Debate: Suicide

Considerable effort is focused on reducing the number of avoidable deaths by suicide, both in wider society and in statutory health services. In recent years we have had better information about people at risk, intelligence and data on high-risk groups, and improved training on risk assessment and suicide mitigation. A range of services has been put in place to support people in crisis; emergency departments have access to mental health liaison services, and there is increased use of crisis lines and single point of access services. Serious incident frameworks have also helped us to improve learning from suicidal intent and action, and duty of candour has improved collaboration.

In England, the National Suicide Prevention Alliance represents a number of organisations working to reduce suicide and support those bereaved or affected by suicide. Their strategic plan for 2016-2019 (National Suicide Prevention Alliance, 2016) has seven key areas of action, including ‘reducing stigma’ and ‘providing appropriate support’. Raising awareness and building knowledge are important to ensure all agencies work together to reduce the number of suicides. The Five Year Forward View for Mental Health (NHS England, 2016) includes the development of local suicide prevention plans, and the more recent Zero Suicide initiative is working to increase support for those contemplating suicide by providing free prevention training.

In Northern Ireland, the Manchester Matrix has been in use in emergency departments since November 2015. This triage process assists registered nurses working in emergency departments to assess the risk of selfharm and suicide and to make decisions about the most appropriate course of action. In 2016, the Department of Health (DHNI) consulted on an updated version of its regional ten-year suicide prevention strategy and action plan, Protect life: a shared vision. This included a commitment to enhance the initial response to, and care and recovery of, people who are experiencing suicidal behaviour or who self-harm. The postconsultation version of this revised strategy has not yet been published (DHNI, 2016).

The Welsh Government has identified suicide as a major public health challenge and set a framework for prevention: Talk to me 2: Suicide and self-harm prevention strategy for Wales 2015-2020 (Welsh Government, 2015). In addition, several National Assembly Committee Inquiries in the last two years have focused on suicide prevention, loneliness and isolation, mental health and wellbeing and made numerous policy recommendations. The most recent statistics on suicide show an improvement in Wales of the age-standardised suicide rate for males and females from 13.0 per 100,000 people in 2015 to 11.8 per 100,000 people in 2016 (Office for National Statistics, 2017).

The Scottish Government is currently developing its next Suicide Prevention Action Plan, due to be published in the summer. It has identified four key themes: improving the use of evidence, data and guidance on suicide prevention; modernising the content and accessibility of training; maximising the impact of national and local suicide prevention activity; and developing the use of social media and online resources. Other Scottish Government strategies aim to contribute to a reduction in suicide, including strategies on mental health, justice, policing, and social isolation and loneliness.

In spite of all of this work – including previous debates on suicide at Congress – there remain significant gaps across services, with many registered nurses still lacking a basic knowledge around suicide and knowing what to do, when to share and when to step in. With the addition of suicide and self-harm to the new NMC education standards, we want to see improvements across all nursing disciplines in suicide awareness, to include the confidence to share information in a timely way. 

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