Understanding and Preventing Suicide: Insights from England's National Confidential Inquiry

1. Professor Louis Appleby Director, National Confidential Inquiry Chair, National Suicide Prevention Strategy (England)

2. Suicide rate, England 1995-2013 • Record low in 2006-7 • Rise from 2008, linked to recession Source: ONS ICD 10 codes X60-X84 (for 10 year olds and over), Y10-Y34 (for 15 year olds and over), excluding Y33.9 - where the coroner's verdict was pending up to 2006. ICD 9 codes E950-E959 (for 10 year olds and over) and E980-E989 (for 15 year olds and over), excluding E988.8.

3. Suicide rates in NHS areas 2011-13 Colour-coded, highest rates = darkest

4. Suicide rates in England, by age and gender • Rates in men 3 x higher • Highest rates in men 40-54 years • Higher in over 75s Source: ONS ICD10 X60-X84 (for 10 year olds and over) and Y10-Y34 (for 15 year olds and over)

5. Age-specific male suicide rates Eng & Wales, 2000-2014 Source: ONS (derived)

6. Six actions National Suicide Prevention Strategy 2012: • Reduce risk in high risk groups • Tailor approaches to improve mental health in specific groups • Reduce access to the means of suicide • Support for those bereaved by suicide • Support media in delivering sensitive approaches to suicide • Support research, data collection and monitoring

7. Patient suicide, UK //

8. Suicide in inpatients and under crisis resolution/home treatment • Suicide under CRHT now 3 x in-patient care • 37% within a week • 43% living alone Source: NCI, 2015

9. Mental health patient suicide: contact with other services/agencies • Patient was also under: • Substance misuse services 12% • Social care 12% • Probation/diversion 2% • Employment services 2% • And in the 3m before suicide: • Left in-patient care 17% • A&E for self-harm 15% • Section 136 MHA 2% Source: NCI

10. Rates of self-harm in persons aged 15+, 2000-2012 • Rising self-harm rate in males • Female to male difference narrowing Source: The Multicentre study of self-harm in England, 2015

11. Self-harm and suicide 50% of people who die by suicide have history of self-harm 1 in 50 of people seen in A&E after self-harm have died within a year Risk of suicide increased up to 50-fold in year after self-harm

12. Suiciderisk & number of GP consultations in previous 12 months • Suicide linked to frequent GP consultation • 12-fold increase with attendance x 2 per month • Risk also high in non-attenders 12.3 7.8 1.67

13. Local suicide prevention plans • APPG survey found that: • 30% of LAs do no suicide audit work • 30% of LAs have no suicide prevention action plan (+ 24% “in development”) • 40% of LAs have no multi-agency suicide prevention group

14. Suicide prevention local action plans • Services that men will access • Plan to reduce heavy drinking • Prevent suicide clusters

15. Suicide prevention at hotspots • Barriers • Helplines • Intervention/patrols • Local media Source: PHE

16. Sensationalising and romanticising suicide

17. Local variation in male suicide rates

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