Better Health For All

Jane Leaman provides her views on the importance of the recently published NICE public health guideline on preventing suicide in community and custodial settings

More than 6,000 people take their own life each year in the UK. The risk of suicide is particularly higher in UK prison populations compared to the general population. In order to tackle and significantly reduce death by suicide, there needs to be a clearer approach to prevention; the recently published NICE public health guidelines aims to do this.

The guideline looks at ways to reduce deaths by suicide and help people bereaved or affected by suicides, including families and emergency responders, who may as a result be at risk of harming themselves. The recommendations also suggest ways to identify and help people at risk, particularly in places where suicide is more likely, such as high-buildings or medical, veterinary or agricultural settings where human or animal drugs may be readily available. Tackling access to high risk places where suicide can occur means we can explore prevention which is very important to consider.

The best way to put these measures in place is to have a multi-agency approach that looks at what plans and training local services need to put in place. A 2015 report published by the All-Party Parliamentary Group on Suicide and Self-Harm Prevention identified 3 main elements essential to the successful local implementation of the national suicide prevention strategy:

1. Carrying out ‘suicide audits’ to collect data on suicides
2. Developing suicide prevention action plans
3. Establishing a multi-agency suicide prevention group

The guideline encourages local authorities to work with local organisations to set up and lead a local multi-agency partnership on suicide prevention. It also advises that there should be consideration of continuous and timely collection of data from police, coroners and other sources. This data will then inform services of suspected suicides and potential emerging suicide clusters and could also be used to identify people who need support after such events.

The guideline also includes evidence-based recommendations on suicide and self-harm in custodial settings. Government records of deaths in prison custody, specifically self-inflicted deaths, have risen steadily over time. The guideline recommends that custodial and detention settings should collect data on sentence type, offence, length and transition periods when gathering data in their institutions to identify trends.

The NICE team also made sure that the core members of the committee who developed the guideline were those who have specific lived experience of this topic or who work within the field such as within a custodial setting. Having such a broad range of views and expertise further strengthens the final recommendations.

A clear message from the guideline is that action needs to be taken at local level to really understand risk factors, demographic profile, and settings and places that could be contributing to suicide levels. Crucially, it makes services and organisations aware that suicide is preventable. By working together and identifying where and by what means suicide occurs, we can look at ways to prevent and support those who are at risk of suicide. As a result we might begin to see a decrease in the current figures for self-inflicted death, particularly in high risk environments such as custodial settings.

Written by Jane Leaman, core member of the public health advisory guideline committee for the National Institute for Health and Care Excellence (NICE) and a Public Health Consultant. NICE is developing a quality standard that supports this guideline and will be published later on this month.