Agenda item

To provide an update on public mental health and suicide prevention.

Ms Zohra Dempsey, Public Health Practitioner, Blackpool Council presented a progress report on the Public Mental Health Action Plan 2016-2019. She had first presented the Plan to Members at their meeting on 5 July 2017. The Plan focused on using medical practice to promote awareness of issues and good mental health, prevent poor health and suicide, reduce stigma and discrimination and effective care and treatment leading to better quality of life.

A sub-regional plan known as the ‘Suicide Prevention Logic Model’ had been developed by the Lancashire and South Cumbria Sustainability and Transformation Partnership. The focus of the meeting update was on suicide prevention work. This was a significant issue which the Committee had previously highlighted.

Representatives and members of mental health and carers’ support organisations were present from Rethink (national mental health support charity); Blackpool Young Boys and Girls Club (local mental health resilience support); and UR Potential (mental health resilience support for young people).

All three organisations had attended the meeting in July 2017 and had maintained interest in the mental health agenda. The Chairman welcomed input from them during the meeting.

Suicide reduction targets

Members noted that Government had a target to reduce suicides by 10% by 2020. Based on the Blackpool rolling average of 19 suicides per year (2014-2016), this target equated to a reduction down to 17 suicides per year locally. The Chairman referred to Mersey Care NHS Foundation Trust which had set an aspirational target of ‘zero’ suicides and were pioneering nationally on zero suicide work. He also queried accountability for meeting suicide prevention targets.

Ms Dempsey explained that the 10% target had been set by NHS England. The ‘zero’ target was a topical discussion and the viability of this depended on local environments. The Chairman contented that Merseyside and Cheshire contained some deprived areas which arguably mirrored Blackpool issues.

A ‘zero’ suicide target was supported by the representative from Blackpool Young Boys and Girls Club. Members discussed the merits of a ‘zero’ suicide target and recommended that a ‘zero’ suicide target should be adopted. Ms Dempsey agreed that the proposed target would be raised at the Suicide Prevention Oversight Group for Lancashire and South Cumbria.

Suicide profiling

Members noted that there had been 57 deaths in Blackpool during 2014-2016 and that there needed to be effective identification of people who committed suicide. They queried what the demographic breakdown of local suicides was in order to identify focus and better plan actions, in particular the high-risk groups of males aged 25-50 (about 70% of local suicides were males).

Ms Dempsey explained that precise profiling of people committing suicide was complex with challenging issues such as substance misuse involved. She confirmed that all suicides were recorded as such when the Coroner reached a verdict of suicide. She clarified that deaths other than suicides, e.g. caused through non-intended overdoses, were not recorded under the suicide count.

In response to Members’ noting the large number of young male suicides, and the ‘Men in Sheds’ initiative not necessarily being appropriate for them, Ms Dempsey explained that there was a range of work being pursued. This included removing stigma of mental health especially for young people, recognising people’s issues such as substance misuse and any other warning signs so that effective support including sign-posting to services could be provided. Head Start helped provide emotional resilience support to young people and there were also awareness-raising campaigns such as ‘Time to Talk’.

She added that a public health outcomes framework existed to help deliver best outcomes including interventions to support young males and other people. Public Health did produce a suicide audit and written demographic profiling information would be provided.

Some Members queried how many suicides involved people new to Blackpool or visiting. They were informed that most suicides were local people and 70% were males but this could be checked if required. Some Members noted that it was more appropriate to focus on suicide prevention rather than developing statistics of limited or dubious value.

Suicide prevention planning

Members found the Logic Model complex to follow. Ms Dempsey acknowledged this and offered to provide a simple summary.

Self-harm / early help

Members were informed that Personal, Health, Social and Economic (PHSE) education was taught at secondary schools and rolled out to primary schools as appropriate. They queried the level of existing school nurses involvement and their level of mental health expertise. They were informed that skilled school nurses still existed. Members would also be looking at the new health visitor service at a future meeting.

Members suggested people performing the role of social workers (not necessarily with that title) placed in schools would be useful and proposed forwarding a request for clarification to the Cabinet Member for Adult Social Care and Public Health. Public attendees supported the idea of social work type support and noted that this happened in secondary schools but believed not in primary schools. They added that this would help with children needing someone to talk or short opportunities away from the ‘crowd. ’Members recognised that there needed to be a variety of options, e.g. schools could make referrals to the ‘Den’ hub for young people. Members hoped that funding for the Den would continue.

Members noted that Better Start existed for 0-5 year olds and Head Start for 10-15 year olds but there was a gap. Blackpool Boys and Girls Club provided support including youth workers for the gap group. The Club relayed that children did not feel that they were listened to.

Members referred to the need for early help including identifying people at risk of suicide or having suicidal thoughts. They noted that self-harm, for which Blackpool had the highest rates nationally, could be linked to a range of social issues including poverty and poor housing. They were particularly concerned that self-harm started as early as infant or junior age and Accident and Emergency (A&E) admissions of that age group had increased significantly. With reference to early help, Members noted that self-harm could result in suicide. Public attendees felt it was important to provide a person with a ‘friendly face’ who could listen and discuss issues.

One of the public attendees queried the absence of a self-harm reduction target given that Blackpool had the highest national rates and also noted that the figures only included those admitted to Accident and Emergency / hospital, i.e. real figures were likely to be even higher. Ms Dempsey confirmed that there was no target but that focus was on building and promoting emotional health and wellbeing support including resilience. She added that data needed to cover all sources including ‘walk-in’ centre. An intelligence officer bid had been put in for the Lancashire and South Cumbria mental health work.

Ms Dempsey acknowledged that there were a significant number of people who self-harmed and attempted/committed suicide. Funding had been secured for developing ‘Core 24’ (mental health crisis support, including for self-harm, available at all times) at Accident and Emergency. This was challenged by public attendees. One attendee felt there was limited support for self-help and support was not easy to find or access, and gave the experience of a relative ringing the crisis line, getting no immediate response or call back. Families and UR Potential provided some support but poor overall support available from services was poor. The relative had been supported by their family but this was an alert of potential system failures.

Public attendees queried the suitability of Core 24 being within Accident and Emergency in view of general pressures plus being a prominent populated place.  Ms Dempsey understood that people with mental health issues would be supported away from the main Accident and Emergency activity. There would be no beds but chairs instead. A public attendee noted that first contact at Accident and Emergency needed to be good. There was still an involved registration process but a separate reception area could help. Public attendees queried whether four chairs was sufficient capacity and that people would have to wait. Confirmation was not available on the capacity issue. Ms Dempsey added that recruiting staff would take some time and would probably involve Lancashire Care Foundation Trust staff.

Suicide prevention actions / support options and thresholds

Public attendees referred to gaps in services. Services existed at Accident and Emergency (Child and Adolescent Mental Health Services / Child and Adolescent Self-Harm Emergency Response) but for different age groups so were not for all young people resulting in delays. Professionals (police and health) were known to argue in front of young people over responsibilities. Public attendees felt that restricted services, delays and arguments were putting young people off. Professionals seemed content to refer people to charitable support but not take ownership (‘right people in right place providing the right support’). Public attendees re-iterated the need to be able to speak to someone (not necessarily a psychiatrist) at any time (24 hours).

Members referred to accessing services which might only be available at ‘crisis’ point [not for early help] and that ‘wrong’ answers might lead to the wrong service. They referred to the NHS 111 helpline. People were asked if they had any ‘suicidal thoughts’. Members were concerned that this question could put people off as people could be wary of admitting they were thinking of suicide.

A public attendee, representing Rethink, who supported people in crisis, felt that the support / intervention threshold was too high, i.e. serious injury was required before support. There needed to be a range of support options covering various groups, peer support networks were effective encouraging people to talk. Research was required identifying the most appropriate and effective support options. Members suggested looking at the Fylde and Wyre Butterfly Phoenix Project (now ceased) for any best practice lessons.

Public Health would look into the range of support options. Blackpool Clinical Commissioning Group were understood to be ‘mapping’ services so would be asked to attend the Committee’s meeting in either March or May 2018. Blackpool Teaching Hospitals’ Families and Mental Health services would be invited to the same meeting to discuss accessing services.

Mental Health / Suicide Prevention best practice including raising awareness

The Chairman cited a US scheme which had promoted real development and participation activities for people (building and growing green spaces) and that the scheme had been proactive in supporting people and raising mental health awareness.  He enquired if this approach could be considered including ‘door-to-door’ awareness. Ms Dempsey referred to ‘middle tier’ awareness-raising through GPs and other routes (not specific services) and agreed that ‘door-to-door’ community knocking and other options for awareness-raising would be considered.

Public attendees referred to the need to support people by allowing them to benefit from the right environments, e.g. communities not Accident and Emergency.

The Chairman referred to Mersey Care NHS Foundation Trust’s website as a highly effective, site with lots of easy-to-use info but the Council’s site was non-existent. Ms Dempsey agreed that this could be considered but various ‘crisis’ support existed. Public attendees challenged that support was easy to find or easy to use.

The Committee agreed:

1.   To recommend that a ‘zero’ suicide target should be adopted within Blackpool; and that Ms Dempsey would raise the proposed target at the Suicide Prevention Oversight Group for Lancashire and South Cumbria providing a written response by the Committee’s next meeting on 14 March 2018.

2.      That Ms Dempsey would provide written demographic profiles of local suicides by the Committee’s next meeting on 14 March 2018.

3.      That Ms Dempsey would provide a simple written summary of the Suicide Prevention Logic Model by the Committee’s next meeting on 14 March 2018.

4.   That Ms Dempsey would consider targeted community options for support and mental health awareness-raising and report back on progress.

5.   That the Cabinet Member for Adult Social Care and Public Health be asked to  clarify current support offered in schools,  such as social worker support (not necessarily with that title),which would be useful help for  young people.

6.   That the Committee would receive an update on school nurses as well as the new health visitors’ service as part of the Public Health Overview Report at the March 2018 meeting.

7.   To invite Blackpool Clinical Commissioning Group to the Committee’s meeting in either March or May 2018 to discuss its ‘mapping’ of mental health and community services work with particular reference to good access and the range of support options available. Public Health and Blackpool Teaching Hospitals’ Families and Mental Health Services would also be invited.