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Thematic review of deaths of children and young people through probable suicide, 2006-2012

Dr Ann John Lead for thematic review. Thematic review of deaths of children & young people through probable suicide in Wales, 2006 - 2012. Thematic review of deaths of children and young people through probable suicide, 2006-2012. Outline. 2 sessions Why we did it What is the context

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Thematic review of deaths of children and young people through probable suicide, 2006-2012

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  1. Dr Ann John Lead for thematic review Thematic review of deaths of children & young people through probable suicide in Wales, 2006 - 2012 Thematic review of deaths of children and young people through probable suicide, 2006-2012

  2. Outline 2 sessions Why we did it What is the context What did we do What we found What we recommended Thematic review of deaths of children and young people through probable suicide, 2006-2012

  3. Why? Work of CDR Programme Rare but important and potentially preventable Top 3 causes of death adolescents Complex Continuum Thematic review of deaths of children and young people through probable suicide, 2006-2012

  4. Why?Wales Suicide Prevention Action Plan 2008-2014 • Promote mental health and well-being • Deliver early intervention • Response to a personal crisis • Manage the consequences of suicide and self-harm • Promote learning and research: SID-Cymru, review those not known to services • Media guidelines • Means restriction Thematic review of deaths of children and young people through probable suicide, 2006-2012

  5. Context3 C’s: Cross-governmental, Cross-sector, Collaborative • Children and young people’s FP plans • Climbing Higher: A strategy for sport and physical activity • All Wales youth Offending Strategy • Hidden Harm • Inclusion and Pupil support • Transport • H, SC & WB Strategies • Substance misuse • Service Frameworks for C,YP and maternity services • Parenting Action Plan • Prison Service Order • Healthy Schools • Tackling Domestic Abuse • Together for mental Health Thematic review of deaths of children and young people through probable suicide, 2006-2012

  6. What we did Collected and reviewed data on the CYP 2 evidence reviews 2 panel meetings Report Thematic Review of Deaths of Children and Young People through Probable Suicide, 2006 - 2012

  7. Case definition • all completed suicides and probable suicides (undetermined deaths) in children 10 to 17 years of age normally resident in Wales, or who died in Wales, that occurred between 1 January 2006 and 31 December 2012. This includes the following ICD-10 classifications: • Intentional self harm (recorded as suicide verdict): X 60 – X 84 • Event of undetermined intent (including open and narrative verdicts): Y 10-34 (excluding Y 33.9 other specified events of undetermined intent, coroner’s verdict pending) Where an ICD code has not been assigned or a child is under 15, a judgement will be made Thematic review of deaths of children and young people through probable suicide, 2006-2012

  8. Sources of information CDR database: • ONS • Police records-25 • Coroner’s reports-8 • Exec summaries SCR-13 • PRUDiC meeting minutes • Media • SID-Cymru • Professionals involved with deceased child from various statutory agencies Thematic review of deaths of children and young people through probable suicide, 2006-2012

  9. Thematic Review of Deaths of Children and Young People through Probable Suicide 2006 - 2012

  10. Panel Meeting 1- 13/11 Risk factor evidence review Male History of self harm Mental disorder (diagnosable but not necessarily diagnosed) Parental mental disorder Experience of loss Family history of suicidal behaviour Substance misuse Physical or sexual abuse Minority sexual orientation Interpersonal difficulties • Source: Hawton, Saunders, O’Connor, 2012 Parental separation/ divorce Being bullied Impulsivity Restricted educational achievement Low socio-economic status Adverse childhood experiences Thematic Review of Deaths of Young People through Suicide 2006 - 1012

  11. Panel Meeting 1- 13/11 • Narrative review of 14 cases • Life charts • Identify risk factors • Are they the same in Wales as identified in the literature? Were there potentially modifiable factors? What more do you need to know to make recommendations for prevention? i.e. What should be done, where and by whom Thematic review of deaths of children and young people through probable suicide, 2006-2012

  12. Panel meeting 2- 11/12 Quantitative summary of cases SID-Cymru Evidence for interventions Recommendations Thematic review of deaths of children and young people through probable suicide, 2006-2012

  13. The children and young people • 34 cases • 22 intentional, 10 undetermined, +2 • 8 female, 26 male • 25 hangings, strangulation suffocation • Others: gas, firearm, moving objects, unspecified, poisoning Thematic review of deaths of children and young people through probable suicide, 2006-2012

  14. The children and young people Thematic review of deaths of children and young people through probable suicide, 2006-2012

  15. Known to services? Thematic review of deaths of children and young people through probable suicide, 2006-2012

  16. Social circumstances Thematic review of deaths of children and young people through probable suicide, 2006-2012

  17. Factors from narrative review Key factors • Restricted educational achievement • NEET • Bullying • History of neglect and/ or abuse • Not living with parents • Relocated • Looked after children • Self harm • Mental health issues Proximal factors • Drugs and alcohol • Escalating self harm • Family estrangement • Inter-personal difficulties • Precipitating life events • Access to means Thematic review of deaths of children and young people through probable suicide, 2006-2012

  18. Intervention evidence review Universal interventions which aim to eliminate or attenuate risk and strengthen protective factors and are aimed at whole populations across different settings (school based but whole population) Selective/ targeted interventions which are aimed at individuals or groups within a population at increased risk of suicidal behaviours (depression, PTSD) Indicated interventions which aim to reduce recurrence in those with known suicidal behaviours Thematic review of deaths of children and young people through probable suicide, 2006-2012

  19. Strengths & Limitations • Multi sectoral panel • All Wales over 7 years • Range of sources • Life charts • Evidence reviews • Case series • Lack of information • Relationship quality • Social media • Involving families and young people Thematic Review of Deaths of Young People through Suicide 2006 - 1012

  20. RECOMMENDATIONS Thematic Review of Deaths of Young People through Suicide 2006 - 1012

  21. Recommendations • Welsh Government • Police • Health care • Partnerships & agencies • Support future reviews Thematic review of deaths of children and young people through probable suicide, 2006-2012

  22. Recommendations-WG Restrict access to alcohol 16-18 year olds support in EET, increase school leaving age All Wales Child Protection Register AWCPR co-ordinated across other nations Explicit guidance rpt attendance ED for SH, MH, alcohol or drug misuse results in assessment by children’s social care with lower thresholds for strategy meetings Thematic review of deaths of children and young people through probable suicide, 2006-2012

  23. Recommendations-WG NICE guidance on short and longer term management of SH Awareness in public, tackle stigma, enable personal responses Gate keeper training Support research Thematic Review of Deaths of Young People through Suicide 2006 - 1012

  24. Recommendations Police-Firearm storage Healthcare commissioners and providers CBT services available for all children sexual abuse Storage toxic medication children suicidal behaviours, in certain households Communication-suicide prevention partnerships (CCC) Communication- between services re CYP at risk of suicide, mechanisms, lower threshold multi- agency meetings Services delivered- content evidence based and evaluated Thematic review of deaths of children and young people through probable suicide, 2006-2012

  25. Recommendations- future reviews WG, explicit statutory guidance information sharing LSCB, PRUDiC, notifiy CDRP all probable suicides Probable suicides CDR thematic review every 3 years SID-Cymru & NCISH WG, sponsor mechanisms to review suicides <25 years, ?commission CDR to do CDR engage families and carers Thematic review of deaths of children and young people through probable suicide, 2006-2012

  26. Thank you Thematic review of deaths of children and young people through probable suicide, 2006-2012

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