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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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