Report calls for ‘Suicide Safety’ in North Kensington

CNWL today (18 September) accepted the considered views from Professor Louis Appleby about ‘suicide safety’ in North Kensington. Report attached here.

Prof Appleby was invited by CNWL in September 2019 to advise us on what additionally we could do to improve suicide safety, particularly in Kensington and Chelsea.

He started meeting the local community in October (see https://www.grenfell.nhs.uk/news-and-publications/news/cnwl-invites-international-expert-meet-grenfell-community).

His report would have been completed earlier in the year but both Professor Appleby and CNWL wanted to make sure that his advice reflected the effects of the current coronavirus pandemic.  Accordingly we agreed together to delay the report until he had had time to take the new situation into account.

We were particularly concerned about the possible impact of a recession triggered by covid-19 because suicide rates tend to rise in recessions. It is a reminder that suicide is not simply about mental health but it reflects wider economic and social factors.

Professor Appleby’s review concludes:

•Suicide rates have not risen as a result of the Grenfell fire

•However, in a small number of individual suicides, the fire is likely to have contributed

•The widespread concern about suicide is important in its own right as it reflects a feeling of insecurity and a belief that the distress of individuals is not fully heard.

He sets out a number of key principles:

(1) suicide prevention should be not only about protecting individuals but ensuring the “psychological safety” of the community for whom the trauma of the fire has exacerbated entrenched disadvantage and mistrust

(2) suicide prevention should be an over-riding local commitment, signed up to by all local leaders and front-line agencies, with visible leadership and broad participation,

(3) mental health and suicide prevention should be prominent in local plans for socio-economic recovery

(4) the emotional security of children and young people is the most important priority long term

(5) the availability of high quality data is an essential feature of suicide prevention

(6) suicide prevention measures in response to Grenfell and Covid-19 should be brought together, as they share central themes of inequality, ethnicity and stigma.

Dr John Green, Clinical Director of GHWS, said,

“I would like to thank Professor Appleby for his advice, he is one of the world’s foremost experts on suicide and we are grateful that he agreed to giving up his time to advise us.  I would also like to thank the many people who took time to talk to him, something he found a powerful and emotional experience.  I would particularly like to thank him for agreeing to extend his work beyond the original brief to cover the potential impact of the coronavirus pandemic on suicide risk, particularly if we see a large rise in unemployment and social disruption as a result.”

“Though he said there was “much to praise” in what we have done so far we are also aware that there is more we need to do and the coronavirus pandemic adds additional impetus to that. When we commissioned his work it was to advise us on how best to improve and enhance services.”

“We’d like to reflect on his suggestions with the people who contributed to the review, and consider how we can make Kensington & Chelsea “suicide safe” with the community, working together for a community feeling of psychological safety.”

“Our partners in other parts of the NHS and the Council have seen the report and I thank them for taking on board his sentiments so positively. We will need to act together on the issue. Suicide is not simply an issue for mental health services alone it is much wider. Many of the recommendations require partnership and discussion between statutory service providers, the voluntary sector, and the local community. We look forward to discussing his suggestions and developing plans together.”

Notes from the Report:

Professor Appleby on the Grenfell Community:

“I should say at the outset that the people I met were impressive: many had behaved selflessly, even heroically. They were perceptive witnesses – every meeting gave me new insights.  Most, probably all, had told their stories many times before and their willingness to help was striking. Indeed it went beyond willingness, it was an insistence, a determination that their stories should be heard. Several said they feared that what happened in the Grenfell tragedy might be forgotten, that the news cycle might eventually move on, that public interest would dissipate, that nothing would change. As a result they were generous with their time, trying to ensure I had understood. This fear that their tragedy might become yesterday’s news is important in considering how the community might recover.”

Professor Appleby on the Grenfell Health & Wellbeing Service:

“… Views of the NHS response to Grenfell are mainly positive, reflecting the perception that CNWL staff were visible from the immediate aftermath of the fire, that the early offer of emotional support made directly through knocking on doors and the screening for mental health problems showed a commitment to the local community. There are also criticisms of what some perceive as a lack of flexibility in what is offered, driven by protocols and form-filling. For people who have been refugees, filling in forms can recall a punitive bureaucracy. Some people felt that their understandable distress was turned into a mental health problem; …. Several think there should have been a greater range of therapies available, and for longer periods when needed.

Professor Appleby's full recommendations:

Issue a clear statement publicly about suicide figures, with these messages:

•Suicide rates have not risen as a result of the Grenfell fire

•However, in a small number of individual suicides, the fire is likely to have contributed

•The widespread concern about suicide is important in its own right as it reflects a feeling of insecurity and a belief that the distress of individuals is not fully heard

Give greater profile to the local suicide prevention strategy:

•Declare Kensington & Chelsea a “suicide safe” community, as an explicit commitment of priority, leadership and collaboration on suicide prevention

•Establish an enhanced strategy oversight body, with visible senior leadership and expanded membership to include members of the community

Improve data under the strategy:

•Establish comprehensive real-time suicide surveillance, continue to monitor possible Grenfell factors when suicides are reported & ensure agreed local suicide figures

•Establish self-harm monitoring through mental health liaison teams in acute trusts locally

•Explore reasons for high self-reported anxiety and other suicide risk factors locally and continue to monitor these

Explore ways of further developing mental health services within CNWL in collaboration with its partners:

•Examine how the cultural diversity of the community can be reflected in care model through, for example, training and third sector partnerships

•Develop further an integrated model of mental health, physical health & social care, with a focus on inequalities and social adversity

•Explore options for making the Health & Wellbeing service more community-based

•Develop the capacity for a wider range of therapies and expand social prescribing

•Monitor PTSD rates and outcomes, in relation to type of trauma, ethnicity & intervention

•Develop bereavement support for people affected by suicide, Covid-19 and Grenfell

•Ensure services can respond to patient groups who may be most affected by Covid-19, i.e. those who are isolated (including digitally excluded), people in crisis, children & families and those with certain conditions such as autism/ASD, self-harm or recent-onset psychosis

•Monitoring of NCISH “10 ways to improve safety in mental health care” especially with reference to SMI and co-existing substance misuse

Enhance community participation:

•Expand social capital, e.g. opportunities for community volunteering

•Explore a possible new commissioning forum with strong input from unaffiliated community members

•Develop options for greater community decision-making through models of budget-holding

Develop a longer-term strategy for mental health recovery as an integral part of economic recovery, that will:

•Address the mental health impact of entrenched economic problems, inequalities and poor housing

•Offer universal mental health training for front-line agencies, employers, faith leaders & others

•Build on community strengths, including its diversity, strong third sector, creative arts and sport

•Pursue long term sustainability of funding with central Government support

Commit to a long-term focus on the future of children & young people (CYP):

•Establish a CYP mental health forum bringing together schools, CAMHS, social care & primary care

•Provide mental health and cultural competence training for teachers & other school staff

•Further develop the skills & capacity for culturally sensitive, family-based therapy

•Develop a programme of employment and training support, exploring local apprenticeships including in the NHS, taking advantage of the Government’s new “Kickstarter” initiatives

•Reporting suicide-related and mental health data on CYP, including self-harm and school exclusion

Publish a new CNWL communication strategy after community consultation:

•Consult on standards for communication with the community, covering timeliness, diverse methods and community input

•Make more frequent and more creative use of social media, after reviewing examples from other NHS and public sector organisations