Promoting improvement in the quality of health and social care

Local action planning in mental health:

Using NCISH recommendations to help improve care

Dr. Kirsten WindfuhrSenior Project Manager

Professor Nav Kapur Professor of Psychiatry and Population Health &

Head of Suicide Research

www.hqip.org.uk

Outline

•What do we do?

•What works?

Collecting the data

All potential cases nationally (suicide and open verdicts from ONS, GRO)

Contact with mentalhealth services

Data collection via questionnaire

Annual Report

Scope

UK England Wales Scotland N. Ireland

Generalpopulation

100,329 78,170 5,475 13,235 3,449

In contact26,216

(26%)

20,300

(26%)

1,260

(23%)

3,705

(28%)

951

(28%)

Timing of last contact with mental health services

18%

32%

22%

13% 14%

0500

10001500200025003000350040004500

< 24 hours 1-7 days 1-4 weeks 5-13 weeks More than 13 weeks

Num

ber o

f pati

ents

What works

1) Focussing on safety in particular settings: o In-patient

•Smaller in-patient bed base•More morbid in-patient population•Falling general suicide rates

•Safety focus: o the environmento absconding

In-patient suicide rates

2.622.28 2.2 2.25

2.03 2.032.24

1.88 1.84 1.92 1.82

1.44

0

1

2

3

4

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

In-p

atien

t rat

e pe

r 100

,000

in

-yea

r bed

day

s

Year of death

In-patient suicide: England 1997/8 – 2007/8

0

20

40

60

80

100

120

Hanging on the ward Suicide after absconding

Freq

uenc

y

1997/98 2007/08

In-patient suicide rates

2.622.28 2.2 2.25

2.03 2.032.24

1.88 1.84 1.92 1.82

1.44

0

1

2

3

4

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

In-p

atien

t rat

e pe

r 100

,000

in

-yea

r bed

day

s

Year of death

In-patient and post-discharge suicide rates

0

1

2

0

1

2

3

4

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Post-discharge rateper 1,000 discharges

In-p

atien

t rat

e per

100

,000

in

-yea

r bed

day

s

Year of death

Patient suicide: weeks following discharge

In-patient suicide and suicide under crisis resolution/home treatment teams (CRHTs)

(Hunt et al Lancet Psychiatry 2014)

What works (or doesn’t)

2) Risk assessment prior to suicide

Assessment of risk prior to suicide

Assessment of risk prior to suicide

Assessment of risk prior to suicide

Risk assessment and management

• Over 80% were rated as at low or no risk at last contact

• In over 1/3 the process of risk assessment was unsatisfactory

• Risk formulation and management plans were the domains most commonly judged to be unsatisfactory

What works

3) National policies and recommendations

•Safety First (2001) 12 Steps to a Safer ServiceoRemoval of ligature pointsoAssertive outreacho24 hour crisis teamo7 day follow-upoNon-complianceoDual diagnosisoCriminal justice information sharingoMulti-disciplinary reviewoTraining in suicide risk management

Questions

• Do mental health services implement policies?

• Do they make a difference?

Do they make a difference

0

2

4

6

8

10

12

14

16

2003 2004 2005 2006

0-6 recommendations 7-9 recommendations

**

*

While et al., 2012; Lancet* = significant difference p<0.05

Do policies make a difference

8

9

10

11

12

13

before after before after before after

Suic

ide

rate

per

10,

000

pati

ents

in

cont

act (

exac

t Poi

sson

95%

CI)

24-hourcrisis team

Multi-disciplinary review

Dual diagnosis policy

While et al., 2012; Lancet

What works

•A new study

o UK wide

o A longer time period

o A wider range of services

Recommendations associated with the largest falls in suicide rates

Outline

•What do we do?

•What works?

What works locally?

• How have NCISH findings or key recommendations impacted on your local services?

• Do you have examples of good practice?

• What has not worked?

• What local mechanisms could be developed to help implement NCISH findings and other relevant work?