On 10th September, the International Association for Suicide Prevention (IASP) collaborates with the World Health Organization (WHO) and the World Federation for Mental Health (WFMH) to host the World Suicide Prevention Day.
World Suicide Prevention Day (WSPD) is an awareness day observed on 10 September every year, in order to provide worldwide commitment and action to prevent suicides. Various activities have been taking place around the world since 2003.
The timing seems only appropriate that we consider the guidelines published in September 2018, when the National Institute for Health and Care Excellence (NICE) produced the guidance Preventing Suicide In Community and Custodial Settings.
Of the many organisations for which this guidance was intended, none are more relevant than those of us working in:
- Prisons (both public and contracted out),
- Children and young people’s secure estate,
- Immigration Removal Centres (IRCs), and
- Probation and Community Rehabilitation Services
High Suicide Risk
NICE determine that “High Suicide Risk” means that the rate of suicide in a group or setting is higher than the expected rate based on the general population (in England). Groups at high risk can include: young and middle-aged men, people who self-harm, people in care of mental health services, family and friends of those who have died by suicide, people who misuse drugs or alcohol, people with a physical illness, particularly older adults, people in the LGBT community, people with autism, people in contact with the criminal justice system, particularly those in prisons, people in detention settings, including immigration detention settings, and specific occupation groups.
Recommendations for Custodial and Detention Settings
There are 10 main recommendations, and listed below are those points within each of those recommendations that I view as being more specific to custodial environments:
Suicide Prevention Partnerships
Set up a multi-agency partnership for suicide prevention in residential custodial and detention settings. This could consist of a core group and a wider network of representatives. Ensure the partnership has:
- clear leadership
- clear terms of reference, based on a shared understanding that suicide can be prevented
- clear governance and accountability structures
…and then include representatives from the following in the partnership’s core group:
- governors or directors in residential custodial and detention settings
- healthcare staff in residential custodial and detention settings
- staff in residential custodial and detention settings
- pastoral support services
- voluntary and other third-sector organisations
- escort custody services
- liaison and diversion services
- emergency services
- offender management and resettlement services
- people with personal experience of a suicide attempt, suicidal thoughts and feelings, or a suicidal bereavement, to be selected according to local protocols
Suicide Prevention Strategies
Identify and manage risk factors and behaviours that make suicide more likely.
Consider collaborating with neighbouring residential custodial and detention organisations to deliver a single strategy.
Suicide Prevention Action Plans
Alongiside developing and implementing a plan for suicide prevention and for after a suspected suicide set out how to:
- Work with the Prison and Probation Ombudsman and coroners to ensure recommendations from investigations and inquests are implemented
- Implement recommendations from internal investigations of instances of self-harm
- Assess suicide and self-harm prevention procedures (for example, HM Prison and Probation Service’s Assessment Care in Custody and Teamwork and Assessment care-planning system, and the Home Office’s Assessment Care in Detention and Teamwork case management systems)
- Interpret and act on those findings
- Ensure systems for identifying risk, information sharing and multidisciplinary working put the emphasis on ‘early days’ and transitions between estates or into the community
- Monitor the impact of restricted regimes on suicide risk
Gathering and analysing suicide-related information
For residential custodial and detention settings, also collect data on:
- sentencing or placement patterns
- sentence type
- length of detention
- transition periods (for example, ‘early days’ and transitions between estates or into the community)
Awareness raising by suicide prevention partnerships
For residential custodial and detention settings, also consider raising awareness of:
- the risk associated with ‘early days’ and transitions between estates or into the community
- the value of peer support, for example the Listener scheme
- the need for institutional support, such as safer custody teams in accordance with PSI 64/2011 – Management of prisoners at risk of harm to self, to others and from others
Reducing Access to Methods of Suicide
- Provide safer cells
- Reduce the opportunity by erecting physical barriers
- providing information about how and where people can get help when they feel unable to cope
- using CCTV or other surveillance to allow staff to monitor when someone may need help
- increasing the number and visibility of staff, or times when staff are available
Training by Suicide Prevention Partnerships
Ensure training is available for:
- those in contact with people or groups at high suicide risk
- people working at locations where suicide is more likely
- people who provide peer support in residential custodial and detention settings
- people leading suicide prevention partnerships
- people supporting those bereaved by suicide
Supporting People Bereaved or Affected by a Suspected Suicide
Use rapid intelligence gathering and data from other sources, such as coroners to identify anyone who may be affected by a suspected suicide or may benefit from bereavement support. Those affected may include relatives, friends, classmates, colleagues, other prisoners or detainees, as well as first responders and other professionals who provided support.
- providing support from trained peers who have been bereaved or affected by a suicide or suspected suicide
- whether any adjustments are needed to working patterns or the regime in residential custodial and detention settings
Preventing and Reponding to Suicide Clusters
After a suspected suicide in residential custodial and detention settings, undertake a serious incident review as soon as possible in partnership with the health providers. Identify how:
- to improve the suicide prevention action plan
- to help identify emerging clusters
- others have responded to clusters
Develop a coordinated approach to reduce the risk of additional suicides.
Develop a standard procedure for reducing – or ‘stepping down’ – responses to any suspected suicide cluster.
Provide ongoing support for those involved, including people directly bereaved or affected and those who are responding to the situation.
Reducing the potential harmful effects of media reporting of a suspected suicide
For residential custodial and detention settings, where a suspected suicide would be reported via the Ministry of Justice, ensure Ministry of Justice press officers follow good practice in suicide reporting.
Baseline Assessment Tool
Alongside these recommendations, NICE also provide a baseline assessment tool that can be used to evaluate whether practice is in line with the recommendations. This assessment tools can then also be used to plan activity to meet those recommendations.
Alongside those recommendations listed above, the tool can then be used to determine:
- whether or not the recommendation is relevelant
- current activity (evidenced accordingly)
- whether or not the recommendation is met
- actions needed to implement the recommendation
- whether there are any associated risks with not implementing the recommendation
- whether or not there is a cost or a saving
- the deadline
- the lead or person responsible
Preventing suicides in custodial environments isn’t something to be done on an annual basis. It is an ongoing commitment that is undertaken day in, day out. However, with the up and coming World Suicide Prevention Day on September 10th, I would encourage all those working within custodial environments to take full advantage on the resources on offer here.