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Suicide Prevention 2003 2010 Yorkshire Humber

The NPSA's Remit. Advise ministersSet local or national goals for improvementImprove patient safety in frontline services Promote a culture of reporting and learning from patient safety incidentsProvide advice and guidance promoting safetyDevelop and implement solutions to problems Promote i

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Suicide Prevention 2003 2010 Yorkshire Humber

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    1. Suicide Prevention 2003 – 2010 Yorkshire & Humber March16th 2010 Vanessa Gordon, Mental Health Lead vanessa.gordon@npsa.nhs.uk

    2. Purpose of the NPSA Turning to the purpose of NPSA, it is to help the NHS to:- learn from things that go wrong develop and implement solutions to problems improve patient safety in frontline services The focus is on:- systems not individuals learning not judgement fairness not blame openness not secrecy all care settings not just acute care Purpose of the NPSA Turning to the purpose of NPSA, it is to help the NHS to:- learn from things that go wrong develop and implement solutions to problems improve patient safety in frontline services The focus is on:- systems not individuals learning not judgement fairness not blame openness not secrecy all care settings not just acute care

    3. Reported incident types in mental  health services in England, July 2008 to June 2009

    4. National Confidential Enquiry into Suicide and Homicide by People with Mental Illness Annual Report 2009 Positives findings: Continued fall in-patient suicides Concerns: Inpatient dying by suicide whilst off the ward The transition from inpatient to community The management of risk and risk assessment

    5. Evidence

    7. Timing of last contact: patient suicides

    9. Suicide and self-harm: ligature points

    10. Aims of the toolkit Support mental health organisations establish a system for suicide audit which fits locally Measure how organisations identify risk Support local suicide prevention strategies Encourage local, regional and national learning

    11. Moving forward: Standards 1 – Appropriate level of care 2 – Inpatient suicide prevention 3 – Post-discharge prevention of suicide 4 – Family or carer contact 5 – Appropriate medication 6 – Co-morbidity/dual diagnosis 7 – Post-incident review 8 – Training of staff

    12. Contents of the toolkit Standards (1-8) Ward manager checklist General audit tool

    13. The Toolkit has two levels of assessment General Audit Tool – It is recommended this is completed on an annual basis. Ward Manager Checklist – It is recommended this is completed on a monthly basis.

    14. Tool kit Pilot Need for standard audit practice Involvement of frontline staff Lack of standard audit process Discrepancy in risk assessment and risk management processes

    15. The Pilot Sites 2gether NHS Foundation Trust Derbyshire Mental Health Services NHS Trust Greater Manchester West Mental Health NHS Foundation Trust Northumberland Tyne and West NHS Trust Oxleas NHS Foundation Trust Suffolk Mental Health Partnership

    16. Practice Issues CPA Risk assessment Ward Environment Observation & Engagement Family & Care’s Involvement

    17. Suicide prevention by mental health services Community care early follow up following hospital discharge care planning and risk recognition Improve treatment compliance intensive support for high risk patients

    18. Ward Manager Checklist Divided into Sections To provide ward managers with an up to date method of tracking and measuring the service users experience. Provides a snap shot of the level of adherence to a selection of the suicide standards It contains a radar diagram and performance dashboard

    19. General Audit tool Based on all 8 standards To be undertaken on an annual basis Includes all features contained in the Ward manager checklist as well as an ‘Action plan’

    20. Suicide Prevention 2003 - 2010 March16th 2010 Vanessa Gordon, Mental Health Lead vanessa.gordon@npsa.nhs.uk

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