Multi storey car parks: improved safety measures

STATES OF JERSEY

r

MULTI STOREY CAR PARKS: IMPROVED SAFETY MEASURES

Lodged au Greffe on 20th September 2005 by Deputy J.A. Bridge of St. Helier

STATES GREFFE

PROPOSITION

THE STATES are asked to decide whether they are of opinion

to c h arge the Environment and Public Services Committee to consult with the Home Affairs and the

Health and Social Services Committees and to erect physical barriers in multi-storey car parks in order to reduce the risk of suicide.

DEPUTY J.A. BRIDGE OF ST. HELIER

REPORT

This proposition is fairly straightforward. I am asking the States Assembly to charge the Environment and Public Services Committee to erect physical barriers in the multi-storey car parks where in conjunction with the Home Affairs Committee and the Health and Social Services Committee they have identified there to be a suicide risk.

The catalyst for this proposition was the recent front-page report of the Chief of Police's concerns about the suicide risk from multi-storey car parks in Jersey.

To an extent I have to say "mea culpa", because when I left the Home Affairs Committee in 2002 I did not follow this issue up personally. I wrongly assumed that the work had been done, as a commitment had been given by the Public Services Committee of the day and money had been allocated in the Public Services Business Plan of 2002 – 2004.

The number of suicides and attempted suicides from multi-storey car parks has been doing the rounds of Committee agendas since 25th April 2002. I have asked the Greffe to perform a search of all Home Affairs, Health and Social Services, Public Services (now Environment and Public Services) Minutes. I have attached those minutes for members' convenience.

I believe that this issue has dragged on long enough and it is time for Environment and Public Services to get on with the work immediately.

I have summarised below a few points in the minutes of the various Committees involved which I hope will persuade members that the issue has been thoroughly aired from all possible angles and all that is required now is for Environment and Public Services to start work on erecting physical barriers immediately.

On 25th April 2002 the Home Affairs Committee discussed the matter of suicide risk from multi-storey car parks. Item A.8 read as follows –

" T h e Committee further noted that liaison with the Public Services Department/Committee had given rise to investigation, by that Committee, of the possibility of introducing physical improvements to multi- storey car parks in order to prevent persons from accessing the outside ledges of car parks; the matter in terms of cost viability, had been included in the 2002 – 2004 Business Plan of the Public Services Committee."

By the time the Home Affairs Committee met on 5th September 2002 there had been one suicide on 10th July 2002 and an attempted suicide occurred on 5th September 2002. The Committee was concerned not to have heard anything from the Public Services Committee. The minutes stated –

"   h a ving received no indication from the Public Services Department of any progress that had been made

to improve safety, agreed to inform that Committee of its grave concern".

Post the meeting on 5th September, I understand that the President was made aware of the fact that the Public Services Committee had met on 8th July 2002 and agreed to approve a one-off payment of £35,000 from the Car Park Trading Account. The minute of item B.2 of the agenda stated –

"T  h e Committee was reminded that Ove Arup and Partners Limited had been commission (sic) to produce

an Engineering Report in August 2001 the purpose of which had been to review aspects relating to vulnerable people in car parks and parapet walls whilst it (the Committee) recognised that it did not have any statutory requirement to do so, it would approve a one off spend of £35,000 from the Car Park Trading Account to be allocated to this purpose.".

On 9th September 2002, the President of the Home Affairs Committee wrote to the President of the Public Services Committee in the following terms –

" W  h ilst I can see the merit in establishing a Working Party to look at suicide generally, I think that

something needs to be done as a matter of urgency at the multi-storey car parks to make it less easy for

people to be able to take their own lives".

On 16th September 2002, the Health and Social Services Committee minutes concur with the views of the Home Affairs Committee, stating at B.10 –

" a coordinated approach between the relevant Committees would be helpful but felt that the £35,000 approved by the Public Services Committee should be targeted on known ways of reducing the possibility of impulsive actions in car parks and rendering them "jump-proof".

Between the meeting of the Home Affairs Committee on 5th September 2002 and its next meeting on 24th October 2002 there were 3 further suicide attempts from car parks. The minutes recorded the Committee's continued concern. Item A14 stated –

"  e ach incident presented a range of life-threatening dangers, both to the individual concerned, police officers and members of the public, as well as trauma to all involved".

On 21st November the Home Affairs Committee received a report from the Chief of Police in which he stated that –

" it ap peared to be generally accepted that the erection of physical barriers in old car parks was the only realistic course of action and that no alternative solution had so far been identified".

Further, the Committee discussed whether Human Rights Legislation when enacted in Jersey, would have an impact. The minutes stated at item A.12 –

"  it had been recognised in the United Kingdom that car park owners, having identified the risks to its patrons, had a clear duty of care under the provisions of human rights legislation and that this might have an impact in Jersey when local human rights legislation was enacted.".

The Health and Social Services Committee met on 27th March 2003 and reiterated their concern in the following terms –

B . 6 " T he Committee, aware that the issue formed part of the Public Services Committee's current

Business Plan, decided to request the Public Services Committee to address the situation as a matter of urgency.".

The Health and Social Service Committee met on 4th June 2003 and "endorsed the prioritised action plan of the multi-agency steering group and requested that a copy of the report be forwarded to other Committees for whom the prevention of suicide was also a matter of concern." (A.18).

On 18th August 2003, the Public Services Committee minutes recorded –

A . 8 " T he Committee noted that a multi-agency Steering Group had for sometime been actively

examining ways of reducing the incidence of suicide in Jersey. One of the Group's recommendations (the placing of Samaritan posters in the multi-storey car parks) was being pursuedThe wording of the posters was presently under review.".

The Home Affairs Committee at its meeting on 24th February 2004 recorded that since the previous occasion on which the matter of suicide risk from car parks had been raised on its agenda there had been 7 further attempted suicides from car parks. The Committee was "extremely concerned that no action had been taken by the Environment and Public Services Committee with regard to this issue."(A.21)

This is the last minute that has been made available to me on this issue so it appears that the issue has not been discussed at Committee level since then by the Environment and Public Services Committee.

I have not provided a cost in this report. However, I am sure that the Environment and Public Services Committee will be able to provide detailed and up-to-date costings. I can talk about the human cost – the trauma to the individual, their family and friends, the trauma to the Police Officers, Ambulance Personnel and Paramedics, and trauma to hospital staff and members of the public.

I  hope  that  this proposition  does  not  have to  be  debated  and  will  happily  withdraw  it  if the  President  of Environment and Public Services is willing to make a Statement in the Assembly outlining the proposed work, an appropriate start date and completion date.

There are financial/manpower implications arising from this proposition.

The former Public Services Committee made £35,000 from the Car Park Trading Account in 2002 for the purposes of suicide prevention. The cost viability was in the 2002 – 2004 Business Plan of the Public Services Committee. Obviously, the figures will have changed and I am sure that the Environment and Public Services Committee are able to provide up-to-date figures in their comments.

Suicide Prevention Strategy Update 2005

Introduction

The Suicide Strategy will be a part of the business plan for the Mental Health Directorate and Public Health Services for 2006-2009. This paper updates the Health and Social Services Committee on the action resulting from the Suicide Prevention Strategy, endorsed by the Committee in 2002. It also describes the current picture regarding suicide rates in Jersey following work undertaken by the Public Heath Intelligence Unit.

Background

Suicide was raised as a public health concern in Jersey, in a section of the 2001 Annual Report of the Director of Public Health Services:

Over the past three years, the Health Promotion Department has been working in partnership with representatives from the statutory and voluntary sector on ways to reduce the number and impact of suicides in Jersey. This paper gives a brief update of the developments over the previous 12 months and the areas of work prioritised for the coming year.

The work around suicide prevention received formal political support through the newly formed Health and Social Services Committee in 2002. The activity resulting from the Suicide Prevention Strategy is currently resourced from existing budgets of those key stakeholders. Support from both senior level service managers and local politicians, continues to be vital in assisting with the effective development and implementation of the strategy.

Suicide Prevention Strategy is implemented through a Steering Group which meets quarterly to Co-ordinate and implement operationally, agreed areas of work derived from the strategy's action plan. The work of the Steering Group has been supported by the creation of four Operational Groups who are responsible for providing hands on' implementation of the priorities set by the Steering Group.  The four Operational Groups cover the four major divisions of the strategy:

Current Preventative Activity

Primary Prevention:

These interventions are aimed at society in general and designed for the whole population. They aim to raise understanding around the issue of suicide and the related areas of public mental health.

Action completed so far:

• D  ir e ctory of Mental Health Services complied and distributed

• P e e r led evaluation of Secondary School Bullying Policy

• A  u d it of resources currently held across services relating to suicide

• D  ev e lopment of resource specifically targeting young people and suicide

Action Planned 2005/6

• P i lo t ing of assessment tool for mapping young peoples emotional resilience

Secondary Intervention:

Secondary (early) interventions encompass interventions which are concerned with effective reduction of the intensity, severity and duration of risk behaviours for suicide. Activity concerning the improvement of health intelligence regarding suicide is also consistent with this stage of intervention.

Action completed so far:

• D  ev e lopment of suicide component of mental health training for voluntary agencies

• I m p r ovements in the collation and recording of deaths by suicide

• A  g re ement of a definition for key terms from which to code A/E activity

Action Planned 2005/6

• A  u d it of A/E recording of self harm and attempted suicide

Crisis Intervention:

The situation and context for this range of interventions is one of crisis where there is imminent danger and high risk of suicide.

Action completed so far:

• P o s t ers with emergency help lines located in suicide hot spot areas

• S u p p ort the development of A/E Liaison Psychiatric Service

• W  o r k has begun to develop a suicide prevention pathway

Action Planned 2005/6

• P l a n ned audit and training re crisis intervention at primary care level*

Post-Vention:

This describes interventions focused on those left behind following a suicide. It encompasses a broad range of activities including survivor and professional accounts to improve services.

Action completed far:

• S p e c ific resource developed and disseminated detailing supporting agencies for those bereaved by

suicide

• W  o r kshop delivered by Survivors of those bereaved by suicide to front line services

• M  e n tal Health Service critical incident policy completed

Action Planned 2005/6

• P l a n ned training to front line emergency staff to be delivered by key voluntary agencies*

*Denotes activity dependent on successful growth bid funding being agreed for 2006

Recent Public Health Intelligence

An important part of the Suicide prevention strategy has been to improve the data collection and analysis in order to inform preventative activity. This work has been led by the Public Health Intelligence Unit.

The analysis of the relevant data tells us that suicide remains a major contributor to local mortality. Mortality refers to the number of people who have died, in this case from suicde, during a given period within a given population. The mortality rate is the number of people who die expressed as a proportion of a standardised population of  100,000. By expressing the mortality as a rate we are able to compare our rates with other countries (Graph 1.1 and 1.2) as well as other causes of mortality (Graph 1.0).

Jersey has a higher number of suicides than England and Wales. Comparison between standardized rates of suicide show that on average England &  Wales have seven suicides per year per hundred thousand where as Jersey has twelve per year per hundred thousand.

After Circulatory Desease and Cancers, Suicde and Road Traffic Accidents are the biggest cause of mortality within the Jersey population. The graph below shows the marked difference between traffic accidents and suicde. The working partnerships formed around accident prevention are currently better formed and developed at present which is partly due to established funding streams.

Locally we can show an overall reduction in suicide rates, which is comparable to that reported in the English Suicide Prevention Strategy Annual Report (2004) whose main message of this report is that there have been reductions in the suicide rates in the key at risk groups of young men.

.

Graph1.1: Jersey Suicide Rates per 100,000 population (Average annual rate over last four decades)

By comparing rates for both the Jersey and Guernsey we can show a slight downward trend in male suicides over the past eight years which are both in line with UK observations.

Figure 1.2: Suicide Mortality Rates for Males in Jersey & Guernsey (Three Year Rolling Averages for 1995 to 2002)

Despite suicide rates decreasing slightly, Jersey still has a higher suicide rate per hundred thousand than England. Furthermore, there is an uneven distribution of suicide according to age and gender across the local population. In Jersey male suicides in age groups 20-24, 25-34 & 45-64 are approximately twice the rate for England and Wales as is the suicide rate for 35-44 women. The suicide rate for Jersey women aged 65 + is four times that of England and Wales.

Summary

High suicide rates in Jersey were first formally recognised as a public health issue in 2001. Holistic approaches to suicide prevention continue to be implemented locally within existing funding streams. Public Health intelligence is improving with regard suicide and is increasingly being used to help inform practice in this area.

Whilst actual numbers of individual suicide appear small in number those bereaved by suicide in Jersey suggest that approximately 65 people per year experience both the short and long-term physical and mental effects of losing someone close to them through a suicide. It is generally accepted that the impact lasts a lifetime.

Recommendation

• T h e Health and Social Service committee are asked to continue their support for the work of the Suicide Prevention Strategy.

07 March 2005

Jill Birbeck: Assistant Director Public Health (Health Intelligence) Andrew Heaven: Assistant Director Public Health (Health Promotion)

STATES OF JERSEY

HEALTH AND SOCIAL SERVICES COMMITTEE

Public Health Services

(Suicide Prevention)

Proposal

This paper looks to inform the Health and Social Services Committee of the action resulting from the Medical Officer of Health's report on Suicide (2001). This work has been led by a multi-agency steering group which has as a result of a consultative process, identified prioritise for action. The overall aim of this group is to reduce suicides in Jersey.

Introduction

Suicide is a devastating event. The effect of a suicide clearly has a big impact on those immediately surrounding the person, including friends, family and associates and also professional staff who might have been involved with the individual both before and after the event.

Suicide is defined as a fatal act of self injury (self harm) undertaken with more or less conscious self-destructive intent, however vague and ambiguous (New Textbook of Psychiatry 1999).

The report of the Director of Public Health Services (DPHS) (2001) described the nature and extent of the problem in Jersey and identified action in the form of a co-ordinated and multi agency response which  would intervene at various points along the preventative cycle.

According to the DPHS Report 2001 there have been on average 13 deaths from suicide and undetermined causes in Jersey per annum in recent years. This accounts for 2% of all deaths and 7% of all potential years of life lost through deaths before the age of 75 years. The age standardised mortality rate for suicides and undetermined death in Jersey is 14.3 deaths per 100,000. This compares with a national rate of 9.18 per 100,000 (1996-98) in England. The average rate of 58 countries is 14.5 per 100,000 population.

Figures seen in Table 1 (below) show the differing methods of suicide used between 1996 and 2000. We know that there are trends in relation to methods of suicide and that wider social factors can play a part in influencing the overall methods of suicide. The number of people who attempted suicide and were unsuccessful is not known.

Table 1. Number of deaths by method and by sex for all suicides and undetermined deaths in Jersey 1996-2000.

(Source: DPHS Annual Report 2001)

Our understanding of underlying factors which may or may not contribute toward suicide locally is currently poor. It is anticipated that a local audit of suicide (currently being undertaken) over the past five years will add to our understanding of how different aspects of Jersey life can impact suicide and suicide attempts.

Background

Following a facilitated workshop which involved over 25 delegates from all agencies providing relevant services, a strategy was formulated based on the information and priorities articulated during the day. A multi agency steering group is currently beginning the process of delivering on specific areas of work as outlined in the strategy. A description of the prioritised action which will be taken forward by the steering group in its first year is set out below.

It is important to note that the financial cost of the actions outlined below represent no new / additional cost to Heath and Social Services. Rather the emphasis is on:

• S e r v ice redesign and development where appropriate.

• M  a k ing sure that issues relating to suicide are considered in other areas of strategy development.

• I m p r oving the connections between voluntary and statuary agencies who have a role to play in preventing suicide.

Primary Prevention

Description of Activity Action Lead Agency: Develop  public  awareness Co-ordinate  audit  of  current Health Promotion Unit campaign  focusing  on  mental information/leaflets  available,

health relevant to the prevention of suicide.

Identify  gaps  in  terms  of  target

audiences.

Description of Activity Action Lead Agency:

Develop directory of services Develop directory appropriately in Soroptimist's, Jersey for both professionals and light of findings from above audit Focus on Mental Health, service users in relation to Health Promotion Unit. mental health issues.

Description of Activity Action Lead Agency:

Evaluate and examine school To identify how the proposed Youth Margaret Brown from policies re bullying and barriers Action Teams and Youth Education Service will

to counselling support for Intervention Programmes will liaise directly with Kathy young people. impact on the proposals in the Bull who has an overview

Suicide Prevention Strategy in order of all of the Youth Action to ensure a joined up approach Teams.

whilst minimising the risk of

duplicating services or activities.

Secondary Prevention

Description of Activity Action Lead Agency: Co-ordinate the responses to Meeting to arrange placement of Gary Milne, Samaritans reducing risk of suicide Samaritan's signs in car parks. and Alan Muir, Public attempts within car parks Services Department

offers of training.

Description of Activity Action Lead Agency: Establish corporate H&SS To review current processes of Ronan Mulherne, Ian agreement on most effective assessing risk in relation to suicide Dyer – Adult Mental means of assessing suicide risk. Health Services

Description of Activity Action Lead Agency:

Identify ways of improving risk To await outcome of Rosemary Wools Mark Warr en – Adult assessment and communication Health Needs Assessment of the Mental Health Services between Police and Prison prison due for completion in June/July

during transfer 2003.

Crises Intervention

Description of Activity Action Lead Agency: Identify patients at risk of To review current processes of Ronan Mulherne, Ian suicide following risk assessing risk in relation to suicide Dyer – adult Mental assessment in A&E. Health Services.

Description of Activity Action Lead Agency:

Review accessibility of out of Crises Resolution Team to come on Ian Dyer – Adult Mental hour's services with a view to line in Jan 2004. Health Services. increasing capacity of outreach

group to intervene in crises.

Post Intervention

Description of Activity Action Lead Agency:

Identify ways of expanding To understand and support Public Health (including critical incident review to how the work on  Health Promotion), Social include all agencies that may be protocols for critical Services and Adult Mental involved. incident reviews and the Health Services.

existing Clinical

Psychology service

around debriefing fit

together.

To begin to develop clear service development strand, out of the resultant critical incident review protocol.

Recommendations/Conclusion

The committee are asked to endorse the:

• p r io r itised action plan of the multi-agency steering group.

• p r io r itised actions of the steering group to the Committees for whom suicide is also an issue (Education

Sport & Culture, Home Affairs, Environment & Public Services).

SUICIDE

Why are they important?

There were on average 13 deaths from suicide and undetermined causes in Jersey per annum in recent years. This accounts for 2% of all deaths, and 7% of all potential years of life lost through deaths before the age of 75 years.

The age standardised mortality rate for suicides and undetermined death is 14.3 per 100,000 (five year average 1996-2000). This compares with a national rate of 9.18 per 100,000 (1996-98) in UK. [see figure 1]

Figure 1

s u ic id e s a n d u n d e te r m in e d d e a th s in is la n d s 1 9 9 6 -1 9 9 8

a g e s ta n d a r d is e d r a te s p e r 1 0 0 ,0 0 0

2 0 1 8 1 6 1 4 1 2

1 0 8

6 4 2 0

G u e r n s e y J e r s e y Is le o f W ig h t E n g la n d Is le o f M a n

What do we know about suicides?

Suicide rates vary with age. They also vary with gender. Suicide rates were higher in older age groups, but these rates have been falling steadily over the past 50 years. In contrast since 1982 in the UK there has been a 75% increase in suicide rates in men aged 15 – 24 years. Since the mid-1970s there has been an increase in the number of suicides among men, but a decrease amongst women. Male suicides now outnumber female suicides by 3 to 1, despite the much higher prevalence of depression in women.

Some people are known to have an increased risk of suicide. About 40% of people committing suicide have a past history of deliberate self-harm. About 1% to 2% of those who deliberately harm themselves in any year will commit suicide in the subsequent 10 years. However, the highest risk of suicide is seen among patients recently discharged from mental health hospitals. Figure 2 shows the  estimated magnitude  of  increased  risk of suicide  for different  groups. To put this  into perspective, only 2% of people in high risk groups will commit suicide in a year. More than one-third of people who commit suicide do not belong to any of the high risk groups.

Table 1 Inc  reased risk of suicides in different groups compared with general population

h risk group Estimated magnitude of increased risk

tients in the 4 weeks following discharge from mental x 200 (males)

lth hospitals x 100 (females)

ohol and drug misusers x 20 maritan clients x 20

tory of deliberate self-harm x 10-30

rent or ex-mental health user x 10

[1]

One study was carried out in the North of England 8 years ago looking at all the suicides that occurred over 5 years . There were 105 cases and most occurred among men aged 20-50 years. Forty cases (38%) had been in contact with mental health services at some time in the past, and 41 cases (39%) had been to see their family doctor in the three weeks prior to death. Just over one-third had some form of physical illness or disability at the time of death, and in twenty cases the evidence suggested that this was a key factor. The most common precipitating factor was relationship problems which were identified in 32 cases (10 women, 22 men).

How big is the problem in Jersey?

On average there have been 10 or 11 suicides per year and 2 or 3 cases where people have brought about their own deaths but an open verdict has been returned at the inquest because suicidal intent was nor proved.

Table 2  Total numbers of suicides and relevant "open verdict" deaths  by agegroup and sex

 Jersey 1996-2000

nder Age group

15-19 20-29 30-39 40-49 50-59 60-69 70-79 80+

males 2 2 5 2 0 2 0 3

les 2 21 12 6 4 3 3 0

There are three times as many men as women, and more than half the deaths are in persons aged 20-39 years. The percentage of all suicides and undetermined deaths by age group is shown in figure 2.

Figure 2  Percentage of all suicides and undetermined deaths, 1996-2000, by agegroup

p e r c e n t a g e  o f  s u i c i d e s  b y  a g e  g r o u p

4 5

4 0

3 5

3 0

m a l e s

2 5 f e m a l e s

2 0

1 5

1 0

5

0

1 5 - 1 9 2 0 - 2 9 3 0 - 3 9 4 0 - 4 9 5 0 - 5 9 6 0 - 6 9 7 0 - 7 9 8 0 - 8 9 a g e  g r o u p

The different methods of suicide are an important part of the analysis in order to try to identify preventable opportunities.

Table 3 N u m  bers of deaths by method and by sex for all suicides and undetermined deaths in Jersey

1996-2000

Hanging accounted for nearly 50 % of deaths in men. The only significant difference between men and women is that women are more likely to take an overdose, usually involving drugs which have been prescribed. 5 who jumped to their death did so from a multi-storey car park. There is scope for prevention here, by erecting adequate barriers.

What can be done about suicides?

It is often assumed that there are known effective measures which can be put in place to reduce suicide rates. There are two problems in measuring the effectiveness of suicide prevention initiatives.

• in te  rv e ntions aimed at high risk groups cannot have any impact on six out of ten suicides. This is because these

people will not have been in contact with health services and identified as being at high risk. Although family doctors are often the point of first contact, their experience of suicide will be relatively limited. On average, a family doctor in Jersey will experience a suicide in his/her practice once in every seven or eight years.

• p o te n tia  l interventions have not been adequately tested. The gold standard in evaluating clinical interventions is known as a randomised controlled trial.  It has been estimated that using this method, to test whether a given

intervention could reduce suicide rates by 15%, the study would have to involve 13 million people.

Local audits

A different approach is to treat a case of suicide as a "critical incident" which must be subject to a special review.  Such reviews should be part of the routine clinical risk management procedures which health services are expected to carry out. These local reviews should be carried out in a systematic way and involve professionals from all relevant disciplines. The lessons learnt in each case must be widely shared so that all professionals can contribute to improving the care of patients at risk. This approach has been adopted in Jersey and will be formally incorporated in a new H&SS policy on dealing with "significant events" – events where the health of patients has been put at actual or potential risk, or where there is an adverse outcome.

The UK has a national Confidential Inquiry into Homicides and Suicides by Mentally Ill People. This inquiry has a remit to identify factors which may be related to the suicide and to make recommendations on prevention. Particular actions have been identified that would reduce the availability of common methods for suicide. These include new designs for car exhausts; limiting the quantity of paracetamol available over the counter (now only available in packets of 16); improved licensing and regular amnesties of firearms.

Targeted treatment

Another approach is to improve the management of people with mental health problems in the community by targeting high risk groups. Although suicide rates are higher in people suffering from depression, it is not possible for the family doctor to predict which individuals will commit suicide. Rather, the issues which need to be addressed are the recognition and management of depression by family doctors. A training programme for Swedish family doctors about recognising and

[2]

treating depression resulted in a reduction of suicide rates. Suicide rates in Sweden were much higher than those in the UK at the time of the study, and this may have contributed to the apparent success. Given that up to 50% of all suicides are committed by clients with undiagnosed or inadequately treated depression, a similar training programme for local family doctors is recommended.

Since those people who have deliberately harmed themselves are known to be at high risk it would be reasonable to target this group. There are arrangements which include an urgent psychiatric assessment for the immediate care of the group of patients who present in the Accident and Emergency department due to deliberate self-harm. Those who identified as having serious mental health problems are diverted to the care of the mental health services.

Getting it right

A number of initiatives could be introduced in order to reduce the number of deaths by suicide in Jersey. Such measures may also reduce the occurrence of deliberate self-harm which is more prevalent than suicide.

It is worth noting that deliberate self-harm is not necessarily a failed suicide attempt – it may be a way of trying to resolve some unbearable pain or life crisis. As such, the whole issue is worthy of consideration in its own right.

[3] The interventions will be discussed in four categories :

Primary Prevention

Early Intervention

Intervention

Post Intervention

Setting the goals for suicide prevention

The goals of suicide prevention, along with intended target groups, must be clearly identified. The factors implicated in

[4]

suicide are complex and interrelated. There is at present a lack of research around the nature of suicide in Jersey. For example, the rates may be different between young people who have always lived in Jersey and those who have come to the island recently. Without this information, the only option is to assume that the target groups identified in the UK are applicable to Jersey. The difficulty with  this approach is that suicide patterns vary, even in similar and relatively proximate cultures:

"Many possible environmental and social explanations for national and regional variations have been considered including climate, latitude or annual light/dark cycles, ethnicity, policies, alcohol consumption and social and political systems.  However, another factor of undoubted importance is variance in societal attitudes about suicide and efficiency of reporting suicide, although regional variations are also present in the United States

[5]

despite presumably similar reporting procedures."

Primary prevention

This intervention is aimed at society in general and is designed for the whole population. It aims to raise understanding around the issue of mental health and suicide and to reduce the stigma attached to mental health problems. This prejudice can often be seen  in Jersey,  for example  in the reaction of the community when application  is  made  to place people  in rehabilitation in local supervised accommodation. Mental health should not be a taboo subject.

A variety of methods should be used, including:

1. A sustained public information campaign which would  focus on:

• A potted history' of suicide placing the present day approach into a historical and cultural context

• A first hand' experience of suicide, possibly from someone who has attempted suicide at some point, or a family member or friend of someone who has taken their own life

• The role of the statutory and voluntary agencies who are able to assist with those who may be experiencing suicidal feelings

2. The  development  of  a  suicide  resource  (information  and  training  packs)  for  use  by  educational  institutions  and community groups.

Early intervention

Early intervention is the "effective reduction of the intensity, severity and duration of risk behaviours for suicide. Therefore,

[6] early intervention strategies encompass improvement in the detection, assessment and management of people at risk."

Certain groups of people are generally acknowledged as particularly vulnerable with regard to the potential for suicide. These are:

• People with depression type illnesses

• People who abuse alcohol and other substances

• Young males (15 - 24) and older males (65+)

• Those who are socially isolated

• Newly imprisoned males

Each lead agency should have a written policy which sets out their approach to the groups mentioned above, and addresses:

• Assessment of current training, protocols and general levels of awareness in relation to suicide

• Evaluation of the services with an emphasis on looking for gaps in both provision and knowledge base, with regard to new research and approaches in the field of suicide treatment and prevention

• Maximises improvements in the overall provision of holistic support for those who are at risk of suicide that could be made by joint working with other organisations

There is good evidence of the effectiveness of guidelines to improve the management of people with depression in primary care, and the introduction of such schemes in Jersey should be facilitated.

One outcome from local audit is a better understanding of the Jersey pattern of suicides. This may identify "hot spots", places or methods for committing suicide that are amenable to local interventions – for example installing safety netting and barriers at places where people commonly jump. It would be possible to reduce access to some of the methods of suicide in Jersey. For example, the installation of safety barriers around certain car parks which have become notorious for their use in suicide attempts.

Intervention

It is important to decide what approach to take in providing services for those who are seriously and imminently at risk of

suicide, or have already recently attempted to take their own life. The situation context is usually one of crises.

The creation of assertive outreach teams in the UK has been viewed with ambivalence by both professionals and users of mental health services. Whilst the government defended the creation of a more aggressive approach to mental health, many are wary of the implications around the erosion of Human Rights, particularly around enforced treatment in the community. However, in relation to the treatment of suicide, it is clear that compulsory treatment in the hospital presents further risks and is far from a problem free solution:

"Both absolute numbers and rates of suicide in psychiatric inpatients have increased progressively in several European

[7]

countries during the last three decades." *

Post intervention

This describes the range of support services which may take place after a suicide has occurred. The additional benefit is the possible prevention of future suicide for those who experience exposure at an early age.

The shock wave created by a suicide has the potential to impact upon:

• Family and friends of the deceased

• Professional and support services involved with the deceased

It is important that the needs of both groups are addressed appropriately. These can be provided by existing or additional counselling and bereavement services, and those existing or additional services which can provide practical support and help, e.g. Citizens Advice Bureau.

The staff in professional and informal support services who are involved with a suicide, particularly a violent suicide or the death of a young person, can suffer long standing detrimental effects on mental and physical well-being. Emergency service personnel who are routinely involved in fatalities, may experience a more profound effect through the accumulative effect of multiple exposure. Support services for these people are crucial and can lead to the protection of the well-being of staff, with an increased ability to cope with exposure to traumatic events.

Proposals for action

1  T o u n d ertake research in order to gain a clearer understanding of suicide in Jersey, particularly in relation to:

A historical perspective on the pattern of suicide in Jersey highlighting any trends or patterns around suicidal

behaviour

A clearly identified method for the ongoing collation and analysis of information in relation to suicide in Jersey

2  T o r a is e public understanding around the issues of mental health and suicide.

3  T o im  p rove the early detection, assessment and support for those who are at risk of committing suicide.

4 T o r e d uce opportunity for suicide at the hot spots' such as car parks.

5  T o e s ta blish assertive outreach teams.

6  T o m  in imise the harmful impact of the suicide of an individual, upon the wider community.

[  1 ] N  ew  c a stle    a n d  North Tyneside HA. With Health in Mind. Annual Rreport of the Director of Public Health 1995/96. [ 2 N] e w c a s tle  ,  1 9 9 6 .        HA TE          

  Health Care Evaluation Unit, University of Bristol. The potential for preventing suicide. Bristol, 1994.

[3]

Cantor CH, Baume PJ. I hSuicaidtee  mpreyvesentiolfn a: an pdubwlica hneatlth to a dppireoach. Aust N Z J Ment Health Nurs 1999; 8(2):45-50.

[ 4] B a u m e  P. , C  lin  to n  I hM  .   Sa uv ic eid ne  op r we v ein ntiogns  inb:u Atd wvanacnedt P troac fticlye in Mental Health Nursing.

[ 5]     I h a v  e n o t e a rs and need to cry

Tondo L, Baldessarini R.J. Suicide – an overview. Psychiatric Clinical Mmanegment Modules. Medscape. March 2001. [ 6] B a u m e  P. , C  lin  to n  I hM  .   Sa ut ice id m e  py rsee v elnf t aionn ind:  wAdavanntc tedo P draicetice in Menatl Health Nursing.

[7]

NHS Health Advisory Service Suicide prevention. Ed: Williams R., Morgan HG  HMSO: London, 1994.

      I h a t e m y se  lf and want to die

      A ll I e  v e r d  o is try

      I c a n ' t g o o  n , my life's a lie

      I h a t e m y se  lf and want to die

(Taken from an anthology of poems by a young woman who worked through mental health difficulties at the Young People's Unit, Newcastle General Hospital)