National strategy and community action: Top down, bottom up and in between

1 June 2016

PHOTO: Example poster from the Stop Suicide campaign noted below

SPA Head of Communications Kim Borrowdale blogs on meetings with England Department of Health as well as a number of their delivery partners such as different branches of the NHS along with community based service suppliers like Mind Cambridge.

Last week I spent time with both the England and Scotland Departments of Health as well as a number of their delivery partners such as different branches of the NHS along with community based service suppliers like Mind Cambridge.

I will go into more detail on my time with our Scottish colleagues, particularly in relation to lessons learned from the Choose Life Scotland suicide prevention strategy in my next blog. For now, I’d like to share some information and thoughts following my meetings with Kate Fleming (Mental Health Policy and Strategy, Department of Health England), Caroline Dollery (Clinical Director for East of England strategic clinical network for mental health, neurology and learning disability), Director of Business Development / Deputy CEO, Dr Aly Anderson (Mind Cambridge) and Charuni Perera (Project Coordinator at Hertfordshire Partnership NHS Foundation Trust).

I visited the community-based programs first, which gave me an interesting perspective on the challenges and opportunities faced by these stakeholders prior to meeting with their funder counterpart in Government.

Zero Suicide – a target, funding proposal, project methodology or a marketing campaign?

In 2013, the East of England Strategic Clinical Network (SCN) set up a program to aim for ‘zero suicides’ in the region. Four projects (Mid Essex, Hertfordshire, Cambridgeshire and Petersborough, Bedfordshire) with aims including improved outcomes for individuals and carers, partnership working, addressing clear gaps in services and a commitment to engage ‘hard to reach’ patient groups. The initiative was launched with a workshop led by Dr Ed Coffey from Behavioural Health Services in Detroit. This was focused on each area setting ‘Wildly Audacious Goals’ (WIGs) and building on approaches developed in the United States. Many thanks to Caroline in particular for the overview of the East of England project.

In September 2015, an evaluation report was published. Read ‘Aiming for zero suicides: An evaluation of a whole system approach in the East of England.’

In reading the evaluation report prior to my site visits and thinking about the range of ways in which those working on, or thinking about ‘zero suicide’ projects articulate their aims and objectives, it really highlighted the importance of always putting the use of the term ‘zero suicide’ into context.

I know there is much debate on whether or not it is appropriate to have a zero suicide target; this is particularly true for our Lived Experience Network, some members of which have commented on their hesitation to endorse it as a target.

This is why in Australia, we are taking some time to look at what a framework for zero suicide in our health system might look like; where can we make improvements to stop loss of life of people in the care of our hospitals and health care services – and what role our members and stakeholders play in such a project – and whether or not zero suicide is public facing target or a methodology by which to structure a project in a very specific group of stakeholders or systems. Suicide Prevention Australia will keep you up to date with this work as it progresses. Sign up to our eNews so you don’t miss out.

For Cambridge and Peterborough, it was not necessarily about labeling the public facing campaign as zero suicide. However, it gave them permission to take a stronger approach to key messages in the community. They chose to focus primarily on awareness of the problem, normalizing the fact that many of us have mental health issues at one time or another in our lives, and how important it is to play our individual part in being prepared to give help or get help.

Check out their award winning suicide prevention campaign that is being delivered by a partnership of three mental health charities; Mind in Cambridgeshire, Litecraft and Peterborough & Fenland Mind, supported by the Cambridgeshire and Peterborough CCG and Cambridgeshire Country Council Public Health teams.

In Hertfordshire, they took a slightly different approach, with their zero suicide campaign focused on a plan to improve treatment of depression. Aims include reducing the risks of suicide and self harm among those with depression, improving outcomes for service users and their families. They have trained 100s of GPs and practice staff in how to 'Spot the Signs and Save a Life’. They have also seen success in engaging other gatekeepers, such as police and job centre staff and plan to expand this work to schools and general public through council and community events. Do have a look at the evaluation report for a summary of both of these projects and the other two sites.

This reminded me of the patient safety work being done at NHS Nottingham that I detailed in a previous blog; some great work being done in this area across the UK.

Making physical and mental health care equally important

Following my time with checking out locally led projects, I was pleased to be able to spend some time with Kate Fleming from Mental Health Policy and Strategy, Department of Health England to talk through the overarching strategy for the country.

The National strategy was published in 2012. Public Health England worked with the Government and other stakeholders to produce a number of resources and guides to help local authorities. Following feedback from authorities developing their suicide prevention action plans, there is more work planned in terms of practical guidance.

There are two annual reports (read 1st report and 2nd report) on the strategy to date with another due later this year.  There is a clear focus on national direction and coordination supporting local implementation. This strategy has been followed up this year (February 2016) with ‘The Independent Mental Health Taskforce report, the Five Year Forward View'.

Everyone I met with on this trip has mentioned this report and are, in the most part, hoping for their recommendations to drive real and sustainable change in their health systems and workforce in particular. Kate pointed out that this has been a really helpful tool to communicate the wider picture of change needed. I recommend you have a read of the report.

“Making physical and mental health care equally important means that someone with a disability or health problem won’t just have that treated, they will also be offered advice and help to ensure their recovery is as smooth as possible, or in the case of physical illness a person cannot recover from, more should be done for their mental wellbeing as this is a huge part of learning to cope or manage a physical illness.”

Interestingly, there is also a big focus on new models for crisis care with the introduction of the Crisis Care Concordat bringing additional funding for health based places of safety (“places of safety” are where an individual is taken if they are deemed by the police to be at risk to themselves or others and potentially in need of assistance due to their mental health – they are taken for a mental health assessment) – something they are already seeing used as part of “street triage” projects in parts of the UK. I referred to this in my earlier blog.

Like Australia, timely, accurate and consistent data is a huge focus for England. The Department of Health funds the Office of National Statistics to provide them with detailed data to support their national advisory group on suicide prevention. See the latest data published in February.

Similarly, the Department works closely with Professor Louis Appleby and the team who work on The National Inquiry into suicide and homicide by people with mental illness. You may find it interesting to have a look at their last report. Read my earlier blog on meeting the team.

Finally, in all of my conversations last week, there has been a real drive to build on work being done with primary school children, teaching them about wellbeing and resilience from as young as age five. On children and young peoples, have a look at the Future in Mind report.

Many thanks to all for their time and insights. Your generosity and candour is very much appreciated.

As always, if you have any questions or comments for me after reading this blog, please get in touch.

Kim Borrowdale, Head of Communications

Note. This blog has been published as part of Kim’s commitment to sharing lessons from the UK as recipient of an Ian Potter Foundation International Learning and Development Grant. She will also be reporting on findings and observations at the 2016 National Suicide Prevention Conference in Canberra in July.


Read 1 June blog post "National strategy and community action: Top down, bottom up and inbetween" 

Read 21 May blog post "No health without mental health: development sector lessons"

Read 19 May blog post "Give them a gift: Thinking differently about data"

Read 17 May blog post "Somewhere between heartbreak and hope"

Read 12 May blog post "Collaborative working: Moving beyond the willing"

Read 10 May blog post "So what? Translating research into practice"