Nottinghamshire Insight

Joint strategic needs assessment

Suicide prevention (2016)

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Topic title Suicide prevention (2016)
Topic owner Nottinghamshire Mental Health and Learning Disability ICG
Topic author(s) Susan March
Topic quality reviewed Feb 2015
Topic endorsed by Nottinghamshire Mental Health and Learning Disability ICG 12/02/2016
Topic approved by Approved by HWIG 20th April 2016
Current version Date 16/02/2016
Replaces version Date V1 January 2015
Linked JSNA topics

Executive summary


“On average, one person dies every two hours in England as a result of suicide. When someone takes their own life, the effect on their family and friends is devastating. Many others involved in providing the support and care will feel the impact” (HM Government 2012).

Suicide is a major issue for society. Nationally, the overall trend in suicide and injury undetermined death rates has been decreasing since 1998 until 2008 and has been rising slightly since.  From 2010 the number of reported suicides has gradually increased with highest number of reported suicides occurring in 2014 with approximately 4,707suicides (ONS 2015).

The impact of every suicide can be devastating – economically, psychologically and spiritually – for all affected (HM Government 2012). The cost of a completed suicide for someone of working age in the UK exceeds £1.6 million (CMO 2014). Suicidal thoughts at some point in a person’s life are relatively common: in 2007 16.7% had thought about suicide, 5.6% reported attempting suicide and 4.9% had harmed themselves without suicidal intent (APMS 2007).

The latest three-year average data shows a national increase of 15.9% in the rate of suicide and injury undetermined deaths from the 2001-2003 baseline (to a rate of 8.9 per 100,000). The rate in the East Midlands dropped from a peak of 9.1 per 100,000 in 2001-2003 to an average lowest rate, 8.8 per 100,000 in 2011-2014(ONS 2015).

For Nottinghamshire there has been a slight increase in the average rate of death by suicide or injury of undetermined intention. For the period 2011 -13, the Nottinghamshire age-standardised rate of 8.5 per 100,000 population, increased to 9.2 per 100,000 population in 2012-14, which is slightly above the England average of 8.9 per 100,000 population. However, as the numbers are small statistical significance is not reached.

In Nottinghamshire, for the period 2012-2014 the highest rate of suicide occurred in the 35-64 age group for both males and females, which is similar to the picture nationally. However, for the 65+ age male group, the suicide rate was higher when compared to the national suicide rate. Although none of these differences are statistically significant due to the small numbers.

Nationally more men die of suicide than women, the ratio of male to female suicide deaths is 3:1. For Nottinghamshire the gender split in the suicide rate is in line with national suicide rates with men accounting for around three quarters of suicides.

There is a socio-economic gradient in suicide risk. Those in the poorest socio-economic group are 10 times more at risk of suicide than those in the most affluent group. Nottinghamshire has a similar pattern, although due to small numbers we need to be cautious in interpretation of our local data.

Suicide prevention goes hand in hand with addressing self- harm. People who self-harm are at increased risk of suicide. UK studies have estimated that in the year after an act of deliberate self-harm the risk of suicide is 30–50 times higher than in the general population. Non-fatal self-harm leading to hospital attendance is the strongest risk factor for completed suicide (Owens et al. 2002).

In England, self-harm is one of the most frequent reasons for emergency hospital admissions (Royal College of Psychiatrist 2006). It accounts for at least 150,000 presentations to general hospitals each year and those who self-harm have a 1 in 6 chance of repeat attendance at A&E within the year (Runeson et al. 2010). When older people self-harm the risk of further self-harm and suicides are substantially higher. All acts of self-harm in people older than 65 years of age should be regarded as evidence of suicidal intent until proven otherwise because the number of people in this age range who go on to complete suicide following acts of self-harm is much higher than in younger adults (Gunnell et al. 2004) .

For the period 2013-2014, the Nottinghamshire emergency hospital admission for intentional self-harm rate was 207.9 per 100,000 population. Nottinghamshire is slightly higher when compared to the England rate of 203.2 per 100.000 population. However, this is not statistically significant.  

There are a wide variety of factors that can contribute to suicide and self-harm (Gunnell & Lewis 2005). These include historical or familial risk factors (e.g. genetic influences, family history and early trauma) and recent risk factors (e.g. psychiatric disorder, physical illness, relationship breakdown and other life events). Changes in socio-economic environment are important, as is exposure to suicidal behaviour by others, including through the media. Availability of suicide methods can contribute to risk, and the danger of the method will partly determine whether an act is fatal or non-fatal.

Suicide prevention is acknowledged to be a complex challenge and is not the sole responsibility of any one sector of society, or of health services alone. Therefore, prevention largely necessitates a general population approach rather than service-related initiatives. For example, restriction of access to means for suicide, population approaches to prevention of depression, improved detection and management of psychiatric disorders in primary care, and voluntary agency and internet-based support (HM Government 2012)

The greatest impact is likely to result from a combination of preventative strategies directed at potential suicide determinants, which include;

  • The factors which increase the  risk of suicidal behaviour in a population; for example, availability of means, knowledge and attitudes concerning the prevalence, nature and treatability of mental disorders, and media portrayal of suicidal behaviour
  • Recognised high risk groups - e.g. people with recurrent depressive disorders, previous suicide attempts, people who misuse alcohol, the unemployed, people with certain co-morbid mental and personality disorders (Hawton and van Heeringen 2000) and people recently discharged from psychiatric in-patient care (HM Government 2012).

The suicide and self-harm prevention agenda is cross-cutting and relates most closely to the following JSNA chapters: Mental Health, (Emotional and Mental Health of Children and Young People (2014), Young adults and older people), Domestic and Sexual Violence, Carers, Employment, Asylum Seekers, Refugees and Migrant workers.

Unmet needs and gaps

The following unmet needs and service gaps have been identified and are aligned to the Nottinghamshire and Nottingham City Suicide Prevention Steering Group Action Plan 2016-2018 and includes;

  • Targeted health promotion initiatives  towards men and older people
  • Targeted suicide prevention programmes to specific groups such as: Black and Minority Ethnic (BME) and Lesbian, Gay, Bi-sexual and Transgender (LGBT) groups
  • Training on self-harm and suicide awareness for frontline professionals in order to improve early identification and signposting those at risk of suicide and/or self harm
  • Improved early identification and access to treatment of depression for older people and those experiencing long term physical conditions
  • The provision of risk assessment and management as part of routine clinical assessment and care planning provided by front line staff working with high risk groups, particularly in primary care and A & E
  • Better support for veterans suffering with depression and/or PTSD
  • Monitoring of means of self-harm and suicide through REAL time surveillance in  order to put in place targeted strategies and interventions
  • Improved information and access to support for those bereaved or affected by someone else’s suicide is required, particularly, in primary care, prisons and social care. This includes support to families immediately following a suicide, support in dealing with the bereavement and follow up for the bereaved families
  • An agreed and joined up approach by all Suicide Prevention steering group stakeholders in communicating self-harm and suicide to the local media
  • A local suicide communication plan for dealing with media on self-harm and suicide
  • Improved access to mental health crisis intervention services for all ages

Recommendations for consideration by commissioners




Public  Health Intelligence and data improvement



Nottinghamshire Public Health at the time of writing this JSNA chapter currently undertaking a Coroners Suicide Audit for all Suicide Verdicts for the period 2013-2014. This audit is due for publication in April 2016. The audit aims are to compare data with findings from previous local suicide audits and to identify local risk factors, groups at risk or localities of higher incidence that will inform the suicide prevention targeted actions

Nottinghamshire County Council Public Health


Implement ‘REAL’ time surveillance in order that clusters and suicide hotspots are identified early

Nottinghamshire County Council Public Health




Develop and implement a local annual suicide prevention campaign programme targeted towards at risk groups and address mental health stigma and discrimination, bullying, and self-harm

Kaleidoscope Plus Group


Raise awareness of mental health problems through campaigns targeting schools and colleges in suicide awareness

Nottinghamshire Public Health Children and Young Peoples team


Develop a local suicide prevention communication plan that promotes responsible reporting of suicide in the media

Nottinghamshire County Council Communications

Early identification and interventions



Improve early identification and access to interventions for those at risk of suicide by ensuring the locally commissioned suicide prevent training programme is including primary care, employers, job centres, Citizen’s Advice Bureau, Emergency Services and Accident and Emergency Departments, teachers, community groups, faith groups in their training programme

Kaleidoscope Plus Group


Primary care workforce trained in undertaking a suicide risk analysis so that patients contemplating suicide have access to early interventions

Kaleidoscope Plus Group

Service quality and accessibility



Data sharing agreements between coroners, primary care, acute hospital and mental health services to enable each suicide and open verdict to be identified investigated and lessons learnt.

Nottinghamshire and Nottingham City Suicide Prevention Steering Group


Commission mental health crisis services

Nottinghamshire CCG Mental Health Commissioners


Commission mental health early identification and targeted interventions services for specific groups at suicide and self-harm

Nottinghamshire CCG Mental Health Commissioners


Reduce the means of suicide and self-harm through ensuring hospitals, mental health wards, care institutions and criminal justice settings are safe by identifying and removing any potential risks

Safety and Quality leads across all hospital, care and criminal justice settings


Ensure pathways are in place that provide effective and timely support for families and other people bereaved or affected by someone’s suicide

Harmless (self harm support)

Key contacts

This is an online synopsis of the topic which shows the executive summary and key contacts sections. To view the full document, please download it.

Full report »