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Suicide Prevention – a partnership approach. Mark Smith Head of Suicide Prevention and Mental Health. Fundamental Issues. Mental Health and Vulnerability Vulnerability and Risk Risk and Consequence Victimisation Criminality & criminalisation Danger to others Danger to self

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suicide prevention a partnership approach

Suicide Prevention – a partnership approach

Mark Smith

Head of Suicide Prevention and Mental Health

fundamental issues
Fundamental Issues
  • Mental Health and Vulnerability
  • Vulnerability and Risk
  • Risk and Consequence
    • Victimisation
    • Criminality & criminalisation
    • Danger to others
    • Danger to self
    • Impact on families & communities
    • Impact on resources
    • Economic impact
    • Liability issues
the rail network
The Rail Network
  • A draw for the vulnerable
  • Transient population
  • Equality Issues

(access to services)

    • Immigration status
    • Homelessness
    • Learning difficulties
    • Alcohol & substance misuse
    • Race and culture
btp national analysis
BTP National Analysis
  • 350 fatalities a year
  • 84% believed to be suicides
  • 41% of deceased had a mental health history
  • 1700 incidents a month which involve mental health issues
  • 2700 incidents of suicidal behaviour per year
  • 680 suicide prevention plans opened in one year
  • Evidence of vulnerable people travelling great distances to attempt suicide and importing demand for services
  • In a 3 month period only 5 out of 11 people involved in suicidal incidents in Camden lived in the Borough
  • London North hotspot area with 30% of suicides & 37% of all related incidents
suicidal incidents
Suicidal Incidents

01/04/12 - 31/03/13

2738 incidents

  • 296 suspected suicides
  • 89 injurious attempts
  • 313 non injury attempts or life saving interventions
  • 44 reconnoitring
  • 796 threats with no attempt
  • 630 third party reports
  • 570 Para-suicide events
btp approach
BTP Approach
  • 2010 new Suicide Prevention Policy and SOP
  • Vulnerability assessment tool & structured suicide prevention plans
  • Public Protection Units & Mental Health Liaison Officers
  • Close working with Rail Industry Partners and the Voluntary sector
  • However barriers to effective working identified -
    • Unfamiliarity with local Health & Social Care services and structures
    • Reluctance of many agencies to share information
    • Lack of medical oversight of police decision making
    • Differences in local Health and Social Care service provision
    • Inconsistency in clinical judgements
    • Detention under S136 often ineffective in reducing risk
  • Need for a new approach to overcome these barriers
  • Need to secure appropriate diversions & free up police officer time
2013 new partnerships
2013 - New Partnerships
  • January - BTP & Network Rail (NR) agree a 3 year project to better coordinate activity in relation to Mental Health and Suicide Prevention which includes closer working with Samaritans
  • February - BTP, NR and NHS London agree 3 month funding to provide a pilot joint health and police intervention capability – ‘Operation Partner’
  • April - NHS England (London) agree further 6 month funding for Operation Partner
  • April - BTP and London Underground agree a 12 month project to join and enhance Operation Partner
  • September - BTP join ‘Street Triage’ programme funded by Department of Health and will seek to re-create Operation Partner outside London
operation partner
Operation Partner
  • Combined Public Protection Unit
  • BTP operational & analytical resources
  • Supported by Mental Health Professionals
  • Key elements;
    • Medical operational review of BTP interventions and PIER plans
    • Support to BTP custody
    • Outreach interventions & assessments
    • Fast access to data
    • Transition from Crisis to Care

689 people reviewed in 2013 – Only 1 later completed suicide on the railway and 1 away from the railway

a new model
A New Model

Joint Intervention Team

  • Identifying Vulnerability
  • Assessment tool
  • Custody Screening
  • Analysis – people & places
  • Providing Care
  • Care Plan
  • Family support
  • Information sharing
  • Escalation process
  • Managing Risk
  • Intervention
  • Diversion
  • Situational solutions
a life saved op partner
A life saved – Op Partner

Suicide Prevented at Twyford Railway Stn 15/03/13

  • 09/03/13 - Male seen acting strangely at station by rail staff
  • 13/03/13 - Male returns – rail staff report to BTP

who attend, gain CCTV images & circulate to rail staff

  • 14/03/13 – PPU circulate Image to all local GPs and local police. MHP circulate to all local Mental Health Units
  • 15/03/13 - Male returns - rail staff call BTP who detain him under S136. Suicide note found in subject’s pocket and he tells officers he was going to do it ‘today or tomorrow’
  • MHP liaised with hospital and after assessment he is further detained
  • MHP have maintained contact with hospital re ongoing treatment and status
  • One life saved – one railway fatality prevented
key benefits
Key Benefits
  • Early access to relevant information
  • More informed and robust decision making
  • Support to frontline officers assisting them to access places of safety/services
  • Better outcomes for vulnerable people
  • Savings in police officer/staff time within the PPU
  • Savings in Officer/PCSO time on the front line
  • Defined progression from Crisis to Care
  • Up-skilling of PPU staff
  • Many examples of MHP intervention being invaluable in breaking down organisational boundaries
key issues
Key Issues
  • Funding challenges
  • Transport Health Needs Assessment – transient demand
  • Most people presenting in mental health crisis or with suicidal behaviour are not offenders
  • Commissioning – strategic fit
  • Care Bill requirements for vulnerable adults
  • Concordat commitments
  • S136 improvement plan for London
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