HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY
Inquiry into the Prevention of Suicide and Self Harm
28 February 2008
Members present for all or part of the proceedings:
Mrs Iris Robinson (Chairperson)
Mrs Michelle O’Neill (Deputy Chairperson)
Mr Thomas Buchanan
Dr Kieran Deeny
Mr Alex Easton
Mr Tommy Gallagher
Mrs Carmel Hanna
Mr John McCallister
Ms Carál Ní Chuilín
Ms Sue Ramsey
Mr Brendan Bonner ) Western Health and Social Services Board
Ms Melanie McClements ) Southern Health and Social Care Trust
Mr Pat McGreevy ) South Eastern Health and Social Care Trust
Ms Gabrielle Nellis ) Northern Health and Social Services Board
The Chairperson (Mrs I Robinson):
The Committee will now have two formal evidence sessions for its inquiry into the prevention of suicide and self-harm. The Committee Clerk has prepared a briefing paper for members’ information. The first session will examine the implementation of the Department’s Protect Life strategy in the four health and social services board areas. Members have been given a copy of the boards’ submissions.
On behalf of the Committee, I welcome the first set of witnesses. I apologise for the late start and for having to go through the Committee’s general business first. I welcome Mr Brendan Bonner from the Western Health and Social Services Board, Ms Melanie McClements from the Southern Health and Social Care Trust, Mr Pat McGreevy from the South Eastern Health and Social Care Trust, and Ms Gabrielle Nellis from the Northern Health and Social Services Board. I invite you each to make a five-minute presentation, and then we will have a question-and-answer session, lasting about an hour.
Ms Gabrielle Nellis (Northern Health and Social Services Board):
I am employed as a suicide-prevention co-ordinator in the Northern Health and Social Services Board. On behalf of all four of us, I thank the Committee for inviting us to give evidence. To save confusion, I should explain that we each represent a board area, but some of us are from boards and some are from trusts. In our presentations, we will cover areas such as background and funding processes, and to illustrate our points, we have each selected a couple of examples of achievements or developments that have been made up to this point.
The Northern Health and Social Services Board and the Northern Health and Social Care Trust both cover the council areas of Coleraine, Ballymoney, Ballymena, Moyle, Cookstown, Magherafelt, Antrim, Carrickfergus, Larne and Newtownabbey. The board deals with a population of over 400,000.
A multi-sector steering group was set up in February 2007 to implement the local suicide-prevention action plan of the Northern Health and Social Services Board and the Northern Investing for Health Partnership. That action plan implements the objectives of the Protect Life strategy, and the joint steering group deals with both the suicide-prevention strategy and the ‘Promoting Mental Health Strategy and Action Plan for 2003-2008’ to ensure that there are no overlaps and that both strategies complement each other.
So far, at least 42 representatives from statutory, voluntary and community organisations — including Family Voices — community networks and local forums, churches, the education sector, youth services, mental-health services and local councils are involved in the steering group. I am sure that I have missed out some sectors, but that gives you an idea of who is involved. They have been developing joined-up working, local needs assessments and local action plans. The partnership agreed that there was a need for a co-ordinator to help implement the action plan. I was employed as the Northern Board’s suicide prevention co-ordinator in March 2007, and the review of public administration (RPA) means that I am working on a temporary contract until September 2008. I am the only co-ordinator in the Northern Board area.
I have played a leading role in the development of the local action plan through local partnerships, developed effective communication with the partners and researched models of evidence-based effective practice for guidance on suicide-prevention initiatives in the local communities. I have also co-ordinated relevant training on, for example, ASIST — the applied suicide intervention skills training — and recently, with the Northern Board’s drugs and alcohol co-ordination team, I co-developed training to meet gaps in drugs and alcohol-related abuse-prevention training. That programme is called DASH — drugs, alcohol, suicide and self-harm prevention practitioner training. I am also involved in other strategies.
The suicide-prevention and promoting mental-health action plans 2007-08 were finalised in May 2007 through consultation with local communities. In July 2007, open advertisements were placed in the local and regional press to attract funding applications to implement those action plans. A funding-assessment panel that comprised cross-sector representatives met for five days to assess the bids that were received.
I have selected five examples to demonstrate how much of the work that has contributed to the Northern Board’s achievements, particularly that which concerned community involvement, is continuing into 2008-09. Through the Northern Board’s community small grants scheme, the board allocated funding for each council area via 10 community networks that cover all the Northern Board areas. That amounted to £220,000. Those networks have links to many and diverse local youth and community groups in every community in the Northern Board, and they involve a lot of rural outreach work. The small grants scheme promotes suicide-prevention and mental-health initiatives in the local community.
The Northern Board’s ongoing public-awareness campaign has been effective in engaging communities, of which seven have been involved so far. It is led by the community networks on our subgroup and by me. It is open to people of all ages from all communities in the Northern Board, and it aims to provide communities with information on local and regional support. Furthermore, it aims to reduce the stigma that is attached to seeking help, encourage local community actions, promote small grant schemes, provide support for the bereaved, and highlight the local and regional developments that have been made in suicide-prevention schemes.
Community networks such as Coleraine rural and urban network (CRUN), south Antrim rural network (SARN) and Newtownabbey community voice have come together to co-ordinate two suicide-prevention conferences, which will be held in March and April. They will target people from the Northern Board areas. The south Antrim rural network, in tandem with the Northern Investing for Health partnership and the Northern Board, has been taking the lead on a successful funding application to the Big Lottery Fund’s Safe and Well funding. Money received from that will be used to consider the feasibility of developing community-support hubs in areas across the Northern Board. That will provide community ownership and capacity building in order to reduce the extent of mental-health issues in local communities.
I am also proud of an inter-church day that we organised on suicide and self-harm. More than 100 inter-church and inter-faith people turned up for what proved to be an informative day. Through evaluation, we have agreed to make that an annual event and develop work that arises from that.
Ms Melanie McClements (Southern Health and Social Care Trust):
I am assistant director of promoting well-being in the Southern Health and Social Care Trust. I have responsibility for community development, health improvement and the work of the health action zone.
The Southern Health and Social Services Board is tasked with leading the implementation of the Protect Life strategy in the southern area. To date, the work of its strategy steering group has included the commissioning of two pieces of research to identify needs and develop primary-care staff training. It has also been involved in campaigns that encourage the disposal of unused medicines, and it has established a community engagement forum, and commissioned services from the trust and its partnerships.
To complement that approach, the Southern Health and Social Care Trust, led by its director of mental-health services, has identified suicide and self-harm as priorities on which action must be taken. Several consultation meetings have been held, which has led to the establishment of a Protect Life implementation group. That group is chaired by the trust and comprises 40 partners from the community, voluntary and statutory sectors.
A joint action plan has been developed, reflecting the priorities of the regional strategy and the requirements of our local communities. To inform the work, all partners have implemented a common needs-assessment framework that considers prevention, intervention and postvention of suicide and self-harm.
The Southern Health and Social Services Board was allocated £406,000 in 2007-08 from the Protect Life strategy, £232,000 of which was allocated non-recurrently to the Southern Health and Social Care Trust to support the work of the inter-agency group. Of that, 15% was allocated to trust-based work and 85% to the community and voluntary sector.
Implementation of the action plan has resulted in: the appointment of two community-development workers to work in local communities — one with the Niamh Louise Foundation, and one with PIPS Newry and Mourne; seven local community resource centres to provide drop-in facilities, assessment and signposting to a range of supportive services and health programmes; increased counselling provision and post-bereavement support; a multi-agency awareness-raising and training programme; local databases to facilitate self-help and access to services; and a cross-border suicide conference to showcase best practice and the support that is available in local communities.
Mentoring programmes are being developed to target the requirements of at-risk young people, and initial groundwork has been done to develop effective inter-agency protocols. We have also been given the opportunity to participate in an international research project on self-harm and suicide prevention. That project aims to influence future service shape and design.
The focus in the Southern Health and Social Care Trust area has been to establish a strong needs-led approach with an emphasis on inter-sectoral and partnership approaches.
Mr Pat McGreevy (South Eastern Health and Social Care Trust):
I am one of the suicide-awareness co-ordinators in the South Eastern Health and Social Care Trust, but I am here to represent the Eastern Health and Social Services Board. The Eastern Board has two trusts — the South Eastern Health and Social Care Trust and the Belfast Health and Social Care Trust, which have a combined population of 660,000.
Before those trusts were established, community of interest groups were set up in south and east Belfast and Castlereagh, north Down and Ards, north and west Belfast, and Down and Lisburn. Those groups bring together community, voluntary and statutory partners to plan, agree priorities and decide how strategy moneys should be invested. To date, 120 groups and organisations are represented in the community of interest groups. The model is bottom-up and ensures that there are local decision-making processes to direct and shape investment and service delivery.
The Eastern Board has also established a suicide-strategy implementation group to enhance co-ordination in the board area, exploit the benefits of joined-up service delivery and report to the suicide-strategy implementation body. Several themes have emerged from the work of the Eastern Board, including: support for bereaved families; raising awareness; education and training; counselling services; mentoring services; support for those who are at risk; complementary therapies; and greater co-ordination throughout the board area.
Funding for the four communities of interest groups comes from the Investing for Health strategy. Those groups decide collectively what the priorities are for that money, and they then commission services and implement a service-level agreement approach to fund the schemes that are chosen. Partners and groups in a community of interest group can bid against project-development moneys to explore and meet previously unmet requirements.
I will highlight four of the main achievements in the Eastern Board area. First, the applied suicide-intervention skills training began in the Eastern Board area through the work of the former Down Lisburn Health and Social Services Trust, and there are now 170 trainers across the region. The next training for them begins in two weeks. Two candidates from south Wales will be joining us, given the situation in that area.
We are pleased to be building on the training that is available for families who have been bereaved by suicide and for people who facilitate support groups on their behalf. Therefore, we are pleased that Dr Frank Campbell from Baton Rouge in the United States will attend the next stage of that training next month.
We have noticed that some young people who are at risk do not engage well with mental-health services. There is therefore a need to expand floating support for those young people. That support has proved successful in helping the young men, in particular, and young women who are at risk. Indeed, it has saved lives potentially. We now have a better and quicker response to families who are bereaved and affected by suicide so that we can provide them with a timely and more accessible service.
Mr Brendan Bonner (Western Health and Social Services Board):
I am the Investing for Health manager in the Western Board area, and I have responsibility for community development and all aspects of health improvement.
When the draft strategy was launched, we immediately started a public consultation process, to which over 108 organisations and individuals responded. The key developments that they wanted to see were: greater integration in the community and statutory organisations; more intensive support for people who have been bereaved by suicide; support for the most vulnerable, particularly young people and people with mental-health problems; better links with other strategies and initiatives beyond suicide prevention; more accurate information about what is happening; quicker response times to any issues that have been raised; improved access to services; and greater user and service involvement. In response, we immediately set up the Western Suicide Strategy Implementation Group (WSSIG). The group has 14 members, seven of whom are from the statutory sector and five of whom are from the community and voluntary sector and two from families. It has two co-chairs, one from the statutory sector and one from the non-statutory sector. The group nominates representatives to the families’ forum and the suicide strategy implementation group, and it makes recommendations on funding.
Initially, we agreed to focus on non-recurrent funding to address the immediate priorities of pilot projects, information, data issues and community grants. It was later agreed that it was time to adopt a long-term strategy that was about a redesign of the whole service, not only in the statutory sector, but in the community and voluntary sector. That redesign includes several initiatives. A new pilot initiative with the PSNI on the reporting of suspected suicides is in place. We have redesigned the roles of the suicide awareness co-ordinators to provide intense, immediate support for families and communities.
We have developed a community response plan, which is being implemented in all the councils, to deal with potential cluster suicides. We have created the new post of strategy-link officer, whose job is to link not only strategies in health and social care, but initiatives such as neighbourhood renewal and extended schools. We have given recurrent funding to Foyle Search and Rescue Service, which is a voluntary organisation that works in the north-west along the River Foyle. We have a training and development programme, the particular priorities of which are the applied suicide-intervention skills training, mental-health first aid and safeTALK training programmes.
Two new posts have been created to deal specifically with self-harm in accordance with National Institute for Health and Clinical Excellence (NICE) guidelines. We are about to sign a contract for a new integrated community delivery project in the community sector to support the networking and delivery of services for community and voluntary organisations. Some of the young people who are involved developed a youth-support programme that identifies a number of priorities that they wish to have addressed. We have introduced intensive support for quicker access to counselling for families who have been bereaved by suicide. One project in particular considers the relationship between mental health and debt. We are also committed to the ongoing monitoring and evaluation of all initiatives.
We are involved in four other initiatives. A pilot mentoring project is being delivered by Zest, which is a community and voluntary organisation. We are involved in a cross-border initiative on the recording of self-harm. We support the review of child and adolescent mental-health services (CAMHS) and the implementation of the recommendations of the Bamford Review. We are involved in ensuring that the mental-health promotion strategy is closely aligned with the suicide-prevention strategy.
On behalf of the boards, I thank the Committee, and we are happy to take questions.
Thank you for those interesting presentations; the list of members who wish to ask questions is growing.
Do the boards and trusts have any facilities to deal with a young person who presents at an accident and emergency department and is anxious, stressed and talking about suicide? Would they be sent away with a card to say that they will get an appointment for a consultation, or would something be done at the accident and emergency unit?
In the first instance, they would be triaged by staff in the casualty department. If it is clear that they are at risk, or are having suicidal thoughts, they are offered a mental-health or a psychosocial assessment from mental-health services. There is a daytime service, and most places have an out-of-hours service to ensure that people are seen. Depending on their assessment, they may be admitted, offered an urgent psychiatric appointment, or some type of follow-up. That is the system in most areas.
The situation would depend on the condition of the young person when they arrive. If he or she has consumed alcohol or taken drugs, we would have to wait until they are in a condition that allows us to be able to talk to them.
One of our concerns — particularly in the Western Health and Social Services Board area — is that around 950 admissions to acute services present with self-harm. That is a huge demand on staff resources, and that is one of the reasons that we have created those two new posts to deal with self-harm. We can ensure that, once a person is discharged, follow-up is available. That follow-up is available not just from the statutory sector; we can also ensure that the community and voluntary sector is tied into the process.
It seems as though a great deal of good work is going on. One of the witnesses mentioned the seven drop-in centres. When the Committee was in Dublin, it visited a centre that is similar to a drop-in centre. That centre is doing a lot of good work. Are centres such as that specifically for people who are threatening suicide? Do the board areas have similar facilities? The Committee was excited about the instrumental work going on in Dublin, and we would like to see something similar introduced in Northern Ireland.
Speaking as a member of the public, I do not see any evidence on the ground of the work that you are doing. How is the stigma being broken down, and how is your message being put across to the general public? I am referring not just to community groups, but to groups right across the board. Everyone is affected.
When the Committee visited the Everton Complex in north Belfast, some of the community groups that we met complained about the lack of a joined-up approach, sharing views and accessing information. They also spoke about longer-term funding and about the problems of being funded on a year-to-year basis only. How are those issues being addressed?
I will answer the first part of the question about resource centres. Predominantly, we want resource centres to be available for self-referral; if someone wants help, they should feel that they can open the door and, hopefully, be empowered and proactive enough to access that service themselves. However, we also want the range of partners with which we work — not just those in the statutory sector —to recognise those centres as a resource into which they can signpost people. We also hope to build a range of statutory services into the resource centre so that it operates as an outreach model. We have the potential to further introduce a range of other services, such as a parenting-support programme or a counselling service.
The board commissioners asked us to pilot one such centre in the southern area. However, when we engaged with the community and voluntary sector partners, they were not happy about piloting just one centre. They pointed out that if a centre were to be piloted in Kilkeel, someone from as far away as Armagh might need help. We felt that we needed to go for an equitable approach across the area, which is why we have gone down that route. The process is in its first year, and we are aware that the seven centres are at different stages of going live. However, there is a commonality in services; for example, the meet-and greet-facilities, drop-in services, someone skilled to assess a person’s needs and to see whether onward referral is needed, and the facility to make the range of support programmes fully available to the person in question. It is an exciting development that has potential.
We have a range of public relations campaigns that involve more than just sending messages to groups. They can involve live work with the media and working in harmony with our partners. If some of our partners have information relating to mental health or suicide prevention, we will work in a joined-up way to get that across. Partnership and non-recurring funding are important issues for us; in order to build credibility and commitment, especially from community and voluntary sector partners, the money needs to be released to trusts recurrently so that we can build sustainable resources.
In the Eastern Health and Social Services Board area, families bereaved by suicide saw a need to open drop-in centres. People at risk of suicide and people who were worried about someone at risk of suicide focused on those centres. The Eastern Board has supported and funded Reaching Across to Reduce your Risk of Suicide and Self-Harm (RAYS) on the Shankill Road, PIPS in north Belfast, and the suicide awareness and support group. Although the centres were set up primarily to consider families bereaved by suicide, they are also examining prevention, awareness raising, intervening with people at risk and looking after families that have been bereaved and affected by suicide; all those measures are supported by the board.
Unlike Scotland and the Republic, we do not have a designated suicide prevention office to get the message out. However, perhaps the suicide strategy implementation body (SSIB) will consider that matter. There is no central focal point that can be visited or accessed by people who want to find out about suicide prevention.
Drop-in centres may work very well in an urban setting. In the Western Board area, however, we have a huge problem with rural issues and suicides. One cannot, therefore, have drop-in centres, which makes things difficult. However, the board is working with organisations that provide that type of support — for example, an organisation in Derry called Zest: Healing the Hurt and other organisations such as Foyle Search and Rescue, which is not a drop-in centre, but its personnel walk the banks of the Foyle.
We met representatives from Foyle Search and Rescue and were very impressed with what they do.
It is more to do with outreach, which is an alternative to a drop-in centre. Regarding publicity, we had a series of bus campaigns — Don’t Drown Your Sorrows — and the current campaign, Listen. We also had a television advertisement campaign — If Your Head’s Away, Just Say. There has been a series of articles in the press advising people where they should go for support when they need it, and we are working with councils to make local representatives aware of what services are available. We agree with the joined-up process, which is why we are about to sign the contract on the integrated community development project.
Recurrent funding is a big issue. When this new money became available, the first message that we were given was that it was not to be used to fund services that already existed; it was for new initiatives. Immediately, there was a challenge: existing organisations were delivering excellent services, but we could not fund them from this new money. Therefore, we have tried to be innovative and get them to collaborate through the integrated community development project.
To be honest, the Northern Board is a bit behind in bereavement support. However, in relation to support centres and self-help issues, there is a massive gap in bereavement services in the Northern Board area, which is extremely rural. A community development worker will soon be employed for three years through the Northern Health and Social Care Trust to work with communities across the region to establish bereavement support facilities.
In addition, the community networks have made a grant application to the Big Lottery Fund’s Safe and Well programme. Across the Northern Board, the networks target a range of small rural areas that cannot always be reached by services. Even I, for example, cannot get out to every area on every occasion. The networks are a perfect way to get the word out. They can work not only with constituted groups but with the general public. The networks decided to make the grant application in partnership, because, in order to be successful, it needed to be a statutory, community and voluntary sector partnership. The support hubs are not only for people who are affected by suicide or self-harm but they will try to redress the issues that might lead people to such a situation — for example, financial or relationship crises. People will know who to approach locally.
Lack of transport is another problem; people cannot travel to the bigger towns such as Ballymena and Antrim where the services are based.
The community networks have been fantastic in getting the word out. If it had not been for their taking a lead on many issues, much work in the past year would not have been done so quickly. The community networks and I led on the public-awareness campaign, which has been open to all. We advertised in all the local chronicles, church bulletins and newsletters, and flyers were put through letter boxes.
On average, 50 to70 people turn up at meetings. In areas such as mid-Ulster, where the suicide rate is higher, we had large attendances. The good thing about opening it up to all is that we can emphasise that it is not a “them and us” situation: even people who work in statutory services can be affected by suicide at any time. We have been trying to get the message across that, if people live or work in the Northern Board area, they are a part of the community.
The general structure of the meetings is as follows. I talk about the overall picture of the Protect Life strategy and about everything that is happening locally in order to keep people up to date with that. People from the Samaritans talk about general suicide awareness in the local community. PIPS has participated in every awareness night that we have held. Its representatives emphasise that the community can come together to develop something in its own area: it does not have to wait for ages to get money to organise. PIPS started from a couple of concerned people.
After the meeting, people can mingle and get information on support services. I bring along a lot of information about statutory and voluntary organisations that can help the local community. We have had present: bereaved people; people who have been through the psychiatric services; and local district council representatives, who can help to get something up and running in the local community. Statutory services sometimes turn up, as do voluntary sector organisations such as Contact Youth and Aware Defeat Depression, which can provide some support. It is a large area, but so far, so good.
Ms Ní Chuilín:
I am keen to find out whether there is a standardised approach to training with the PSNI when suicides occur. More often than not, the PSNI are the first on the scene. Recently, there has been an improvement, but that has not been the experience across the board. Is that within your remit? If so, can you explain that standardised approach?
Can you tell us about the after-hours services in your areas. When Committee members visited the Mater Hospital, we talked about the establishment of an after-hours service on site.
You are correct about rural areas: the rural experience is completely different to the urban one. Rural people should have equal access to services. People should not be excluded because they live in the countryside.
I will answer your question about the PSNI. In the past, the problem was that, when a suicide occurred, most health officials were unaware of it, until the community or — more likely — the press contacted them for a comment.
Therefore, we worked with the PSNI and the Chief Forensic Medical Officer to devise a mechanism whereby, when suicide is suspected, a report is sent to the Western Trust. That report gives details of the location and the methodology. An important element records whether police officers have spoken to the family and whether our services can approach the family to offer support. That report is sent to the trust and is referred to the suicide co-ordinators, who then contact the family.
We can now monitor what happens so that we can pick up quickly on whether clusters are forming. We look for connections: are they known to mental-health services? We are working with the PSNI to ensure that all officers likely to attend the scene of a suicide undertake ASIST training; all forensic medical officers should also undertake ASIST training. The PSNI is also considering whether they can embed safeTALK training and make it available to all officers. At the moment, that is available only in G division in the north-west; we are now rolling it out to F division in the south-west. It has been in operation only since October, so it is too early to try to ascertain how effective it has been. We have noticed, in talking to bereaved families, that early intervention of the available services and a connection with them has been important.
Access to out-of-hours services is still being developed. However, community and voluntary sector organisations have told us that, because of the awareness that has been created, they are getting better access to out-of-hours services and are receiving the support that they need, which had not happened previously. The system is not perfect and much work remains to be done. However, we are committed to pushing that through.
During the most recent ASIST training for trainers course, a PSNI community policewoman joined our team as a trainer. She has since started to do more awareness work in the Police Service and is trying to get the work joined up regionally. Little things like that are happening, which has been very beneficial for links with the police,
I am a youth and community worker and am still learning a lot about the services offered by the Northern Health and Social Services Board. However, I am aware that there is an out-of-hours crisis response service in Antrim that deals with self-harm and suicide. We will soon link up closely with the mental-health management team to try to bridge the gap between its work and development work in the Northern Board area, because that team connects with many bereaved people. It is possible to see trends in certain areas and age groups, so a subgroup will shortly be set up; meetings have already been held to arrange that.
Working with the police is crucial because, being the first on the scene, their attitude can affect a bereaved family and how they feel about help, and hope, in general. If a family experience an insensitive reaction from those first responders, it can put them off seeking help at all, so it is crucial that the police are aware of, and sensitive to, the needs of families.
A couple of initiatives are already in place in the Eastern Board area. We have developed a training programme for police officers that raises awareness about suicide, considers what can be done to intervene with people at risk and also deals with the issue of responding to bereaved families in a sensitive manner. Many reports state that police officers are sensitive in most cases. However, there can still be thoughtless comments that can have a long-lasting effect — hence the training for police in the Eastern Board area.
After the spate of suicides among young people last summer in the Southern Trust areas of Mullavilly and Tandragee — of which I am sure you are aware — PSNI engagement with the Southern Health and Social Care Trust was terrific. Something positive that came out of that engagement was not only the need for local training but the idea that we will influence the foundation training for new officers on the necessary skills.
The internal communication processes in the PSNI came to light, because different officers and different divisions did not necessarily communicate with one another, so they have started to work on that. The PSNI is working with us on inter-agency protocols, from the first response, to the media, funeral directors, the PSNI and our own service. It can be difficult to ring a trust and try to talk to the appropriate person. Therefore, we must examine our internal arrangements and consider how people access our service and get to the right person, so that has been beneficial. The PSNI has also been involved in community schemes — for example, schemes such as midnight football, which provide a diversion for young people, have been terrific. The PSNI involvement has been positive.
Our crisis response teams work out of hours, and we have also been working on a self-harm pathway to consider people receiving immediate responses within the first 24 hours or the first three days, depending on their level of need. The value of the partnership and the resource centres is important, because we have a mixed economy, and can examine the skills in different sectors. Therefore, we are able to tell people who are living in a rural community that, although they might not be able to access their local A&E department, there is a service in their local community — through the voluntary and community sector or the statutory services — that we hope they can connect with.
The South Eastern Health and Social Care Trust is working on a document that we hope to leave with families that have been bereaved by suicide. It will outline the role of all the people who will respond to them, from the ambulance paramedics to the police, their GP and the clergy. The family will therefore know what those people do and what they can expect from those services.
I welcome Gabrielle, Melanie and the two gentlemen whom I already know, Pat and Brendan. One of you mentioned suicide clusters; I have been reading that another two young boys who attended a school in County Mayo have committed suicide, eight days apart. My thoughts are: here we go again.
In the coming days, another family will bury a daughter in County Tyrone following a terrible car accident. I have been working as a doctor for 27 years, and every death is tragic and devastating. However, if I had to select a worst cause of death, it would be suicide, because of the devastation it brings and the work that it requires of doctors. I mean no disrespect in saying that, and you all mentioned how everyone must work with the devastated bereaved families.
My main interest is prevention. As I have said to other members of the Committee, young people are taking their lives before doctors, relatives and friends even know that there is a problem. The first we hear is that they are dead. Those young people experience a vulnerable period of a week, or perhaps even a couple of days. If, during that time, they can be persuaded to contact someone who can talk them through that difficult period and follow-up therapy can be provided, if required, that must be the way forward.
Melanie, you talked about drop-in centres. How qualified are the staff? Brendan rightly said that there is a difficulty with locating drop-in centres in rural areas. However, that should not exclude access to support, and I know that he was not suggesting that it should. The Committee has talked about how every child knows about ChildLine. We need a catchy phrase so that people know who to phone for help. There must also be the facility for immediate, direct referral, not only by medical staff, police and accident and emergency departments but by friends, spouses and girlfriends, who can phone and get immediate help for the individual concerned.
Brendan, you told the media that you have informed people of where they need to go for help. To what places did you advise them to go? To repeat my colleague’s words, last week the Committee was highly impressed when it visited the Pieta House facility in Lucan. It provides exactly the service that I outlined, although it is not yet available 24 hours a day. It provides direct, immediate access to services and the facility of self-referral to help people through that extremely vulnerable period. Staff there told us that 1,100 people have used the facility in the past two years, and, as far as I know, not one of them went on to take his or her life or to self-harm. That is staggering. If our Health Service were to match that achievement, we would be extremely proud.
I used to work as an out-of-hours doctor, but I can no longer do so because I have to run about all over the place. However, during that time, out-of-hours doctors were accompanied by a community psychiatric nurse — not throughout the night but at least a specialist health professional was available. Perhaps we should consider that option, because there must be immediate, direct referral to prevent the suicide of people who never become clinically depressed but simply experience an event in life that to them was a crisis. To the rest of us, it may be nothing more than a life event, and someone could talk them through it.
As over 70% of people who take their lives are not known to mental-health services, your point is correct. Last year, in response to a suicide by a relative of mine, we took a particular course of action. He had been involved in a sports club, so we went there, through the community and voluntary sector, and we worked with the coaches and parents to persuade them to talk to the young people. They identified five serious cases, and one parent went on to prevent a suicide.
It is a matter of local intervention and encouraging those who work with, and are trusted by, young people to talk to and listen to them. We want that strategy to be rolled out more widely, particularly the safeTALK programme, which is a good example that can be adapted and to which people respond well.
I agree that there must be immediate support available when people need it, particularly for those with mental-health problems and their families, because the carers are also at risk and require support. A regional helpline is due to be launched, although there is much debate about it being rolled out before it has been evaluated, but at least it will be a service that people can contact.
Is that helpline for Northern Ireland?
People seem to forget that the Samaritans is open 24/7. I attended a public meeting in Strabane recently, and a woman there said that there was nowhere for people to telephone in a crisis. When I mentioned the Samaritans, she said that she had forgotten about it. Yet, its reputation and the service that it provides are excellent.
There was a question about the information that we provide in the media. A list of all available services in the community and voluntary sector appears in all the media in the Western Health and Social Services Board area. If someone has a relationship problem, they can contact Relate, or, if they have a drugs or alcohol problem, they can contact the drugs and alcohol intervention education and referral team (DIVERT) or SOLACE.
One of the greatest problems is that the list of organisations can take up a full page in the newspaper; therefore, we are trying to create an integrated approach to reduce the amount of telephone numbers. There are so many organisations out there, and our concern is that every time there is an unfortunate loss of life through suicide, the families affected respond by setting up another project. We must work with those families not to create new projects but to get various initiatives working together. That is vital.
I will take up the points about suicide prevention and the media. The ASIST programme is a vital prevention programme. If someone has a heart attack, there are people trained in cardiopulmonary resuscitation (CPR) to help them; the ASIST programme provides a similar service for those who are contemplating suicide. People are trained in the statutory, voluntary and community sectors to recognise signs of distress that may be a warning signal that a person is having suicidal thoughts. Youth club leaders, teachers, bus drivers and the police have all been trained, and that training is continuing to spread. Those people are not therapists; they are first-aiders in suicide. The ASIST programme has been running for five years, and we must keep rolling it out.
The Health Promotion Agency runs a public information campaign, which is a slow-release campaign. We hope that we will soon be able to tackle the issue of suicide and the myths surrounding it. For instance, some people think that talking about suicide puts the idea into people’s heads. Therefore, it is vital that we explode some of those myths through a media campaign.
Dr Deeny enquired about resource centres. They are staffed by a range of paid and volunteer staff in the voluntary and community sector, and they manage the seven resource centres. When we were standardising those centres, we were careful to ensure that the person who meets and greets people has, for example, suicide-awareness/first-aid ASIST skills. Therefore, that is built into the training programme so that the first point of contact can offer some sort of service. We have worked hard to create a locality database for a wide range of issues, including financial, mental-health and relationship issues. Therefore, we can maximise the opportunities that are out there rather than always feeling that we have to recreate new services, which is a big link into signposting. I hope that a regional helpline with a catchy telephone number will also highlight immediate points of contact for people.
The assessment by the psychiatric nurses in our out-of-hours crisis response team is essential. We need to provide services for people outside the 9-to-5 window for that initial assessment and onward referral. Furthermore, there is a healthy living centre in Banbridge, which, according to the 2005 figures, was the area with the highest suicide rate in Northern Ireland. However, that may not be the case any more. A co-funded project among the business community, the GPs, the trust and some of the Protect Life funding examined a service for people at risk in that local healthy living centre. There have now been 150 referrals from GPs to that project. Therefore, there is some value in that pilot project. We know that 80% of people who die by suicide have visited their GP in the past six months, and 36% of them have visited their GP in the past month, not always with a mental-health-related issue. However, we must maximise that critical link between the GP and the community and primary-care fields.
You mentioned the model in the South, but I would like to find out more about the Maytree Respite Centre in Finsbury Park, London. It is a community house that offers four nights’ respite for people in a crisis. It is a self-referral centre. I heard about that model at the International Conference on Suicide Prevention in Killarney, and it involves an inter-agency committee. The centre is in a terraced house with gardens, and it offers people a place to stay and basically escape from life for four days. The training that the volunteers receive is similar to that received by those who work in the Samaritans and with the helping skills model, but staff can also give people information on where to access help after they leave. A mother or father can refer their son or daughter to the centre, or people can refer themselves. The centre provides the proper assessment under psychiatric care. If people have been involved with mental-health services, they would need to go back to those services. The centre knows that it cannot take anybody and everybody, and it is a small model, but one that the Committee might be interested in considering. I have not got round to examining it properly yet, but I would like to do so.
On a personal note, the frustrating aspect of working on suicide prevention is that many funding decisions are made on the basis of statistics, and, as everybody knows, those statistics are not definite. There can be a delay in getting definite statistics on suicide — as definite as statistics can be. By the time those statistics are available, the decisions have been made on how much money goes to each area. The money is put in only when the problem gets so big that it can no longer be ignored. However, that approach is more reactionary than preventative. We should be given the money to introduce preventative measures so that the problems can be dealt with before they escalate. For example, I heard yesterday that suicide rates in the south Antrim and mid-Ulster areas are now above the Northern Ireland average, whereas two months ago I was told that the rates were below the average and that there would be no additional in-year funding. Now, however, we might get that funding. Thus, we are given the money because the problem has escalated. In my opinion, that is a problem with any issue in Northern Ireland.
Thank you for outlining the good work that the trusts and boards are carrying out. You all mentioned the resources that are drawn down, particularly for community initiatives — healthy living centres and such like. I often hear how those kinds of agencies have difficulty because of short-term funding arrangements. Does that create difficulties for the trusts and boards? It must be frustrating, because it is important to build trust and develop relationships with those at risk. Those funding arrangements lead to a high staff turnover, and everybody, including the person at risk, is set back as a consequence.
We now have a strategy with recurrent resource, but we are still being issued non-recurrent resource to trust level. That is an issue in our work to build relationships with the community and voluntary sector. Short-term posts are less of a risk for statutory agencies, because, as a bigger organisation, they can carry that risk. However, a small community group in the voluntary sector cannot take those risks. They must have some form of sustainability.
There is a grey area in that we do not have a solution to suicide and self-harm. We must grow our own local evidence, but to do so involves investing and taking risks. If we opt for permanency and it does not work out, that creates many issues. We need small windows of opportunity to enable us to develop innovative practice, but we really must have recurrent funding. Commitment and vulnerability are big factors, especially for the community and voluntary sectors so we must be able to give some sort of longer-term sustainability.
That is a problem for all aspects of health issues, not just suicide. One of our initiatives has three-year funding, and that allows us to commit for three years but also to tie in a robust monitoring and evaluation. That arrangement will help us to decide how that project evolves, so the relationship can be worked on. It is a three-year funding programme with options to develop either an exit strategy or a focus on sustainability. Therefore, we can be open-minded about that programme.
At the end of January, the Minister announced the introduction of a regional 24/7 helpline. Are co-ordinators aware that that helpline has been introduced? If so, do you think that they can quote the number?
It is 0800 0808 0880
Is it 0800 800 8000?
That seems to prove our point. Given that the pilot exercise is ongoing, the Committee felt that the helpline was introduced prematurely. None of the Committee members could have quoted the correct number either, so you are not alone.
Perhaps the Health Promotion Agency for Northern Ireland (HPA) could be tasked with promoting and publicising the helpline as part of its strategy.
There is also talk that the number may be changed to comprise three digits, making it like 999.
The pilot will prove useful when it is finalised and implemented. The creation of a booklet that can be distributed to every home seems logical. None of us know what is behind a face, even in our own households. Sometimes we do not know what our children are thinking. They cover up bullying and peer pressure, or they are picked on because there is a stigma attached to not wearing designer clothes, for example. Therefore, a booklet containing all the appropriate numbers should be sent to every household, thus allowing easier access to the proper services — when they are established — across Northern Ireland.
I thank all of you sincerely for attending. You have been a great help to the Committee, and I wish you a safe journey home.