Preventing suicide in community and custodial settings

Why the committee made the recommendations

Approximately 6,000 people take their own life each year in the UK. The risk of suicide in the UK prison population is considerably higher than among the general population. The number of people dying by suicide in custodial or other detention settings such as prisons, immigration detention centres, young offender institutions and police custody has increased over the past decade.

Many local agencies can be involved in preventing suicide in the community. Although the evidence was limited, the committee felt strongly that these agencies need to work together to focus on the most effective and cost-effective interventions. By combining expertise and resources, partnerships can cover a much wider area more effectively and implement a range of activities.

Likewise, different services within residential custodial and detention settings can be more effective if they work together in a local multi-agency partnership and with similar partnerships in the community.

How the recommendations might affect practice

Improved communication and information sharing between statutory agencies and community organisations may have resource implications. For example, the costs of staff time, communication, interventions and the meetings associated with multi-agency teams.

But multi-agency partnership working is already enshrined in the Department of Health and Social Care's suicide prevention strategy for England, updated in the Department of Health and Social Care's suicide prevention: third annual report. As a result, multi-agency suicide prevention partnerships have been set up in most community and residential custodial and detention settings, so no additional costs are expected.

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Why the committee made the recommendations

Some evidence and expert opinion showed that having a strategy for how to connect local organisations can help prevent suicide in community and residential custodial and detention settings. For general reasons why we have made the recommendations, see the rationale section on suicide prevention partnerships.

If the strategy has clear leadership and is based on what is currently happening in the area or setting, it is likely to be effective. This involves gathering data on suicide rates and sharing best practice. A strategy may also help to ensure organisations are prepared to respond to a suicide.

Expert opinion showed that when partnerships share knowledge and experience, this is of greater benefit than working individually. It may include collaborating with neighbouring organisations in the same setting to develop a shared strategy.

How the recommendations might affect practice

Improved communication and information sharing between statutory agencies and community organisations may have resource implications. For example, the costs of staff time, communication, interventions and the meetings associated with multi-agency teams.

But the Department of Health and Social Care's suicide prevention strategy for England advocates multi-agency partnerships, and suicide prevention strategies have been set up in most community and residential custodial and detention settings. So no additional costs are expected.

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Why the committee made the recommendations

Having a detailed action plan based on local knowledge and clear leadership can help prevent suicide in the community and in residential custodial or detention settings. The plan will be effective if it is based on knowledge of what is happening in the area or setting, involves stakeholders and is adaptable. (For general reasons why we have made the recommendations, see the rationale section on suicide prevention partnerships.)

How the recommendations might affect practice

Multi-agency suicide prevention action plans have been set up in most community and residential custodial and detention settings, so no additional costs are expected. For example, Public Health England's Suicide Prevention Profile shows which local authorities have suicide prevention plans.

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Why the committee made the recommendations

Good information is essential for planning, monitoring success and improving the strategy and plan for all settings. The committee agreed that the information should come from different sources to get a clear picture of what is happening. But they also agreed that it is important to make sure the local data collected is as reliable as possible, so that the strategy and plan is as effective as possible.

Although the evidence was limited, the committee agreed with an expert that more rapid and frequent information gathering (rapid intelligence gathering) is important, for example for early detection of suicide clusters.

The committee also agreed that because analysing information on suicides may expose staff to some distressing material, training and support is essential to help them cope.

How the recommendations might affect practice

Gathering and analysing data may involve some additional resources. But most multi-agency suicide prevention partnerships have some work already in place. So we do not expect this will have a significant resource impact.

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Why the committee made the recommendations

Many people who take their own lives are not in contact with mental health services and may not necessarily be in contact with a GP, so opportunities for clinical interventions can be limited. Non-clinical interventions, such as telephone or text helplines or volunteer-run face-to-face talking are important to support people with suicidal thoughts and keep them safe.

There is increasing demand for non-clinical interventions but little evidence on the benefits. Research is needed to evaluate how effective they are (see the recommendation for research on non-clinical interventions).

The committee agreed that awareness-raising activities and messages, tailored to people's needs and circumstances, can help get rid of common misconceptions about suicide and self-harm and let people know where they can go for help. They also agreed that increasing local awareness of suicide and the support available is likely to encourage people to seek help. But there can be a fine line between helpful and potentially harmful messages (see the recommendation for research on supporting people bereaved or affected by a suicide).

In residential custodial and detention settings, they agreed that extra support during particularly vulnerable times, such as 'early days', might reduce the risk of suicide. Peer support, along with measures such as the provision of 'safer cells', might also help to act as deterrents. But there is a lack of evidence and more research is needed to evaluate the effectiveness of different interventions in a range of custodial settings (see the recommendation for research on suicide prevention in custodial and detention settings).

How the recommendations might affect practice

Increasing local awareness of suicide and the support available could encourage more people to seek help and so increase health and social care costs.

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Why the committee made the recommendations

The committee agreed that it is important to identify local suicide trends, including common methods and locations where suicide is more likely, such as bridges and railway stations. That way action can be taken to reduce people's access to both the methods and places.

Physical barriers like fences and netting could reduce the number of suicide deaths in places where suicide is more likely because it makes it more difficult for people to put themselves in danger. Evidence showed that if a barrier stops a person from taking their life in one place, they will not automatically go somewhere else and try again.

Similarly, compliance with national guidance, for example on safer cells in custodial settings (see the Ministry of Justice's Quick-time learning bulletin on safer cells) and restrictions on painkiller sales in the community can act as an effective deterrent.

The committee agreed that, despite the lack of evidence, it may be worth thinking about implementing these measures because they can sometimes give people time to stop and think – and so may prevent deaths. The presence of staff at high-risk locations may also give people a chance to reconsider, as well as being a source of timely support.

How the recommendations might affect practice

Where physical barriers or other measures are needed this may have a resource impact in terms of staff time and construction and maintenance costs. NICE has an implementation tool to help determine the cost effectiveness of different interventions.

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Why the committee made the recommendations

Some evidence showed that training improves people's knowledge about suicide, the risks and how to prevent it. The committee agreed that it may be effective to train a range of people involved with both the public and with occupational groups known to be at high risk of suicide. That way they can help spread general prevention messages and encourage people at risk to talk and seek help.

But UK evidence on the effectiveness of gatekeeper training is limited and there are only a few specific training programmes available. Training for all gatekeepers is important because it may help to identify more people at risk of suicide. But research is needed to evaluate how effective it is (see the recommendation for research on training).

How the recommendations might affect practice

Training can be costly. But it is expected to be made available through existing continuous professional development programmes, so the costs for professionals and organisations could be minimised. For example, Health Education England has developed generic and specialist competencies for people working with adults and children with suicidal behaviour or ideas, and for non-specialists working in community settings.

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Why the committee made the recommendations

The committee agreed that people affected by a suspected suicide may, as a result, be at risk of harming themselves. This includes family members and friends of people who have died, as well as first responders.

The committee heard that bereavement support can reduce this risk, especially when tailored to the person's needs. People who had bereavement support were also likely to experience lower levels of depression and anxiety. Some of these benefits were based on personal accounts because the evidence was limited.

Some services have been developed locally to provide this type of support. But because there is very little evidence on the benefits, local authorities are reluctant to commission such services. Research is needed to build an evidence base on these interventions for people in the community so that effective and cost-effective statutory and voluntary services can be developed (see the recommendation for research on supporting people bereaved or affected by a suicide).

How the recommendations might affect practice

The committee recognised that providing support for people affected by suicide may be cost effective from a societal perspective, when the costs of productivity losses are taken into account. However, because of the lack of evidence this supposition needs to be treated with caution.

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Why the committee made the recommendations

Suicide clusters can emerge quickly and unexpectedly. But an expert told the committee that if the right systems are in place, then it is possible to reduce the likelihood of further deaths.

This was supported by the committee's own experience. An expert also explained to the committee that the police and the coroner's office need to notify agencies as soon as possible when a suspected suicide is being investigated. That is because an inquest to confirm cause of death is usually only held 6 to 12 months after the event. This is too late to prevent new suicide deaths if a cluster is developing. Residential custodial and detention settings have a duty to undertake and learn from reviews of incidents of self-harm to prevent future occurrences and make custody safer.

Based on this information and their own experience, the committee agreed that rapid intelligence sharing is important.

How the recommendations might affect practice

Improved communication and information sharing between statutory agencies and community organisations may have resource implications. For example, the costs of staff time, communication, interventions and the meetings associated with multi-agency teams.

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Why the committee made the recommendations

Irresponsible reporting of suicide may have harmful effects, including potentially increasing the risk of suicide.

Reports of the method used in a suspected suicide seems to increase the risk of other people copying the suicide – so‑called copycat suicides. And inaccurate media reporting upsets people bereaved by suicide. So steps to encourage responsible reporting could prevent further suicide deaths.

Although there was little evidence on the personal effect of suicide or suicidal behaviour being shared through social media, the committee agreed that the guidance given to the media should also apply to social media.

To combat the harmful effects of irresponsible reporting, the committee agreed that it is important to promote best practice and also monitor media coverage.

How the recommendations might affect practice

Providing training for journalists may have cost implications. But better reporting generally has beneficial outcomes.

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