Suicide Prevention – a partnership approach

1. Suicide Prevention – a partnership approach Mark Smith Head of Suicide Prevention and Mental Health

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. Life Saving Interventions

13. 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