior Health Improvement Specialist, LB Barnet

Dr Lake reported that the National Suicide Prevention Plan appeared to have shown some improvements and a clearer picture had emerged on the most useful actions needed locally and regionally. Significant developments had been made as part of the London-wide Suicide Prevention Framework, including the development of the Thrive London information-sharing portal for partners to exchange information where possible suicide was suspected. Targeted help was available for individuals affected by suicide particularly given that such individuals were known to also be at increased risk of suicide.

Dr Lake presented Barnet’s Action Plan which included work on self-harm and ideation, and a review of safety planning for discharge after an episode of self-harm or a suicide attempt. There was also support for those bereaved or affected by suicide and a review of the data would be undertaken to try to identify any hotspots in the Borough. A working group met annually and has six-month review meetings and workshops on particular topics.

Professor Marzano reported that Middlesex University was involved in several projects which make up a piece of work commissioned by the Samaritans and funded by the Rail Industry. Professor Marzano also worked with the media on its portrayal of suicide to try to avoid any unhelpful messaging. She was also keen to apply international work locally such as recommendations by the International Association of Suicide Prevention.

Ms Kayikci reported that as part of the Public Health Team in Barnet, her role is to contribute to the annual Suicide Prevention Report, review data and work with partners to make sure that actions set out are achieved.

Ms Thompson noted that she works directly with patients in collaboration with the CCG in Barnet and has operational responsibility for both inpatient and crisis patients. Her role involves ensuring safe discharge as well as producing support packages for affected families. She noted that a Serious Incident Review is undertaken for every suicide attempt, checking that the service had done all it needed to do including a review within 72 hours.

A Member asked about the risks in relation to SEND adults. Ms Thompson responded that a care coordinator was responsible for coordinating referrals and this depended on individual needs. Dr Lake added that some work had begun with the Lead Commissioner for Learning Disabilities on suicide with a report scheduled to be available around Autumn 2019.

A Member enquired about how referrals could be made. For example, the Samaritans were not able to make direct referrals. Ms Thompson noted that the highest percentage of referrals came from GPs and people could also self-refer. She added that the Samaritans’ policy had changed recently in that if someone is thought of as an immediate risk the Samaritans can and should  break confidentiality. However, callers were often anonymous. The Barnet Mental Health Team was working with Barnet Homes and other work was ongoing to find out what the barriers were to seeking help. For example, some residents were not registered with GPs and for some their mental health needs were preventing them from accessing accommodation.

Dr Lake noted that the issue of confidentiality was reflected in the thematic review work that the working group had done. Families typically did not want schools to be notified of events or concerns and often they were not keen to share information. However, safeguarding concerns could override this.

Professor Marzano reported that Middlesex University has a Student Wellbeing Committee as suicide was something  the University was very concerned about especially as there had been clusters of suicide at both Bristol and Canterbury Universities.

A Member asked how key performance indicators (KPIs) are driven. Dr Lake responded that these were not in relation to the number of suicides and no specific action was required by partners, although they were willing to do as much as they could. The workshops had been helpful in identifying opportunities. After a few years of creating Action Plans, clarity was appearing about appropriate actions. The Group was considering a KPI around training.

Ms Thompson reported that the Psychiatric Liaison Service had a KPI to hold a review within four hours of an incident. Middlesex University has a specific team that would deal with situations such as first presentation psychosis and this had strict KPIs. In addition, there were KPIs around the support of individuals affected by loss of someone to suicide. For example, these individuals were engaged in the investigation process and were asked how they felt their loved one was looked after.

Dr Djuretic noted suicide prevention should be seen as part of a continuum of mental health. She offered to consider possible wider KPIs with this in mind. Raising awareness of mental health was important. It was thought that one third of individuals with depression were not even registered with a GP.

Prof Marzano noted that Middlesex University was discussing how some of its metrics, for example on student engagement, might be used in suicide prevention. She was likely to have more information on this by the time of the next meeting.

Action: Governance Officer

A Member asked about red flags for suicide, for example, around eating disorders, drinking and self-harm? Ms Thompson responded that over half of suicides were a surprise and patients were not known to any services. Only one third of suicide patients were in contact with mental health teams prior to committing suicide. There are few strong indicators for risk factors, which makes preventing suicide a challenge, though there are a broad range of wider determinants. Safety planning rather than risk assessment was favoured, such as considering triggers that make individuals feel bad, support networks and plans to work with individuals to keep them safe. Ms Thompson reported that evidence-based psychological therapy and giving people support to manage behaviours when they need it were considered to be of benefit. She also stated that self-harm was on the increase.

Dr Lake reported that funding was in place for the intervention service due to be launched in March 2020. This would offer bereavement support and an information hub which should present opportunities. This should be helpful to the police who do not have the opportunity at present to see outcomes of their referrals even though every Met Police Officer deals with someone in crisis. The service would link in with the Barnet Multi Agency Hub (MASH). 

The Chairman enquired about suicide hotspots. Dr Lake responded that even though there was data, no suicide hotspots had been identified. The Transport Police were considering training its staff to help them to identify people at risk.

A Member asked about joint working with other Boroughs. Dr Lake responded that Barnet was collaborating and continuing to look for additional links.

The Chairman thanked all for attending and wished Dr Lake well in his new role as he would be leavingLB Barnet shortly.

RESOLVED that the Committee noted the Draft Suicide Prevention Plan and Report.