S-Kit Suicide Prevention Local Implementation Framework

S-Kit
Suicide Prevention Local Implementation Framework

A Strategic Multi-Agency Toolkit Aimed at Saving Lives
Document Purpose: Positive Practice Guidance and Benchmarking Toolkit

Author: Tony Roberts, Mark Needham and Jude Stansfield,
Suicide Prevention Programme Care Services Improvement Partnership (CSIP),
North West Development Centre, Hyde Hospital, 2nd Floor,
Grange Road South, Hyde, Cheshire, SK14 5NY
Telephone: 0161 351 4920 Facsimile: 0161 351 4936
Email: mark.needham@northwest.csip.org.uk; Jude.stansfield@northwest.csip.org.uk
Website: www.northwest.csip.org.uk
Have you visited our Knowledge Community? www.kc.nimhe.org.uk
Consultants: North West Standard 7 Leads Forum
Publication Date: August 2006
North West Target Audience: Standard 7 Leads, Public Health Leads, Senior Management,
Practitioners, Commissioners, Strategic Health Authorities, Local Authorities, Users of Mental
Health Services (including individuals with caring responsibilities).
Cross-reference With: Department of Health (2002) National Suicide Prevention Strategy for England
Artwork: Artwork on the front cover was supplied by Start in Manchester. START is an award-winning
organisation that helps people to improve, maintain and protect their mental wellbeing. Start students are
all recovering from a period of serious and long-term mental ill-health. They use art and gardening to build
confidence, self-esteem and practical life skills. Part of Manchester Mental Health and Social Care Trust,
Start is widely recognised as a leader in its field. For more information go to www.startmc.org.uk
Renowned anthropologist Margaret Mead informs us that when

individuals in the South Pacific were feeling suicidal they would
take themselves out to sea in a small boat as a sign for other
community members to respond, go out and collect them. The
need for all communities to work together as a social response
to early, tragic and preventable death is global.
Single service responses are not enough for effecting real
change and improvement that communicates strong messages
to vulnerable people, that there are alternatives to taking your
own life, are needed. This is particularly the case with suicide
prevention because it is a multi-sector issue involving a wide
range of independent and public services including, for example,
health, social care, transport, education, the police and criminal
justice system alongside community members and advocates.
Local strategies provide a whole system response to this complex
issue that can not be achieved through single action.
Effective suicide prevention requires local leaders to have
the passion and energy to lead the agenda within their own
communities. Complex partnership working and commitment
across organisations is critical to making a real difference, as
is the involvement of people with the experience of feeling
suicidal or of being bereaved by suicide.
The National Suicide Prevention Strategy has encouraged
pro-active approaches to reducing rates of suicides across
England with the aim of a 20% reduction by 2010. The latest
figures suggest we are on target.
This publication provides a practical tool which we believe will
be of real value in broadening our approach to suicide prevention
and saving lives.
Professor John Ashton C.B.E., Regional Director of Public Health,
Government Office North West.
Dean Repper, Director CSIP North West Development Centre.
Foreword
Suicide is a devastating event for an

individual, their family and the whole
community. The prevention of suicide
is a test of community resilience and
our ability to respond to individuals
and their distress.
Contents
1: Introduction
Executive Summary
Getting Started
Encouraging Partnership
10
2: Benchmarking Standards
11
Goal 1: Reduce Suicides in High-Risk Groups
19
Goal 2: Promote Mental Wellbeing in the Wider Population
30
Goal 3: Reduce Access to Means
35
Goal 4: Improve Media Reporting of Suicide
37
Goal 5: Promote Research on Suicide Prevention
40
Goal 6: Improve Monitoring of Progress
43
3: Appendix
44
Suicide Prevention Service Matrix
58
Glossary
60
References
Getting Started
Introduction
Executive Summary
Purpose
This toolkit aims to provide local public services and Suicide
Prevention Standard 7 Leads with resources, policy links, ideas
and recommendations for developing and delivering local
suicide prevention strategies.
Policy and Strategy

The Suicide Prevention Strategy for England was
published by the Department of Health in 2002 to support
the Saving Lives: Our Healthier Nation target of reducing
the death rate from suicide by at least 20% by 2010. This
is now a Public Service Agreement.
This National Strategy followed a number of studies,
recommendations and policies, which highlighted the need
for a cohesive and systematic approach to reducing suicide.
These included:
National Service Framework for Mental Health (MHNSF):
Standard 7
Safety First: Five-Year Report by the National Confidential
Inquiry Promoting Suicide Toolkit
Making It Happen: A Guide to Delivering Mental
Health Promotion
National Service Framework for Older People
Managing Deliberate Self-Harm in Young People,
Royal College of Psychiatrists Council Report
Executive Summary
The MHNSF Standard 7 places the responsibility for implementing

local action to reduce suicide on the Chief Executives of local
Primary Care Trusts. Subsequent performance monitoring by the
Strategic Health Authority (SHA) and the Health Care Commission
ensured that local services were accountable for implementing:
. A local strategy to reduce suicide

. A local population-based audit of suicide
. Monitoring and evaluation methods
for measuring the impact of local action
About the S-Kit

The S-Kit has been developed to support the local implementation
of the national Suicide Prevention Strategy for England. The North
West Development Centres regional development work identified 3
critical questions and support needs from Standard 7 Leads tasked
with the responsibility of developing local strategic approaches to
preventing suicide:
. How do you start developing a strategy for suicide prevention?

. What does a strategic approach to suicide prevention look like?
. How will I know if it has any real impact and how can I
measure this?
.
.
Mark Needham and Tony Roberts co-ordinated a regional network

which employed a collaborative methodology to develop this
resource with Standard 7 Leads, with the aim of saving lives and
preventing suicide.
The Suicide Prevention Strategy laid out the actions that

would be required, at a national level, to reduce suicide in
England according to 6 Goals:
Target Audience
Goal
Goal
Goal
Goal
Goal
Goal
The S-Kit is primarily aimed at organisations involved in suicide

prevention at a strategic level and directly supports the work of
Standard 7 (suicide prevention) Leads. It is not a clinical toolkit for
practice related work nor aimed at support for people in distress.
Readers seeking support might consider contacting NHS Direct,
The Samaritans or local organisations.
1:
2:
3:
4:
5:
6:
Reduce Suicides in High-Risk Groups

Promote Mental Wellbeing in the Wider Population
Reduce Access to Means
Improve Media Reporting of Suicide
Promote Research on Suicide Prevention
Improve monitoring of Progress
How to use the S-Kit

The S-Kit is designed to act as a benchmarking tool to support
local Suicide Prevention Partnerships in developing and delivering
a local suicide prevention strategy.
10 Steps to an Effective Suicide Prevention Strategy (p 7)
Offers a simple development process and framework for starting
a suicide prevention strategy.
Encouraging Partnership (p 8)
Outlines some of the multi-agency partnerships and responsibilities
for suicide prevention. This information is also available in a Suicide
Prevention Service Matrix which outlines responsibilities (see
Appendix 1).
Suicide Prevention Benchmarking Standards
Identifies a set of benchmarking standards for each objective of the
National Suicide Prevention Strategy as well as actions that could
be incorporated into local strategies.
Interactive Online Audit Tool
Organisations will be able to audit local suicide preventions
strategies against the standards laid out in the S-kit. For more
information please contact Mark Needham or Jude Stansfield
(see p 1).
10 Steps to an Effective Suicide Prevention Strategy

Outlines a simple development process and framework for starting a suicide prevention strategy.
Step
Benchmark
Responsibility
A suicide prevention lead is in place with capacity to co-ordinate and organise suicide
prevention work in the locality.
PCT
A suicide prevention workgroup is in place with multi-agency sign up including

members from senior management positions.
PCT
Members of the workgroup have dedicated time, resources and capacity to lead work
streams within the strategy.
All
The workgroup identifies where suicide prevention activity can be located within relevant
policy/strategy.
All
Champions are identified to consult on strategy within key organisations and feed back
to working group.
All
A first draft of strategy is developed with key objectives for each goal and proposed
responsibility for action.
S7 Lead
Getting Started
Draft is circulated for consultation and multi-agency sign up from key stakeholders.
7
A final draft strategy is completed with agreed implementation plan, action points
and timescales.
All
Suicide prevention is integrated into key strategy, policy and practice with sign up from
PCT Board and partnership organisations.
All
A suicide audit process is agreed - public health/whole population (see Goal 5).
PCT/Coroner
10
Systems for ongoing evaluation and monitoring are in place (See Goal 6).
S7 Lead monitors the

implementation of strategy
Obtain 6 monthly feedback from all responsible agencies on progress towards actions.
Formal evaluation of this work-plan at 6 monthly intervals.
The Department of Health identifies that Suicide Prevention

Strategies are led by Primary Care Trusts. However, preventing
suicide is not the sole responsibility of any one statutory agency,
nor just a health service related issue. Good quality partnership
working, joint targets, collaboration and shared responsibility are
the cornerstones of an effective approach.
This guide outlines some of the multi-agency responsibilities
for suicide prevention. Suicide Prevention Strategy is a co-ordinated
set of activities that will take place over several years.
A broad strategic approach is necessary - one that co-ordinates
the contributions of public services and organisations, academic
research, voluntary groups, the private sector and concerned
individuals and families.
The benchmarks set out in this toolkit aim to provide a useful
guide for local services in developing a comprehensive, evidence
based suicide prevention strategy. Below is a brief outline of
the responsibilities and strengths of different organisations in
supporting a suicide prevention strategy.
Primary Care Trusts

Responsible for appointing a Standard 7 Suicide
Prevention Lead and for co-ordinating and compiling the local
Suicide Prevention Strategy. The Public Health departments
are responsible for compiling the local Suicide Audit.
Specialist Mental Health Provider Services

Responsible for implementing the Safer Services guidance and
for ensuring that local Mental Health Services are delivering effective
CPA, post-discharge follow up, safe environments and Serious
Untoward Incident Reviews. Mental Health Services are also an
invaluable source of information, skills, knowledge and expertise
in risk assessment, audit, interventions and integrated working,
which can be shared with other agencies. May have a lead role
for suicide prevention and audit.
Local Strategic Partnerships (LSPs)
Criminal Justice System
Suicide Prevention is a PSA target, and should feature in the

action plans of Local Strategic Partnerships. LSPs are instrumental
in engaging communities, local agencies and authorities in joint
working and can recommend local action to promote mental health
and develop non-specialist services.
Suicide prevention is a key target in the criminal justice system

with suicide rates in prisons being far higher than in the general
population. The HMP Expectations document gives specific targets
for prisons to work towards. Prisons can also be isolated if not
included in local Standard 7 groups. There is considerable potential
for joint working as well as learning between prisons and community
sector organisations that promotes integrated pathways of care.
Police and Transport Police

Often at the frontline of suicide prevention in the community, the
police have a role in assessing risk and taking the necessary action
to alert mental health services to the needs of vulnerable people.
The police are also instrumental in the objectives of reducing suicide
by firearms, jumping from high places and on the railways. Local
police forces and transport providers may also be willing to share
data systems which can be utilised by the strategic group to
determine the incidence of attempted suicides, talk-downs, and
pick-ups etc. This data can be essential when assessing the risk
of hot spots in a locality.
Independent Sector
(Private and Voluntary Organisations)
The independent sector is part of a whole systems approach
to suicide prevention which involves local networks of statutory and
independent service provision. Organisations in the voluntary sector
are often the first port of call for people in distress. The voluntary
sector can be a rich source of knowledge and practical experience
for suicide prevention strategies to draw upon. Private organisations
are delivering a range of specialist services (i.e. in-patient, out of
area treatments, secure units, PICUs etc.). Strategic approaches
to suicide prevention that promote robust relationships with
the independent sector are more likely to result in early forms of
intervention for mental health difficulties that recognise suicide risk
and encourage appropriate referrals to specialist services.
Coroners Office
The coroners office holds details of all deaths by suicide and
undetermined injury. The information held by the coroner is more
detailed than that available through the public health mortality file,
making it advantageous for public health teams to work with the
coroners office in making sense of this valuable data resource.
Service User Groups and Families

Suicide prevention strategies require input, ratification and
consultation with the people most affected by its recommendations.
This is particularly the case when looking at preventing suicide in
acute in-patient settings and in how services respond to people in
crisis. The experiences and views of people using mental health
services are invaluable for informing the development of effective
and supportive services that promotes individuals well-being and
social inclusion. Equally, those who have been bereaved by suicide
can provide valuable input; particularly regarding post-vention.
Goal 2
Goal 3
Goal 4
Goal 5
Goal 6
Improve Monitoring of Progress
Benchmarking Standards
Goal 1
Introduction
The National Strategy applied clear criteria to select high-risk
groups identified from research/evidence available at the time
it was written.
Goal 1
These high-risk groups are:

1.1 People in Contact with Mental Health Services
1.2
1.3
1.4
1.5
Recent Self-Harm
Young Men
Prisoners
Occupational High-Risk Groups
The national criteria used for selecting high-risk groups was that:
. The group has been shown to have a statistically increased

risk of suicide
. Actual numbers of suicides in the group are known

. Evidence exists on which to base preventive measures
. Ways of monitoring the impact of preventive measures exist
These groups have been identified as at risk of suicide based
upon national statistical trends and research samples. When
targeting services and investment it is advisable to crosscheck
national recommendations of high-risk groups with the local
evidence base.
Goal 2 - Mental Health Promotion also identifies high-risk
groups in terms of mental well being. It is advisable that local
Suicide Prevention Partnerships use local suicide audit processes,
information and resources to check if these high-risk groups
match local trends.
The Toolkit offers a range of audit options to identify local at risk
groups by developing a local evidence base. This includes using
the suicide audit process as well as considering expertise and
knowledge from local stakeholders into the identification of local
need (see Goal 6 for more details).
Objective 1.1
Reduce the number of suicides by people who are currently or have recently been in contact with mental health services.
Standards
Monitoring and
Responsibility
Resources
SMHT and All Partners
Safety First5
Risk Assessment Training

100% Mental Health clinical staff - plus key staff in A&E, Ambulance, Police, Social Services, Prison - who
are in contact with patients at risk of self-harm or suicide, receive training in the recognition, assessment
and management of risk at intervals of no more than 3 years.1
Preventing Suicide Toolkit6

STORM Training7
The training is approved by the organisation and approval should be based on the evidence that training leads
to benefits.3
All Partners
The training is comprehensive, the quality and effectiveness of the training is continuously evaluated.4
All Partners
ASSIST Training8
Effective CPA
All known Mental Health (MH) patients with severe and enduring mental health problems, who are at high-risk
of self-harm or suicide, have their care co-ordinated through Enhanced Care Programme Approach (CPS).9
SMHT
Patients at risk of suicide are allocated to the enhanced level of the CPA.10
SMHT
Effective CPA
All care plans for Enhanced CPA should include explicit plans for responding to the needs of service users
who find their care package unacceptable or who do not wish to engage with services.
SMHT
Clinical Governance
CPA documentation forms part of case notes and is not maintained separately.11
SMHT
CPA is monitored through clinical governance12 and multi-agency audit.13
SMHT
Preventing Suicide Toolkit

Safety First
Effective CPA
Community PIG
Secure and Forensic Mental Health

Patients with Schizophrenia with complex needs if convicted of an offence are normally treated in hospital
rather than the prison service.14
SMHT/Criminal Justice
There is sufficient capacity in the provision of low and medium secure beds and PICU beds.
PCT/SMHT/Secure
Commissioning
National minimum
standards for PICU and
Low Secure Environments15
12
Objective 1.1 (continued)

Reduce the number of suicides by people who are currently or have recently been in contact with mental health services.
Standards
Monitoring and
Responsibility
Resources
Atypical anti-psychotics prescribed according to NICE guidelines.
SMHT and PCT
NICE Guidelines
on Schizophrenia16
Atypical anti-psychotics dispensed according to NICE guidelines.
Primary Care Trust
Monitoring of Antipsychotic prescriptions via regular audit cycles.
PCT/SMHT
Prescription and Dispensing Atypical Anti-psychotics
Safe Clinical Areas17

Ligature points removed from mental health wards, accident wards and A&E.
SMHT/Acute Trust
Preventing Suicide Toolkit
Care suites in prisons to conform to safer standards.
Prison
Daily safety checks performed on mental health wards, A&E and accident ward.
SMHT/Acute Trust
Goal 3 reducing
numbers of suicides by
hanging and strangulation
Monitoring arrangements in place for ensuring that safety checks are effective.
Acute and SMHT
Safety First
Medical acute health settings follow similar safety precautions to mental health care settings.
Acute Trust
Therapeutic Activity18
13
Creative responses to service user needs for therapeutic, social and recreational activities, during in-patient
care, need to be developed and supported by multi-disciplinary teams and other community support services
including voluntary and non-statutory services.
SMHT
There is a clear service user focus on safety, recovery, engagement, social access and inclusion.
SMHT
Service users need to be able to leave the ward to attend activities elsewhere in the building and to access
usable outdoor space.
SMHT
Acute Care PIG
Objective 1.2
Reduce the number of suicides in the year following deliberate self-harm.
Standards
Monitoring and
Responsibility
Resources
Acute Care Trust and Ambulance staff implementing NICE self-harm guidance.
Acute Care/Ambulance Trust
NICE Guidelines of Self-Harm
Operational protocols developed using the NICE guidance inc. interventions for a harm minimisation approach.
Primary Care/SMHT
Childrens NSF20
There is specific training and protocols for children and young peoples services.
CAMHS Local Steering Group
National Confidential Inquiry into

Young People and Self-Harm
All mental health staff have training on self-harm to support the implementation of the guidance.
SMHT
Non-mental-health staff receive appropriate training and tools to support them in screening and identification
of self-harm.
MH LIT
NICE Guidelines on Self-Harm19
Post Discharge Prevention of Suicide

Prior to discharge in-patient and community teams carry out a joint case review.
SMHT
Preventing Suicide Standard 3
Discharge care plans specify arrangements for promoting compliance/engagement with treatment.
SMHT
Effective CPA21
Care plans take into account the heightened risk of suicide in the first three months after discharge and make
specific reference to the first week.
SMHT
An agreed member of the clinical team follows up patients who have been at risk of suicide during the period
of admission within 7 days of discharge.
SMHT
Assertive outreach teams have been established to prevent loss of contact with vulnerable and high-risk patients.
SMHT
Crisis resolution teams have capacity to effectively follow-up high-risk patients discharged from hospital.
SMHT
Follow recommendations and findings from the National Confidential Inquiry into Young People and Self-Harm.
CAMHS
Statutory agencies effectively work in partnership with the voluntary and community sector to support and
advise on the identification of self-harm issues and to ensure rapid responses where appropriate.
SMHT/Community Sector
CMHT PIG22
Safer Services
National Confidential
Inquiry into Young People
and Self-Harm23
Oldham Self-Harm Pilot24
14
Objective 1.3
Reduce the number of suicides by young men.
Standards
Monitoring and
Responsibility
Resources
SMHT and PCTs/

Connexions/Youth Offending/
Youth Services/Education
NSF PIG25
Establish and maintain strong links between health and non-health voluntary sector organisations that support
young men with advice and support.
S7 Group
CALM27
Set up networking and joint learning initiatives to share skills and best practice between statutory and community
sector organisations.
S7 Group
Develop operational relationships and referral systems between sectors and agencies to facilitate rapid response
where needed.
S7 Group
Multi-agency working arrangements supported by gender awareness training.
S7 Group
Early Intervention in Psychosis

In partnership with education and youth services an early intervention in psychosis team is operational with
sufficient capacity.
Newcastle Declaration26
Multi-agency Interventions
Mens Health Forums28

NIMHE Young Mens
pilot projects
Looked After Children

Effective follow up arrangements are in place for vulnerable people leaving Local Authority care with a specific
focus on emotional wellbeing.
Local Authority
Emotional Health of Looked

After Children29
Probation/Youth Offending
Teams/Police
The Tower30
Criminal Justice
Local community safety partnerships are working strategically and operationally to offer targeted support
for young men who come into frequent contact with the criminal justice system, especially in connection with
drug-related crime and anti-social behaviour.
15
Objective 1.4
Reduce the number of suicides by prisoners.
Standards
Monitoring and
Responsibility
Resources
Partnership Working
Transfer of health care commissioning responsibilities from HMP to PCT.
PCT/HMP
HMP Suicide Prevention Officer sits on Suicide Prevention Group.
HMP Lead
Suicide Prevention Lead sits on HMP Safer Establishments Group.
S7 Lead
Mental Health Training

Prison Officers to access mental health awareness training.
HMP
Prison Officers to be trained in Risk Assessment as part of ACCT Implementation.
HMP
CSIP MH Awareness
(in custodial settings)
Self Directed Workbook
Samaritans to train Prison Listeners.
Samaritans
A Pocket Guide to ACCT31
Evaluate the impact of training.
Samaritans
Insiders Peer Support Schemes32
HMP to review reception screening for risk management and opportunities for intervention.
HMP
HMIP: Expectations33
Officers trained in Mental Health Awareness to be MH Liaison on wings.
HMP
Suicide is Everyones Concern34
A multi-disciplinary suicide prevention committee monitors the prison policy and procedures effectively.
HMP
Risk Management
The committee includes a suicide co-ordinator, prisoner representatives and a member of the local
community mental health team.
16

Reduce the number of suicides by prisoners.
Standards
Monitoring and
Responsibility
Resources
Managers and staff promote an understanding and demonstrate respect for all ethnic and cultural groups
including prisoners, staff and visitors. Inappropriate language or conduct by staff or prisoners is challenged.
HMP
HMIP: Expectations
An anti-bullying (violence reduction) strategy is in place and is based on an analysis of the pattern of bullying
in the prison.
HMP
Policy and Ethos
Access to Support
17
Prisoners have unhindered access to sources of help including counsellors, the chaplaincy team, Listeners
and the Samaritans at all times.
HMP
A care suite should be available and of sufficient size to cater for the needs of the population.
HMP
HMIP: Expectations
Objective 1.5
Reduce the number of suicides by high-risk occupational groups.
Standards
Monitoring and
Responsibility
Resources
Improving the mental health of employees in the health service is given strategic priority and investment.
All NHS
Improving Working
Lives Standard35
Mental Health at Work policies aimed at promoting positive mental health exist in all statutory organisations.
All Statutory Organisations
Policy and Strategy
NHS Employers Website36

Local Strategic Partnership (LSP) recommends workforce mental health policy development.
LSP
Lord Mayor of London Report

into Mental Health in Workplace37
Practice
HSE Management Standards on Stress at Work are being implemented consistently in all statutory and
voluntary sector organisations.
LSP
Health and Safety Executive

Stress Management Standards38
Working time directives are being consistently met by all relevant organisations.
Working Time Directive
Guidelines and resources for supporting mental health in the workplace distributed to managers and staff
across all sectors.
LSP
Multi-agency workforce mental health training commissioned locally to support managers in promoting
positive mental health in the workplace.
Health, Work and Wellbeing39
Rural Communities
Formal links exist between Standard 7 and rural agencies such as DEFRA, Countryside Alliance, Rural
Network and local voluntary organisations, etc.
S7 Group
Local partnership arrangements exist to ensure effective mental health provision is dedicated to the rural
sector, in particular, specific arrangements for pathways and access routes to services where necessary.
S7 Group
Clear responsibility and accountability exists between PCTs and SMHTs for the commissioning and provision
of mental health care to rural communities.
PCT and SMHT
DEFRA40
Rural Stress Network41
Rural Stress Proofing Guidelines
Responsible Commissioner
18
Goal 2
Introduction
Suicide rates reflect the mental health of the community as a
whole. Standard 1 of the National Service Framework for adult
mental health adopts a similarly broad approach by stating that
health and social services should:
Promote mental health for all, working with individuals
and communities
Combat discrimination against individuals and groups with
mental health problems and promote their social inclusion
.
.
The National Strategy focuses on a number of groups within

society for whom additional specific measures should be taken.
These are not the groups at high-risk of suicide defined in goal
one. Department of Health consultation and evidence review
has shown that these are vulnerable groups of people about
whom concerns have been expressed.
Local Suicide prevention strategies may wish to incorporate
other vulnerable groups or shift the emphasis of mental health
promotion according to local need.
Objective 2.1
Promote the mental health of socially excluded, deprived and other vulnerable groups.
Standards
Monitoring and
Responsibility
Resources
SHIFT/NIMHE/
Standard 1 Leads
Social Exclusion
and Mental Health42
Reduce Stigma
A local stigma partnership has been established to work to reduce stigma associated with mental health.
SHIFT43
Rethink44
Social Exclusion Report
The recommendations of the Social Exclusion Unit's "Action on Mental Health: A Guide to Promoting Social
Inclusion" are being implemented and evaluated.
LIT/LSP
The 27 point plan of the Mental Health and Social Exclusion Report are being implemented and evaluated locally.
LIT/LSP
Action on Mental Health45

Social Exclusion Unit Website46
Homeless People
There is a local plan for improving the health of and reducing the numbers of rough sleepers as identified by
the social exclusion unit.
Housing/PCT/LSP
Local mental health services target specialised support at rough sleepers and homeless people.
SMHT
NSF 5 Years On
LSP
Social Exclusion Unit
Rough Sleeping Report by SEU47

Off the Streets and Into Work48
Community Development
There are local multi-agency action plans for Social Inclusion, Community Development and Neighbourhood
Renewal which are being monitored and evaluated.
Neighbourhood Renewal
Policy Action Team
(PAT) Reports
Commissioning for Social Inclusion

Mental health day services are being commissioned to refocus on mainstream community resources that
promote social inclusion.49, 50
PCT/Local Authority
Social Inclusion Programme51
20
Objective 2.2
Promote mental health among people from black and ethnic minority groups, including Asian women.
Standards
Monitoring and
Responsibility
Resources
A local strategy/action plan for improving the Mental Health of BME Communities is being implemented
and evaluated by a multi-agency group.
Standard 1 Lead
Inside Outside52
This strategy is incorporated and integrated into the local Public Mental Health Strategy.
Standard 1 Lead
Voluntary and community groups are actively involved in the planning, delivery and evaluation of services
to BME communities.
Standard 1 Lead
Local Strategy
Making It Possible53
Delivering Race Equality54
Community Development Workers (CDW)

The workforce target for Community Development Workers for BME Communities has been achieved.
PCT/LA/SMHT/LSP
The workers are operating effectively within a locally agreed strategic framework.
PCT/LA/SMHT/LSP
CDW PIG55
Stigma and Discrimination

Specifically targeted anti-stigma work is being implemented and evaluated locally in line with national
guidelines and messages.
Standard 1 Lead
SHIFT
All local statutory agencies have robust and formal Race Equality and Diversity policies and schemes
in operation.
LSP
Race Equality (amended) Act57
The recommendations for Delivering Race Equality: A Framework for Action are being implemented and
monitored including data collection on service delivery at board level.56
PCT/SMHT
Delivering Race Equality:

A Framework For Action
There is a local diversity and celebrating culture strategy in place, with effective evaluation.
Race Equality
21

Promote mental health among people from black and ethnic minority groups, including Asian women.
Standards
Monitoring and
Responsibility
Resources
All NHS organisations are actively implementing the Essential Shared Capabilities framework.
All NHS
Essential Shared Capabilities58
Non-NHS organisations actively implementing race equality and diversity schemes.
All Agencies
Workforce Confederation
Workforce
22
Objective 2.3
Promote the mental health of people who misuse drugs and/or alcohol.
Standards
Monitoring and
Responsibility
Resources
A strategy exists for the comprehensive care of people with co-morbidity/dual diagnosis, i.e. people with
mental health problems who also engage in alcohol and/or substance misuse.
SMHT/DAT
No Longer a Diagnosis
of Exclusion59
Staff who provide care to people at risk of suicide are given approved training in the clinical management
of cases of co-morbidity/dual diagnosis.
SMHT/DAT
Dual Diagnosis Good

Practice Guide60
Statistics for co-morbidity/suicide are collected and used to inform decision making on resources.
SMHT/DAT
People with Dual Diagnosis
Harm Reduction
Multi-agency training on harm minimisation for alcohol and drugs is in place and is being evaluated.
DAT
A local alcohol harm reduction strategy is in place, incorporating measures to encourage and promote
sensible drinking.
PCT/Local council
The Local Strategic Partnership is working towards promoting responsible alcohol use in licensed premises
and public places.
LSP
Local communities are actively involved in promoting the mental health of people who abuse drugs
and/or alcohol.
LSP
National Alcohol Harm

Reduction Strategy61
HIT Website62
Younger People
Age-appropriate alcohol and drug services, advice and information available, accessible and acceptable
to young people.
23
PCT
BMA Website63
MindBodySoul Website64
Objective 2.4
Promote the mental health of victims and survivors of abuse, including child sexual abuse.
Standards
Monitoring and
Responsibility
Resources
Partnership Working
Statutory services work in partnership with the community sector to provide suitable specialist services
such as Womens Centres, Crisis Centres, Refuges, self-help groups, etc.
All Statutory services have

protocols/SLAs and joint
working agreements
Local Strategy
There is a local strategy for Womens Mental Health which is being implemented and evaluated.
PCT
Womens Mental Health

Implementation Guidance65
Appropriate and sensitive female-only day service provision is available locally.66
SMHT
Supporting Women into

the Mainstream
Female and family friendly mental health in-patient services are available locally.
SMHT
Gender Sensitive Service Provision
Domestic Violence
Incidence of domestic violence is monitored and local Community Safety partnerships are taking
appropriate action to address local issues with LSP partners.67, 68
LSP
Domestic Violence
Resource Manual69
Work to address domestic violence is evaluated for effectiveness.
LSP
Women and Equality Unit70
24
Objective 2.5
Promote mental health among children and young people (aged under 18 years).
Standards
Monitoring and
Responsibility
Resources
Working in partnership with local Sure Starts, nurseries and community organisations - such as parenting
classes, baby massage and exercise activities.
LSP
Choosing Health71
Children's Centres actively seek to incorporate mental health promotion into mainstream work with health
visiting, screening and parenting courses, etc.
Childrens Centres
Early Years
Schools
PCT/Healthy Schools
National Healthy Schools72
LA
Promoting Health of Looked

After Children73
PCT/LA
Childrens NSF74
There is a local multi-agency strategy/action plan for improving the mental and emotional wellbeing of children
and young people.
LSP/PCT/SureStart/LA
Choosing Health: Children

and Young People
This strategy is incorporated and integrated into the Public Mental Health Strategy.
LSP/PCT/SureStart/LA
Childrens NSF Standard 975
Local schools are working towards, or have achieved, the Emotional Health Standard of Healthy Schools.
Looked After Children
The recommendations of the Emotional Health of Looked After Children are being implemented and evaluated.
Childrens NSF
The actions and recommendations from the Childrens NSF are being implemented and monitored.
Mental Health Promotion Strategy
25

Promote mental health among children and young people (aged under 18 years).
Standards
Monitoring and
Responsibility
Resources
PCT and/or Provider
LSP
Young Adults with Complex

Needs Report76
CAMHS
There is a comprehensive CAMHS Service which specifically includes a mental health promotion function.
Social Inclusion
There is local action to implement the agreed action points from the social exclusion units Young Adults with
Complex Needs report.
26
Objective 2.6
Promote mental health among young women during and after pregnancy.
Standards
Monitoring and
Responsibility
Resources
PCT/Maternity
Childrens NSF
There is a local multi-agency strategy/action plan for improving the mental and emotional wellbeing of young
women during and after pregnancy.
PCT/Sure Start/Childrens Trusts
Childrens NSF
PCT/Sure Start/Childrens Trusts
Screening and Detection

Protocols exist locally for screening, identification and early intervention for young mothers who are at risk
of mental health problems during and after pregnancy.
Partnership Working
Every Child Matters77
Family Friendly Mental Health Services

Secondary mental health services provide family friendly in-patient and community services, and make
suitable and appropriate provision for mothers requiring mental health care.
PCT/SMHT
Women's Mental Health

Implementation Guidance
(DH, 2003)
PCT/Maternity Services
Maternity Services
Ensure that pregnant women receive high quality care throughout their pregnancy, have a normal childbirth
wherever possible, are involved in decisions about what is best for them and have choices about how and
where they give birth.78
27
Objective 2.7
Promote mental health among older people.
Standards
Monitoring and
Responsibility
Resources
PCT and Social Services
Better Health in Old Age80
Screening and Detection

Routine screening in primary and social care for bereavement, social isolation, loneliness, dementia, depression
and suicide risk.79
Older peoples mental health

CSIP website81
Partnership Working
There is integrated local support for older adults to maximise their independence, keep physically active, access
support, maintain social contact and contribute to their communities.82
LSP
Data on the mental health

of older people83
Centre for Policy on Aging84
National Service Framework

There is a clear action plan to implement and evaluate the older persons NSF, in particular standards 7 and 8
and the Mental Health NSF Standard 1.
Older People NSF LITs
Older persons NSF

Mental Health NSF85
Mental Health Service Delivery

The arbitrary age barrier at 65 in mental health and other care services operates flexibly to meet the needs
of the individual not the definition of the service.
PCT/SMHT/LITs
Older Persons NSF
28
Objective 2.8
Promote the mental health of those bereaved by suicide.
Standards
Monitoring and
Responsibility
Resources
Families/carers are given a clear mechanism for making contact with an informed member of the clinical team
at all times.
SMHT
2.8 Standard 4:
Family/Carer Contact
Families/carers are given appropriate information promptly following a suicide.
PCT
CRUSE86
Contact with Services
SOBS87
Papyrus88
Children
There are mechanisms in place to ensure support is readily and quickly available for children who are bereaved
by suicide.
PCT
Childhood
Bereavement Network90
Post-Suicide Review
There is an opportunity for families/carers to contribute to a multi-agency post-suicide review irrespective of
whether their relative was known to mental health services.
29
Winstons Wish89
PCT
Goal 3
Reducing access to lethal methods of self-harm is known to be

an effective way of preventing suicide. One reason is that suicidal
behaviour is sometimes impulsive, so that if a lethal method is not
immediately available a suicidal act can be delayed or prevented
altogether.91 Although method substitution does occur, a number
of people will not go on to use another method and lives may
therefore be saved.
This strategy focuses on reducing access to the main methods
of suicide. Hanging and strangulation are particularly associated
with mental health wards and prisons but these are also frequent
methods of suicide in the community, especially among young men.
Introduction
Objective 3.1
Reduce the number of suicides as a result of hanging and strangulation.
Standards
Monitoring and
Responsibility
Resources
Wards are audited at least annually to identify and minimise opportunities for hanging or other means by which
patients could harm themselves.
SMHT
Standard 2:
In-patient Suicide Prevention
Likely ligature points on in-patient units have been removed or covered.
SMHT
Acute Care PIG
A protocol has been developed to allow potential ligatures to be removed from patients at high-risk of suicide.
SMHT
Environmental difficulties in observing patients are made explicit and remedial action is taken as far as possible.
SMHT
Observation policy and practice reflects current evidence about suicide risk.
SMHT
Patients under any form of increased observation are to be allowed to participate in normal on and off ward
activities following a realistic risk assessment and weighing benefits against risks.
SMHT
A&E, accident wards and other acute health settings follow similar safety precautions to mental health
care settings.
Acute Care Trust
Prisons follow similar safety precautions to mental health care settings.
HMP
Improving the Safety of Care Settings
31
Safer Services
Objective 3.2
Reduce the number of suicides as a result of self-poisoning.
Standards
Monitoring and
Responsibility
Resources
Patients at risk of suicide receive the right medication in the right amounts.
SMHT/Primary Care/
Pharmacies/Acute Trusts
Standard 2:
In-patient Suicide Prevention
Safer Prescribing Protocols are adhered to and monitored.
SMHT/Primary Care/
Acute Care PIG
Safe Prescribing and Dispensing
Local suicide prevention partnerships use local knowledge to determine that local stores are selling medication
within the legally allowed limit.
Safer Services
SMHT/Primary Care/
Objective 3.3
Reduce the number of suicides as a result of motor vehicle exhaust gas.
Standards
Monitoring and
Responsibility
Local population-based suicide audits collect information on the use of vehicle exhaust in suicide and suicide
attempts to ascertain any opportunities for prevention.
Standard 7 Lead
Resources
32
Objective 3.4
Reduce the number of suicides on the railways.
Standards
Monitoring and
Responsibility
Resources
Work with Rail Authorities and Transport Police to identify potential hotspots on the local rail network and
evaluate safety issues at local stations according to Suicide and Open Verdict on the Railway Network (SOVRN)
guidelines and the Rail Safety Standards Board.
Rail Authority and

Transport Police
SOVRN92
Local population-based suicide audits collect information on suicide and suicide attempts on the railway network
to ascertain any opportunities for prevention.
Standard 7 Lead
Collaborate with helplines, poster campaigns (e.g. Samaritans helpline telephone numbers in known hot spots).
Standard 7 Group
Rail Safety and

Standards Board93
Objective 3.5
Reduce the number of suicides as a result of jumping from high places.
33
Standards
Monitoring and
Responsibility
Resources
Local Council/
Transport Authorities
Samaritans94
Identification of known hotspots using data from Police, Ambulance Service, Local Council and Suicide Audit
- particularly where negotiators have talked down a suicidal person.
PCT
Goal 5
Take appropriate action to reduce risk at hotspots (e.g. fencing, access, CCTV, etc.).
Local Council
Public Health Audit Tool
Objective 3.6
Reduce the number of suicides using firearms.
Standards
Monitoring and
Responsibility
Local Strategic Partnerships work together with the police in supporting the control of gun ownership - including
protocols for reporting gun ownership.
LSP/Police
Local population-based suicide audit to detect any use of firearms in suicides, then monitor trends/patterns and
high-risk groups.
PCT
Resources
34
Goal 4
Introduction
Any suicide is a newsworthy event. If an individual has chosen to
end their life, quite deliberately and prematurely, it is likely to attract
the attention of the public.
The sad truth is that there are over 6,000 suicides every year in
the UK. Many of these deaths go unreported, yet the effect of each
individual suicide has a profound impact on the family, friends and
colleagues, even if it doesn't reach a wider audience.
For the journalist, a suicide presents a difficult dilemma.
As suicide is an issue of concern to the public, it is clearly the
responsibility of the reporter to present the facts as they happen
without glamourising the story or imposing on the grief of those
effected. Indeed, there can be a positive aspect to reporting suicide
as debate may help to destigmatise the subject. However, some
research shows that inappropriate reporting or depiction can lead
to "copycat suicides".
The actions in this standard seek to support local services by
working in partnership with the local media to responsibly and
sensitively cover suicide and mental health.
Objective 4.1
Promote the responsible representation of suicidal behaviour in the media.
Standards
Monitoring and
Responsibility
Resources
A local Press Pack has been developed in collaboration with local press covering recommendations, local
mental health info and contacts, and is used consistently.
Stigma Partnership
WHO Reporting Guidelines95
Local news media are consistently adhering to journalistic and international guidelines on the reporting of suicide.
Media groups
Working with Local Media
National Union of Journalists96

Response Ability97
Local Media Champions have been identified to drive forward positive reporting and are able to do so effectively.
Media training and support is available to Media Champions.
Local partnerships and communications leads take a proactive approach to reporting positive, non-stigmatising
stories about mental health issues.
Communications Leads
Negative or sensationalised reporting is followed up by local communications leads.

Local Campaigning
Local services and community groups utilise new media (internet, multimedia, etc.) to promote positive messages
about mental health and provide access to information on services to the public.
Standard 7 Group
Local campaigning and public awareness initiatives are having a positive impact on the public perception
of suicide.
Standard 7 Group
Mental Health Media98

SHIFT
36
Goal 5
Introduction
Research evidence on suicide prevention is a central aspect of
suicide prevention strategies. A large amount of evidence has been
reported from epidemiological and clinical studies on risk factors
associated with suicide. However, there have been no intervention
studies in which suicide prevention has been the main outcome.
This is largely because of the huge sample of people (running to
several million) that would have to be in such a study before reliable
results could be produced.
This strategy aims to develop our research base in two key areas:
. Detailed studies of high-risk groups from which we can draw

conclusions on prevention with reasonable certainty
. Intervention studies with more common outcomes that will act as

proxy measures for suicide
Knowledge on suicide prevention is not strictly limited to formal or
large scale research projects. There is a wealth of locally accessible
information that is collected as part of current audit and monitoring
processes in supporting individuals at risk of suicide.
Performance Monitoring and Improvement Departments
(PCT/SMHT)
Patient and Public Involvement99
A range of standards are suggested for collecting local
grassroots information that could be fed into both the development
and evaluation (Goal 6) of local suicide prevention strategies.
Objective 5.1
Improve research evidence on suicide prevention.
Standards
Monitoring and
Responsibility
Resources
Research Participation
Academic/research Lead linked into suicide prevention workgroup.
Standard 7 Group
Information Sharing
Respective organisations to exchange information on suicides and check against databases of known
individuals using mental health services.
SMHT/Coroners/PCT
Local knowledge: Live Audit

Conduct qualitative local studies to capture information and develop local evidence base.
Clinical Governance
(PCT/SMHT)
Involve users of services and teams providing services to collect local data and information on uncompleted
suicides and recovery.
Acute Trust (A&E)
1) Local factors influencing suicide.
Secondary Mental Health

Services inc. Crisis Teams/
Patient/ Participation
Involvement (PPI)/Police/
Transport Police
2) Operational audit of best practice that reduces level of risk and prevents suicide. This could be built into
existing team audit/reporting procedures as part of regular team meetings.
3) Interrogation of NPRS system for data on risk assessment and management.
4) Liaise with A&E and Medical Admissions wards for data on admissions for self-harm and attempted suicide.
5) Work with local police and transport police for data on talk-downs, locations, follow up, Section 136, etc.
38
Objective 5.2
Disseminate existing evidence on suicide prevention.
Standards
Monitoring and
Responsibility
Resources
Utilise available mechanisms for updating knowledge, sharing information and facilitating communication
including electronic/website communication.
ST1 Mental Health Promotion
Mental Health Foundation100
Regional networks - participation in local and regional Suicide Prevention Network to share information and
good practice across the region.
Standard 7 Group
Ensure availability of public information on suicide prevention - patient/public leaflets, campaigns, websites, etc.
PCT/SMHT
Communications Officer
Utilise the local press to share up-to-date information on suicide prevention with general public, e.g. information
on services, phone lines and good practice.
Communications Officer
Keep up-to-date with Local, Regional, National and International developments in suicide prevention through
NIMHE Knowledge Community.
S7 Group
Knowledge Sharing and Communication
39
Samaritans101
MASH102
Oldham Self-Harm Project103
NIMHE Knowledge
Community104
Goal 6
Primary Care Trusts are responsible for compiling local

population based suicide audits. The task of conducting the
audit most commonly falls to the Public Health Teams. The
Primary Care Suicide Audit toolkit aims to provide some of
the main considerations, headings and questions that can
be addressed in a suicide audit, and gives recommendations
for good practice.
Population based suicide audits are a valuable tool in analysing
patterns and trends in suicide across the whole local population.
They support suicide prevention work by identifying high-risk
groups and geographic hotspots, as well as provide a vehicle
for enhanced information and data sharing between agencies.
The effectiveness of any strategy lies in its monitoring and
evaluation. It is essential that the Suicide Audit is not simply a
tick-box exercise but, instead, that it forms part of an over-arching
review of the local strategy, informing future developments.
Improve Monitoring of Progress
Introduction
Objective 6.1
Monitor suicide statistics relevant to the goals and objectives in the strategy.
Standards
Monitoring and
Responsibility
Resources
Local suicide audit to incorporate information on:

Completed suicides in the whole population
Self-harm
Individuals at risk
CPA data on risk assessment
Police data on attempted suicides
Coroners data from reports
Standard 7 Lead
PH Audit Tool105
Liaise with local coroner over the use of a specialised template for recording suicides for data analysis.
PCT/Coroner
Analyse trend data of 3 year averages by gender, age, ethnicity, method, location, etc.
PCT
Analyse data and statistics from local prison on self-harm and suicide.
Prison/PCT
Population Based Suicide Audit
Public Health Observatory106
Data Sharing
41
Develop data sharing mechanisms between PCT, SMHT, Coroner, Police, Acute Trust, Prison and Ambulance.
Standard 7 group
Local SUI Policy
Share relevant findings from SMHT Serious and Untoward Incident Review panel.
SMHT
Audit Toolkit
Conduct a post-suicide review for all completed suicides in PCT area.
Standard 7 Group
Objective 6.2
Evaluate the local suicide prevention strategy.
Standards
Monitoring and
Responsibility
Resources
Develop a local performance monitoring tool for updating on strategy progress.
S7 Group
S-Kit Performance
Monitoring Framework
Formally evaluate the actions of the local strategy on an annual basis.
S7 Group
Performance Monitoring
Annual Report
Prepare written evaluation/annual report and present to LIT/LSP and other relevant boards.
S7 Group
Amend accordingly the actions and outcomes of the strategy annually in response to evidence and evaluation.
S7 Group
42
Appendix

Glossary
References
The service matrix comprises a number of tables detailing the

lead responsibilities of:
Primary Care Trusts
Secondary Mental Health Trusts
Local Strategic Partnerships
Prisons and Criminal Justice
Acute Hospital Trusts
Multi Agency Responsibilities
Suicide Prevention Strategy Group
.
.
.
.
.
.
.
It is important to note that, whilst an organisation may not have

lead responsibility for a given standard, the success of a local
suicide prevention strategy lies in effective partnership working.
The Matrix does not contain every single organisation that can be
involved in suicide prevention. There is no intention to exclude any
organisation or agency from suicide prevention. The purpose of the
Service Matrix is not to be dictatorial but to provide some clarity
of roles and responsibilities for use in local arrangements that
may also be added to.
This Suicide Prevention S-KIT Service Matrix is designed to

compliment the full S-KIT by providing organisations with a quick
reference guide to their responsibilities in preventing suicide.
The Service Matrix outlines the areas in which an organisation is
the lead responsible agency. A number of the S-KIT standards have
shared responsibilities and organisations should refer to the main
document for guidance on implementing these standards. Likewise,
local arrangements may mean that some of the responsibilities
highlighted in the Matrix may fall on a partner organisation. The
key is not that the Matrix is used verbatim but that it acts as a
guide for local delivery.
Primary Care Trusts

Objective
Standard
1.1
There is sufficient capacity in the provision of low and medium secure beds and PICU beds.
Atypical anti-psychotics prescribed according to NICE guidelines.
Atypical anti-psychotics dispensed according to NICE guidelines.
Monitoring of Antipsychotic prescriptions via regular audit cycles.
1.3
In partnership with education and youth services, an early intervention in psychosis team is operational with sufficient capacity.
1.4
Transfer of health care commissioning responsibilities from HMP to PCT.
1.5
Clear responsibility and accountability exists between PCTs and SMHTs for the commissioning and provision of mental health care to rural communities.
2.1
A local stigma partnership has been established to work to reduce stigma associated with mental health.
2.2
A local strategy/action plan for improving the Mental Health of BME Communities is being implemented and evaluated by a multi-agency group.
The workforce target for Community Development Workers for BME Communities has been achieved.
The workers are operating effectively within a locally agreed strategic framework.
The recommendations for Delivering Race Equality: A Framework for Action are being implemented and monitored including data collection on service delivery
at board level.
Specifically targeted anti-stigma work is being implemented and evaluated locally in line with national guidelines and messages.
2.3
A local alcohol harm reduction strategy is in place incorporating measures to encourage and promote sensible drinking.
Age-Appropriate alcohol and drug services are available, accessible and acceptable to young people.
2.4
45
There is a local strategy for Womens Mental Health which is being implemented and evaluated.
Primary Care Trusts (continued)

Objective
Standard
2.5
The actions and recommendations from the Childrens NSF are being implemented and monitored.
There is a Comprehensive CAMHS Service which specifically includes a mental health promotion function.
2.6
Protocols exist locally for screening, identification and early intervention for young mothers who are at risk of mental health problems during and after pregnancy.
Ensure that pregnant women receive high quality care throughout their pregnancy, have a normal childbirth wherever possible, are involved in decisions about what
is best for them and have choices about how and where they give birth.
2.7
Routine screening in primary and social care for bereavement, social isolation, loneliness, dementia, depression and suicide risk.
2.8
There are mechanisms in place to ensure support is readily and quickly available for children who are bereaved by suicide.
There is an opportunity for families/carers to contribute to a multi-agency post-suicide review - irrespective of whether their relative was known to mental
health services.
3.3
Local population-based suicide audits collect information on the use of vehicle exhaust in suicide and suicide attempts to ascertain any opportunities for prevention.
3.4
Local population-based suicide audits collect information on suicide and suicide attempts on the railway network to ascertain any opportunities for prevention.
3.5
Identification of known hotspots using data from Police, Ambulance Service, Local Council and Suicide Audit particularly where negotiators have talked down
a suicidal person.
3.6
Local population-based suicide audit to detect any use of firearms in suicides and then monitor trends/patterns and high-risk groups.
6.1
Conduct local population based suicide audit.
46
Secondary Mental Health Trusts

Objective
Standard
1.1
100% Mental Health clinical staff who are in contact with patients at risk of self-harm or suicide receive training in the recognition, assessment and management
of risk at intervals of no more than 3 years.
All known MH patients with severe and enduring Mental Health problems, who are at high-risk of self-harm or suicide, have their care co-ordinated through
Enhanced CPA.
Patients at risk of suicide are allocated to the enhanced level of the CPA.
All care plans for Enhanced CPA should include explicit plans for responding to the needs of service users who find their care package unacceptable or who do
not wish to engage with services.
CPA documentation forms part of case notes and is not maintained separately.
CPA is monitored through clinical governance and multi-agency audit.
Ligature points removed from mental health wards.
Daily safety checks performed on mental health wards.
Monitoring arrangements in place for ensuring that safety checks are effective.
Creative responses to service user needs for therapeutic, social and recreational activities during in-patient care need to be developed and need to be supported
by multi-disciplinary teams and other community support services, including voluntary and non-statutory services.
There is a clear service user focus on safety, recovery, engagement, social access and inclusion.
Service users need to be able to leave the ward to attend activities elsewhere in the building and to access usable outdoor space.
1.2
All Mental Health staff have training on self-harm to support the implementation of the NICE Self-harm guidance.
Prior to discharge in-patient and community teams carry out a joint case review.
Discharge care plans specify arrangements for promoting compliance/engagement with treatment.
Care plans take into account the heightened risk of suicide in the first three months after discharge and make specific reference to the first week.
47
Secondary Mental Health Trusts (continued)

Objective
Standard
An agreed member of the clinical team follows up patients who have been at risk of suicide during the period of admission within 7 days of discharge.
Assertive outreach teams have been established to prevent loss of contact with vulnerable and high-risk patients.
Crisis resolution teams have capacity to effectively follow-up high-risk patients discharged from hospital.
1.5
Clear responsibility and accountability exists between PCTs and SMHTs for the commissioning and provision of mental health care to rural communities.
2.1
Local mental health services target specialised support at rough sleepers and homeless people.
2.2
The recommendations for Delivering Race Equality: A Framework for Action are being implemented and monitored - including data collection on service delivery
at board level.
2.3
A strategy exists for the comprehensive care of people with co-morbidity/dual diagnosis, i.e. people with mental health problems who also engage in alcohol and/or
substance misuse.
Staff who provide care to people at risk of suicide are given approved training in the clinical management of cases of co-morbidity/dual diagnosis.
Statistics for co-morbidity/suicide are collected and used to inform decision making on resources.
2.4
Appropriate and sensitive female-only day service provision is available locally.

Female and family friendly mental health in-patient services are available locally.
2.6
Secondary mental health services provide family friendly in-patient and community services, and make suitable and appropriate provision for mothers requiring
mental health care.
2.7
The arbitrary age barrier at 65 in mental health and other care services operates flexibly to meet the needs of the individual, not the definition of the service.
2.8
Families/carers are given a clear mechanism for making contact with an informed member of the clinical team at all times.
3.1
Wards are audited at least annually to identify and minimise opportunities for hanging or other means by which patients could harm themselves.
Likely ligature points on in-patient units have been removed or covered.
A protocol has been developed to allow potential ligatures to be removed from patients at high-risk of suicide.
48
Secondary Mental Health Trusts (continued)

Objective
Standard
Environmental difficulties in observing patients are made explicit and remedial action is taken as far as possible.
Patients under any form of increased observation are to be allowed to participate in normal on and off ward activities following a realistic risk assessment and
weighing benefits against risks.
3.2
6.1
Relevant findings from SMHT Serious and Untoward Incident Review panel are shared with suicide prevention group.
Local Strategic Partnerships

Objective
Standard
1.5
LSP recommends workforce mental health policy development in all partner organisations.
HSE Management Standards on Stress at Work are being implemented consistently in all statutory and voluntary sector organisations.
Guidelines and resources for supporting mental health in the workplace distributed to managers and staff across all sectors.
2.1
The recommendations of the Social Exclusion Unit's "Action on Mental Health: A Guide to Promoting Social Inclusion" are being implemented and evaluated.
There is a local plan for improving the health of, and reducing the numbers of, rough sleepers as identified by the social exclusion unit.
Local multi-agency action plans for Social Inclusion, Community Development and Neighbourhood Renewal are being monitored and evaluated.
49
Local Strategic Partnerships (continued)

Objective
Standard
2.2
All local statutory agencies have robust and formal Race Equality and Diversity policies and schemes in operation.
2.3
LSP is working towards promoting responsible alcohol use in licensed premises and public places.
Local communities are actively involved in promoting the mental health of people who abuse drugs and/or alcohol.
2.4
Incidence of domestic violence is monitored and local Community Safety partnerships are taking appropriate action to address local issues with LSP partners.
Work to address domestic violence is evaluated for effectiveness.
2.5
Working in partnership with local Sure Starts, nurseries and community organisations such as parenting classes, baby massage and exercise activities.
There is a local multi-agency strategy/action plan for improving the mental and emotional wellbeing of children and young people.
There is local action to implement the 27 agreed action points from the social exclusion units Young Adults with Complex Needs report.
2.7
There is integrated local support for older adults to maximise their independence and keep physically active, access support, maintain social contact, and contribute
to their communities.
3.6
LSPs work together with the police in supporting the control of gun ownership including protocols for reporting gun ownership.
Prisons and Criminal Justice

Objective
Standard
1.1
Patients with schizophrenia with complex needs if convicted of an offence are normally treated in hospital rather than the prison service.
Care suites in prisons to conform to safer standards.
50
Prisons and Criminal Justice (continued)

Objective
Standard
1.3
Local community safety partnerships are working strategically and operationally to offer targeted support for young men who come into frequent contact with the
criminal justice system, especially in connection with drug related crime and anti-social behaviour.
1.4
Prison Officers to access mental health awareness training.

Prison Officers to be trained in Risk Assessment training as part of ACCT Implementation.
HMP to review reception screening for risk management and opportunities for intervention.
Officers trained in Mental Health Awareness to be MH Liaison on wings.
A multi-disciplinary suicide prevention committee monitors the prison policy and procedures effectively. The committee includes a suicide co-ordinator, prisoner
representatives and a member of the local community mental health team.
Managers and staff promote an understanding of, and demonstrate respect for, all ethnic and cultural groups including staff and visitors.
Inappropriate language or conduct by staff or prisoners is challenged.
An anti-bullying (violence reduction) strategy is in place and is based on an analysis of the pattern of bullying in the prison.
Prisoners have unhindered access to sources of help including counsellors, the chaplaincy team, Listeners and the Samaritans at all times.
A care suite should be available and of sufficient size to cater for the needs of the population.
3.1
Wings and cells are audited at least annually to identify and minimise opportunities for hanging or other means by which patients could harm themselves.
Likely ligature points have been removed or covered.
A protocol has been developed to allow potential ligatures to be removed from inmates at high-risk of suicide.
Environmental difficulties in observing inmates are made explicit and remedial action is taken as far as possible.
Inmates under any form of increased observation are to be allowed to participate in normal on and off ward activities following a realistic risk assessment.
51
Acute Hospital Trusts

Objective
Standard
1.1
Key staff in A&E and hospital wards who are in contact with patients at risk of self-harm or suicide receive training in the recognition, assessment and management
of risk at intervals of no more than 3 years.
Ligature points removed from Accident ward, A&E and other key clinical areas.
Daily safety checks performed on mental health wards, A&E and Accident ward.
1.2
Acute Care Trust and Ambulance staff following NICE Self-harm guidance.
2.6
Ensure that pregnant women receive high quality care throughout their pregnancy, have a normal childbirth wherever possible, are involved in decisions about what
is best for them and have choices about how and where they give birth.
3.1
A&E, accident wards and other acute health settings follow similar safety precautions to mental health care settings.
3.2
Safer Prescribing Protocols are adhered to and monitored.
6.1
Contribute to suicide audit through sharing of data on self-harm and attempted suicide admissions.
52
Multi-Agency Responsibilities
Objective
Standard
1.1
Key staff in A&E, Ambulance, Police, Social Services, Prison and other organisations, who are in contact with patients at risk of self-harm or suicide, receive training
in the recognition, assessment and management of risk at intervals of no more than 3 years.
The training is approved by the organisation and approval should be based on the evidence that training leads to benefits.
The training is comprehensive and the quality and effectiveness of the training is continuously evaluated.
1.2
Non-mental-health staff receive appropriate training and tools to support them in screening and identification of self-harm.
Statutory agencies effectively work in partnership with the voluntary and community sector to support and advise on the identification of self-harm issues and ensure
rapid responses where appropriate.
1.3
In partnership with education and youth services, an early intervention in psychosis team is operational with sufficient capacity.
1.5
Improving the mental health of employees in the health service is given strategic priority and investment.
Mental Health at Work policies aimed at promoting positive mental health exist in all statutory organisations.
Working time directives are being consistently met by all relevant organisations.
Multi-agency workforce mental health training commissioned locally to support managers in promoting positive mental health in the workplace.
2.1
The recommendations of the Social Exclusion Unit's "Action on Mental Health: A Guide to Promoting Social Inclusion" are being implemented and evaluated.
2.2
All local statutory agencies have robust and formal Race Equality and Diversity policies and schemes in operation.
All NHS organisations are actively implementing the Essential Shared Capabilities framework.
Non-NHS organisations actively implementing race equality and diversity schemes.
2.4
53
Statutory services work in partnership with the community sector to provide suitable specialist services such as Womens Centres, Crisis Centres, Refuges,
Self-Help Groups, etc.
Multi-Agency Responsibilities (continued)

Objective
Standard
2.5
The recommendations of the Emotional Health of Looked After Children are being implemented and evaluated.
There is a local multi-agency strategy/action plan for improving the mental and emotional wellbeing of children and young people.
2.6
There is a local multi-agency strategy/action plan for improving the mental and emotional wellbeing of young women during and after pregnancy.
2.7
There is a clear action plan to implement and evaluate the older persons NSF, in particular, standards 7 and 8 and the MH NSF Standard 1.
4.1
A local Press Pack has been developed in collaboration with local press covering recommendations, local mental health info and contacts and is used consistently.
5.1
Respective organisations to exchange information on suicides and check against databases of known individuals using mental health services.
Conduct qualitative local study to capture information and develop local evidence base.
54
Suicide Prevention Strategy Group

Objective
Standard
1.3
Establish and maintain strong links between health and non-health voluntary sector organisations that support young men with advice and support.
Set up networking and joint learning initiatives to share skills and best practice between statutory and community sector organisations.
Develop operational relationships and referral systems between sectors and agencies to facilitate rapid response where needed.
Multi-agency working arrangements supported by gender awareness training.
1.4
HMP Suicide Prevention Officer sits on Suicide Prevention Group.

Suicide Prevention Lead sits on HMP Safer Establishments Group.
1.5
Formal links exist between Standard 7 and rural agencies such as DEFRA, Countryside Alliance, Rural Network and local voluntary organisations.
Local partnership arrangements exist to ensure effective mental health provision is dedicated to rural sector, in particular, specific arrangements for pathways
and access routes to services where necessary.
3.3 and 3.4
4.1
Local services and community groups utilise new media (internet, multimedia, etc.) to promote positive messages about mental health and provide access
to information on services to the public.
Local campaigning and public awareness initiatives are having a positive impact of public perception of suicide.
55
5.1
Academic/research Lead linked into suicide prevention workgroup.
5.2
Regional Networks - participation in local and regional Suicide Prevention Network to share information and good practice across the region.
Suicide Prevention Strategy Group (continued)

Objective
Standard
6.1
Develop data sharing mechanisms between PCT, SMHT, Coroner, Police, Acute Trust, Prison and Ambulance.
Conduct a post-suicide review for all completed suicides in PCT area.
6.2
Develop a local performance monitoring tool for updating strategy progress.

Formally evaluate the actions of the local strategy on an annual basis.
Prepare written evaluation/annual report and present to LIT/LSP and other relevant boards.
Amend accordingly the actions and outcomes of the strategy annually in response to evidence and evaluation.
56
This glossary of terms and abbreviations aims to clarify the

meaning of some of the terms and phrases used in this Toolkit.
ACCT
Assessment, Care in Custody and Teamwork. This is the new
approach that the Prison Service is taking to address prisoner
distress, self-harm and suicide.
Assertive Outreach Team
These teams were set up with the aim of providing an alternative,
flexible approach to engaging people with complex mental health
problems, who find it difficult to receive mainstream care from
Community Mental Health Teams.
Atypical Antipsychotics
These are a newer form of medication used in the treatment of
schizophrenia and psychosis. They have fewer side effects than
conventional antipsychotics and are shown to be more effective at
reducing symptoms and enabling people to recover more quickly.
CAMHS
Child and Adolescent Mental Health Services are often operated
by the Primary Care Trust and provide a range of support to people
under 16 who are suffering mental health problems. They also
advise carers and professionals, and plan strategic delivery of care
with all partner agencies.
Glossary
Clinical Governance
An approach to evidence based, safe and effective clinical practice
which is in place in all health care trusts.
CPA
The Care Programme Approach sets the standards of care
for people suffering mental health problems and for their carers.
Through CPA, different organisations can work together and
communicate more effectively. eCPA is a new electronic
recording system used by services to enable better access
to and recording of information.
Criminal Justice Liaison Team

This team works alongside Community Mental Health Teams and
local criminal justice agencies to identify people with mental health
problems who have come into contact with the criminal justice
system. Their role is one of advice, support and signposting.
Crisis Team
These teams provide acute community care to people in crisis. They
have links to A&E and Home Treatment Teams and are instrumental
in reducing the need for many people to go into hospital.
CSIP
Care Standards Improvement Partnership. The umbrella
body for NIMHE (see definition below) and other NHS care
improvement organisations.
DATs
Drug Action Teams are the partnerships responsible for delivering
the drug strategy at a local level.
Early Intervention Team
A developing service which aims to target people aged 13-35
suffering from early onset and first episode psychosis. The teams
offer flexible packages of care aimed at maximising the person's
independence and prognosis.
HMP
Her Majesties Prison.
Ligature Point
Any fixed point - such as a curtain rail or exposed pipe - which
could withstand the weight of someone hanging from it.
LIT
The Local Implementation Team is a partnership of all organisations
involved in developing mental health care across a locality. The LIT
is charged with achieving the targets set in the National Service
Frameworks for Mental Health.
LSP
Local Strategic Partnership.
PIG
The Policy Implementation Guides are published by the
Department Of Health to support the implementation of the
MHMDS
The Mental Health Minimum Data Set is a database of information
collected by secondary care providers regarding the service they
provide. This information is collated at both a national and local level
to ensure that services are addressing peoples needs effectively.
NSF recommendations. They set the standards for service

developments and are the benchmark against which service
improvements are measured.
MHS
Mental Health Services provide specialist mental health care to
people living in a region. They are funded by local PCTs (see
definition below) and work closely with Social Services to provide
integrated care.
NICE
The National Institute of Clinical Excellence is part of the Department
of Health. It reviews evidence based practice at a national level and
produces guidance on care delivery standards.
NIMHE
The National Institute of Mental Health in England provide
support, advice, training and networking across England. They
lead on service development and advise the Department of Health
on current and future policy. The NW Development Centre is the
regional arm of NIMHE and is based in Hyde, Manchester.
NSF
The National Service Framework was produced by the Department
of Health in 2002 and is the driving force behind the suicide strategy
and many current developments in mental health care. Standard 7
of the framework deals exclusively with Suicide Prevention.
PCT
The Primary Care Trust is responsible for the planning and
commissioning of all health care for the people in their locality.
PICU
Intensive Psychiatric Unit.
POPO
A Home Office initiative to target those people who are causing the
majority of crime in an area and to work across agencies to prevent
offending, and to catch, convict and rehabilitate offenders.
Prison Inreach Team
A specialist mental health team who operate inside of the prison
walls. The team works on the same principles as a Community
Mental Health team working predominantly with people suffering
severe mental illness or who are at acute risk of suicide and
self-harm. They also support and advise the prison staff and
governors on the care of people with mental health problems.
PSA
Public Service Agreement.
Public Health Intelligence
This team is part of the Public Health Directorates. Its role is to
collect and analyse a range of data and information relating to the
health of the population. Their work is instrumental in ensuring
effective planning and targeting of services.
SHA
The Strategic Health Authority is the overseer of health care
delivery in the region. They provide guidance, advice and
performance management to all health care services and ensure
that service improvements are carried out effectively and on time.
SMHT
Specialist Mental Health Trust.
SUI
Serious Untoward Incident.
58
1 National Institute for Mental Health in England (2003)

Preventing Suicide - A Toolkit for Mental Health Services,
National Institute for Mental Health in England, Leeds.
2 See 1
3 Department of Health (2001) SAFETY FIRST: Five-Year Report
of the National Confidential Inquiry into Suicide and Homicide by
People with Mental Illness, Department of Health, London.
4 See 1
17 See 1
18 Department of Health (2002) Mental Health Policy
Implementation Guide: Adult Acute In-patient Care Provision,
Department of Health, London.
19 National Institute of Clinical Excellence (2004) Self-harm:
The Short-term Physical and Psychological Management and
Secondary Prevention of Self-harm in Primary and Secondary
Care, NICE, London.
6 See 1
20 Department of Health (2004) National Service Framework for

Children, Young People and Maternity Services, Department of
Health, London.
7 STORM Training www.medicine.manchester.ac.uk/storm/
21 See 10
8 Applied Suicide Intervention Skills Training (ASIST)

www.livingworks.net/ASX.php

Implementation Guide: Community Mental Health Teams,
5 See 3
9 See 1
10 Department of Health (1999) Effective Care Co-ordination
in Mental Health Services: Modernising the Care Programme
Approach - A Policy Booklet, Department of Health, London.
11 See 10
23 Young People and Self-Harm, National Inquiry Website

www.selfharmuk.org
24 Oldham Self-Harm Project www.nimhenorthwest.org.uk/SelfHarm
25 Department of Health (2000) National Service Framework: Policy
Implementation Guide, Department of Health, London.
12 See 1
26 Newcastle declaration www.rethink.org/newcastledeclaration/
13 See 10
References
27 CALM www.thecalmzone.net
14 See 1
28 Mens Health Website www.malehealth.co.uk
15 Department of Health (2002) National Standards for PICU
and Low Secure Environments, Department of Health, London.
16 National Institute of Clinical Excellence (2002) Core Interventions
in the Treatment and Management of Schizophrenia in Primary and
Secondary Care, NICE, London.
29 Department of Health (2002) Promoting the Health of Looked

After Children, Department of Health, London.
30 The Tower Project www.csp.blackpool.org.uk/Tower/08%20
Tower%20Project%20Carat%20Agreement.pdf
31 HM Prison Service,
The ACCT Approach, A Pocket Guide for Staff
www.hmprisonservice.gov.uk/adviceandsupport/prison_life/selfharm/
46 SEU Website www.socialexclusion.gov.uk

47 Social Exclusion Unit (1998) Rough Sleeping - Report by the
Social Exclusion Unit, Social Exclusion Unit, London.
32 HM Prison Service, Prisoner Peer Support: Good Practice Guide

to Insiders Peers Support Schemes, HM Prison Service, London.
33 HM Inspectorate of Prisons (2005) Expectations, HMIP, London.
34 HM Inspectorate of Prisons (1999) SUICIDE IS EVERYONES
CONCERN: A Thematic Review, HMIP, London.
35 Department of Health (2000) Improving Working Lives Standard
NHS Employers Committed to Improving the Working Lives of
People Who Work in the NHS, Department of Health, London.
48 Off the Streets and Into Work Website: www.osw.org.uk

49 National Inclusion Programme (2006) From Segregation to
Inclusion: Commissioning Guidance on Day Services for People
with Mental Health Problems, CSIP, London.
50 National Inclusion Programme (2006) Vocational Services
for People with Severe Mental Health Problems: Commissioning
Guidance, CSIP, London.
51 Social Inclusion Programme Website www.socialinclusion.org.uk
36 NHS Employers Website www.nhsemployers.org

37 Mentality (2003) Mental Health in the Workplace: Finding the Key
to Inclusion, Lord Mayor of London, London.
38 HSE Stress Management Guidelines www.hse.gov.uk/stress
39 HM Government (2005) Health, Work and Well-being - Caring for
Our Future A Strategy for the Health and Well-being of Working Age
People, HM Government, London.
52 National Institute for Mental Health in England (2003) Inside

Outside Improving Mental Health Services for Black and Minority
Ethnic Communities in England, NIMHE, London.
53 National Institute for Mental Health in England (2005) Making
It Possible: Improving Mental Health and Well-being in England,
NIMHE, London.
54 Department of Health (2003) Delivering Race Equality: A
Framework for Action, Department of Health, London.
40 DEFRA Website www.defra.gov.uk

41 Rural Stress Network Website www.ruralnet.org.uk/~rsin//
42 Social Exclusion Unit (2004) Mental Health and Social Exclusion
Report, Office of the Deputy Prime Minister, London.
43 SHIFT Website www.shift.org.uk
44 Rethink Website www.rethink.org
45 Social Exclusion Unit (2004) Action on Mental Health:
A Guide to Promoting Social Inclusion, Office of the Deputy
Prime Minister, London.
55 Department of Health (2004) Community Development

Workers for Black and Minority Ethnic Communities, Department
of Health, London.
56 Department of Health (2005) Delivering Race Equality in Mental
Health Care: An Action Plan for Reform Inside and Outside Services
and the Governments Response to the Independent Inquiry into the
Death of David Bennett, Department of Health, London.
57 Race Relations (Amended) Act (2000) Office of Public Sector
Information, London.
60
58 Department of Health (2004) The Ten Essential Shared

Capabilities - A Framework for the Whole of the Mental Health
Workforce, Department of Health, London.
59 National Institute of Mental Health in England (2003) Personality
Disorder; No Longer A Diagnosis of Exclusion, NIMHE, London.
Implementation Guide: Dual Diagnosis Good Practice Guide,
61 Cabinet Office (2004) Alcohol Harm Reduction Strategy for
England, Strategy Unit, London.
70 Women and Equality Unit Website

www.womenandequalityunit.gov.uk/domestic_violence/index.htm
71 Department of Health (2004) Choosing Health: Making Healthy
Choices Easier, Department of Health, London.
72 National Healthy Schools, Wired for Health Website
www.wiredforhealth.gov.uk
73 Emotional Health of Looked After Children
Children, Young People and Maternity Services, Department of
Health, London.
62 HIT Website www.hit.org.uk

63 British Medical Association
www.bma.org.uk/ap.nsf/Content/Alcoholyoungpeople

Children, Young People and Maternity Services: The Mental Health
and Psychological Wellbeing of Children and Young People,
64 Mind Body and Soul Website www.mindbodysoul.gov.uk

65 Department of Health (2003) Mainstreaming Gender and
Womens Mental Health: Implementation Guidance, Department
of Health, London.
66 Department of Health (2006) Supporting Women Into The
Mainstream Commissioning Women-Only Community Day Services,
67 Crime Reduction Domestic Violence Website
www.crimereduction.gov.uk/dv01.htm
61
76 Social Exclusion Unit (2005) Transitions: Young Adults with

Complex Needs, Office of the Deputy Prime Minister, London.
77 Every Child Matters Website www.everychildmatters.gov.uk
78 Childrens NSF Standard 11 - See 73.
79 Department of Health (2001) National Service Framework
for Older People, Department of Health, London.
80 Department of Health (2004) Better Health in Old Age - Report,
68 Home Office Violent Crime Unit (2004) Developing

Domestic Violence Strategies A Guide for Partnerships,
Home Office, London.
81 Older Peoples Mental Health CSIP Website

www.olderpeoplesmentalhealth.csip.org.uk/Home
69 Department of Health (2000) Domestic Violence:

A Resource Manual for Health Care Professionals,
82 Social Exclusion Unit (2006) A Sure Start to Later Life:

Ending Inequalities for Older People, Office of the Deputy
Prime Minister, London.
83 Office of National Statistics (2003) Mental Health of Older

People, HMSO, Norwich.
98 Mental Health Media Website www.mhmedia.com

99 Commission for Patient and Public Involvement www.cppih.org
84 Centre for Policy on Aging Website www.cpa.org.uk/index.html

100 Mental Health Foundation Website www.mentalhealth.org.uk
Mental Health: Modern Standards and Service Models, Department
of Health, London.
86 CRUSE Website www.crusebereavementcare.org.uk
101 See 94
102 MASH Website www.mash.man.ac.uk/MaSH/index.cfm
87 SOBS Website sobs.admin.care4free.net/about.htm
103 Oldham Self-Harm Project

www.nimhenorthwest.org.uk/SelfHarm
88 Papyrus Website www.papyrus-uk.org
104 NIMHE Knowledge Community kc.nimhe.org.uk
89 Winstons Wish Bereavement Support Website

www.winstonswish.org.uk
105 Public Health Audit Toolkit

www.nimhenorthwest.org.uk/PCSuicideAudit
90 Childhood Bereavement Network Website

www.childhoodbereavementnetwork.org.uk
106 Public Health Observatory Website www.apho.org.uk/apho/
91 Department of Health (2002) National Suicide Prevention

Strategy for England, Department of Health, London.
92 Abbott R, Young S, Grant G, et al. (2003) Railway Suicide:
An Investigation of Individual and Organisational Consequences.
A Report of the SOVRN (Suicides and Open Verdicts on the Railway
Network) Project, Doncaster and South Humber Healthcare NHS
Trust, Doncaster.
93 Rail Safety and Standards Board Website www.rssb.co.uk
94 Samaritans www.samaritans.org.uk
95 WHO (2000) Preventing Suicide: A Resource for Media
Professionals, WHO, Geneva.
96 National Union of Journalists Website www.nuj.org.uk
97 Response Ability Website www.responseability.org
62

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S-Kit

Suicide Prevention Local Implementation Framework

Document Purpose: Positive Practice Guidance and Benchmarking Toolkit

Renowned anthropologist Margaret Mead informs us that when

Suicide is a devastating event for an

Goal 1: Reduce Suicides in High-Risk Groups

Goal 2: Promote Mental Wellbeing in the Wider Population

Goal 3: Reduce Access to Means

Goal 4: Improve Media Reporting of Suicide

Goal 5: Promote Research on Suicide Prevention

Goal 6: Improve Monitoring of Progress

Suicide Prevention Service Matrix

Policy and Strategy

The MHNSF Standard 7 places the responsibility for implementing

. A local strategy to reduce suicide

About the S-Kit

. How do you start developing a strategy for suicide prevention?

Mark Needham and Tony Roberts co-ordinated a regional network

The Suicide Prevention Strategy laid out the actions that

The S-Kit is primarily aimed at organisations involved in suicide

Reduce Suicides in High-Risk Groups

How to use the S-Kit

10 Steps to an Effective Suicide Prevention Strategy

A suicide prevention workgroup is in place with multi-agency sign up including

S7 Lead monitors the

The Department of Health identifies that Suicide Prevention

Primary Care Trusts

Specialist Mental Health Provider Services

Local Strategic Partnerships (LSPs)

Criminal Justice System

Suicide Prevention is a PSA target, and should feature in the

Suicide prevention is a key target in the criminal justice system

Police and Transport Police

Service User Groups and Families

Reduce Suicides in High-Risk Groups

Reduce Suicides in High-Risk Groups

These high-risk groups are:

. The group has been shown to have a statistically increased

. Actual numbers of suicides in the group are known

SMHT and All Partners

Risk Assessment Training

Preventing Suicide Toolkit6

CPA is monitored through clinical governance12 and multi-agency audit.13

Preventing Suicide Toolkit

Secure and Forensic Mental Health

Objective 1.1 (continued)

Atypical anti-psychotics prescribed according to NICE guidelines.

SMHT and PCT

Atypical anti-psychotics dispensed according to NICE guidelines.

Primary Care Trust

Monitoring of Antipsychotic prescriptions via regular audit cycles.

Prescription and Dispensing Atypical Anti-psychotics

Safe Clinical Areas17

Preventing Suicide Toolkit

Care suites in prisons to conform to safer standards.

Acute and SMHT

Acute Care PIG

Acute Care/Ambulance Trust

NICE Guidelines of Self-Harm

CAMHS Local Steering Group

National Confidential Inquiry into

NICE Guidelines on Self-Harm19

Post Discharge Prevention of Suicide

Preventing Suicide Standard 3