nick cleggDeputy Prime Minister Nick Clegg has called on all NHS trusts to commit to a new ambition for ‘zero suicides’ in order to dramatically reduce suicides in the health service. 

Clegg wants health services to focus on strategies to reduce the number of people who take their own life, such as having personal safety plans in place for patients and keeping in touch with those who have moved back home after being on a ward.

Almost 4,700 people died by suicide in 2013 in England – with nearly 3,700 (78%) of those being men. Suicide remains one of the biggest killers for men under the age of 50. 

The ‘zero suicides’ approach has already been successful in the US: a mental health programme in Detroit, which signed up to a ‘zero suicide’ commitment has reported that nobody in the care of their depression services has taken their own life in more than 2 years.

In the UK, health workers in Liverpool, the South West and in the East of England are already re-thinking how they care for people with mental health conditions to achieve this ambition for ‘zero suicides’. Clegg wants the health service to look at this work being done by these 3 pioneering areas, saying that adopting these approaches across the country could save thousands of lives.

While everywhere will be different, it is envisioned that methods to reduce suicide could include:

• Keeping in touch with patients who move back home after being on a ward

• Having a personal safety plan in place so that patients, family and friends know what to do and where to go for help if they need it and have regular contact with someone they know and trust

• Bringing safety systems in line with treatment for physical health – for example, designing a process for any member of staff to follow if a patient is at high risk of suicide. This would tell staff what to do, who to call, where to send the patient, and how to follow it up

• Joining all services up so that patients who are at risk will not fall through the cracks – linking GP, carers and mental health services.

The government said the ‘zero suicide’ ambition is about changing how people who are in NHS care are treated so that they are not forgotten when they move or leave the service they have been in. All of this will be done in close collaboration with GPs, other specialist providers, commissioners, public health experts and others.

“Suicide is, and always has been, a massive taboo in our society,” said Clegg. “People are genuinely scared to talk about it, never mind intervene when they believe a loved one is at risk.

“That’s why I’m issuing a call to every part of the NHS to commit to a new ambition for zero suicides. We already know that this kind of approach can work in dramatically reducing suicides.

“This isn’t about blame. It is doing more in every area of our society to ensure that people don’t get to that point where they believe taking their own life is their only option.”

Care and Support Minister Norman Lamb added: “When it comes to our physical health we believe the NHS should do everything possible to keep us alive and well – the same must be said for mental health.

“Suicide is not inevitable for people in crisis and these deaths can be prevented with the right care. Three areas have this vision already and are doing incredible things to improve and importantly to save lives. I want every part of the health service to be as ambitious.

“We all have a role to play. By talking openly about suicide we can remove the fear that stops people asking for help. We may feel uncomfortable, or frightened of saying the wrong thing, but if we tackle this stigma then we will save lives.”

Welcome report

Professor Sir Simon Wessely, president of the Royal College of Psychiatrists, welcomed the call, in particular for more support to be given to patients after they have been discharged from hospital, including personal safety plans. “This is a crucial period of time; the 2014 National Confidential Inquiry into Suicide and Homicide report found that mental health patients are at their highest risk of dying by suicide in the first two weeks after leaving hospital – accounting for 18% of all patient suicides,” he said.

“It is therefore vital that effective care planning is put in place for patients before they are discharged, including those who self-discharge, and with early follow-up appointments carried out as a matter of routine. Indeed, the College has strongly supported the Government's recent proposal to record every suicide which takes place after contact with an NHS Service, and to use this as one of the headline indicators to judge the performance of the NHS.

“However, while we do support the Deputy Prime Minister’s ambitious target to reduce the number of suicides, it cannot be ignored that mental health services are currently under huge pressure, facing a 'perfect storm' of increasing demand and years of cuts to budgets. Therefore, if this welcome aspiration is to be realised, commissioners must give mental health services  the necessary resources to ensure that the highest possible standards of patient safety can be achieved.”

Greater investment

Meanwhile, Paul Farmer, chief executive of mental health charity Mind, called for greater investment in mental health services: “No one who is in touch with services, asking for help, should reach the point of taking their own life. It is essential that we have services that can respond when people reach out, from early treatment to help people manage their mental health problems as soon as possible, to crisis care services that can step in when someone becomes acutely unwell.

“Historical underfunding for mental health, compounded by cuts over the last few years, mean that services are struggling to cope with demand. If the Government is serious about reducing the suicide rate they have got to start investing properly in mental health services and giving mental health the priority it deserves.

“We must also remember that suicide isn’t just about mental health services. A person’s wellbeing and ability to cope is affected by every area of life. We know that welfare reform and unemployment have really taken their toll on people’s mental health and the stigma that continues to surround mental illness prevents many from speaking out and seeking help. We need an approach to suicide reduction that tackles these and other social factors as much as the health service.”