AWP Zero Suicide Ambition for 2021 - Progress and update January 2021 Anthony Harrison - Suicide Prevention Lead - Avon and Wiltshire ...
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AWP Zero Suicide
Ambition for 2021
Progress and update
January 2021
Anthony Harrison – Suicide Prevention Lead
Our Zero Suicide
ambition
1. Our partners
10. Learning
and networks
2. Inpatient
9. Families and
suicide
carers
prevention
8. Staff
3. Leadership
competency
4. Community-
7. Environmental
wide suicide
safety
prevention
6. Medicines 5. High risk
safety service users
Our Zero Suicide Ambition We see every life lost to suicide as a tragic and catastrophic event, and our zero suicide ambition is a long-term one. We believe that no suicide death is inevitable and it is this that will help us identify more and more suicide prevention opportunities. Our drive for zero suicides is a long-term ambition and aim, not a performance target. The following summarises our initial ZSA ambitions, our progress during 2020 and individual deliverables against each of the 10 elements of the ZSA.
1. Our partners and networks
What we said we would do:
• We will collaborate and remain actively involved with all local networks and suicide
prevention forums.
• We will support and participate in the work of our local authority public health
partners with community-wide suicide prevention activities.
• We will work with our local universities and further education colleagues to support
their work to improve access for students to mental health care provision, and suicide
prevention activities.
• We will be an active participant in the national Zero Suicide Alliance network.
What we have been doing throughout 2020:
1. We have strengthened existing networks and made new ones over the past year. Examples include contributing to both STP
systems-wide suicide prevention networks:
i) Bristol, South Gloucestershire and North Somerset (BNSSG) – data-sharing and intelligence regarding suspected suicide deaths
across the area, developing ways of measuring our performance against the NCISH Improving safety in mental health services, and
development work on risk assessment for people who have autism.
ii) Bath & North East Somerset, Swindon and Wiltshire (BSW) – collaboration to secure Wave II government funding for suicide
prevention projects in secondary care.
2. Some of the local authority work was scaled back during 2020 as a consequence of COVID-19.
3. Participation in the student mental health network organised by local universities, to ensure appropriate and timely responses
for students experiencing a mental health crisis. Our local operational service managers have input to this forum as a way of
ensuring a timely response to any highlighted areas of concern.
4. Membership of the Zero Suicide Alliance and mandatory completion of their suicide prevention awareness
training for all staff. AWP has joined the National Suicide Prevention Alliance (NSPA) and we look forward to
working with them over the next 12 months.
5. Renewed our licence and promoted our presence on the Stay Alive online and app platform.
Our partners and networks
What we plan to do during 2021:
• We will collaborate and remain actively involved with all local networks and suicide prevention forums.
• We will support and participate in the work of our local authority public health partners with community-wide suicide
prevention activities.
• We will work with our local universities and further education colleagues to support their work to improve access for
students to mental health care provision, and suicide prevention activities.
• We will be an active participant in the national Zero Suicide Alliance network.
2. Inpatient suicide prevention
What we said we would do:
• We will make suicide prevention within inpatient services a priority.
• We will use the NCISH template, Improving Safety in Mental Health Services to guide our
work.
• We will link this with our work to improve environmental safety in inpatient settings.
• We will work hard to improve discharge planning and aftercare, with the focus on
patient safety.
• We will implement a plan to reduce ‘restrictive practices’ and enhance engagement and
therapeutic observation.
What we have been doing throughout 2020:
1. We have developed measures (‘performance metrics’) for four of the ten elements of the NCISH Improving Safety in Mental
Health - out of area admissions, staff turnover, number of ward ligature incident report, percentage of patients receiving face-to-
face follow-up within 72-hours of hospital discharge.
2. Working on developing metrics for the remaining six domains.
3. We have a dedicated ligature reduction group and have developed an incremental plan to address risk ligature risks across our
inpatient estate.
3. Our plans regarding detailed work on aftercare and immediate post-discharge have been delayed due to the need to re-prioritise
services as a result of COVID-19 – this will be carried over to 2021.
4. Working with colleagues and service users in Wiltshire and our secure services to identify some best practice in reducing
restrictive practice and sharing this trust-wide.
5. Finalist in the 2020 Health Service Journal patient safety awards for efforts to reduce restrictive practices within the
Daisy Unit, Wiltshire.
6. Finalist in the 2020 Health Service Journal mental health initiative of the year awards for efforts to reduce
restrictive practices within Bradley Brook Ward, Fromeside (Secure Services).
7. Developing a Reducing Restrictive Practice forum to coordinate the development and oversee the
implementation of quality improvement work in this area.
Inpatient suicide prevention
What we plan to do during 2021:
• Develop metrics and measures to capture the remaining six NCISH safety elements, and incorporate these into our monthly
suicide prevention monitoring framework.
• Establish a short-life working group to review and develop standards regarding discharge planning and immediate post-
discharge care. This will include consideration of whether to reduce the minimum period for face-to-face contact from 72-hours
to 48-hours.
• Further develop the work of the Reducing Restrictive Practice forum and disseminate the information trust-wide.
3. Leadership
What we said we would do:
• Reducing suicides and improving patient safety will always be our number one priority.
• Our suicide prevention work will be led and overseen by our Director of Nursing &
Quality, with input from other executive directors.
• To keep suicide prevention at the heart of our work we will identify a non-executive
director to take on the role of Zero Suicide Champion.
• The Zero Suicide Ambition will be at the centre of all our suicide prevention activity.
• We will produce annual reports on the progress of our suicide prevention work.
What we have been doing throughout 2020:
1. Board-level commitment and sign-up to suicide prevention as one of AWP’s four core priorities.
2. Direct reporting and oversight of suicide prevention activity by the Director of Nursing (DoN). A suicide prevention group reports
to the DoN’s ‘Safe’ governance group.
3. Identification of a non-executive director as a Zero Suicide Champion.
4. We produce quarterly reports as part of our Learning from Deaths report which is scrutinised by the AWP Trust Board.
What we plan to do during 2021:
• Monthly oversight and review at executive level of all suicide prevention work as part of our Safe Sub-
Group.
• Re-establish a dedicated suicide prevention group, to include people with lived experience, which meets
regularly and feeds-in to the Safe Sub-Group.
• Ensure we promote and reinforce the suicide prevention messages as part of our ZSA commitments, both
internally and externally.
• Continue to monitor and analyse suspected suicide deaths that have occurred in people being cared for by
AWP services.
• Share the learning and improvements that are highlighted from our reviews and analysis, and ensure this
informs our wider suicide prevention work.
4. Community-wide suicide
prevention
What we said we would do:
• Reducing suicides and improving patient safety will always be our number one priority.
• Our suicide prevention work will be led and overseen by our Director of Nursing &
Quality, with input from other executive directors.
• To keep suicide prevention at the heart of our work we will identify a non-executive
director to take on the role of Zero Suicide Champion.
• The Zero Suicide Ambition will be at the centre of all our suicide prevention activity.
• We will produce annual reports on the progress of our suicide prevention work.
What we have been doing throughout 2020:
1. We have been very active in our various local authority and STP partners’ suicide prevention groups and networks.
2. Of note is our work with the BNSSG group to develop and share timely intelligence and data regarding suicides and unexpected
deaths.
3. A project to address suicide risk and improved ‘sign-posting’ and support for people with autism – this work is currently on-going.
4. Liaison and collaboration with HM Coroner for Avon to monitor all suicides across the footprint of four local authorities. This
work was suspended in March 2020 due to the impact of the COVID-19 pandemic.
What we plan to do during 2021:
Be an active stakeholder with public health colleagues in developing a local post-vention support service for people
bereaved following a suspected suicide.
Complete our work looking at suicide risk in people with autism and support a roll-out across the AWP footprint
(commencing with BNSSG).
Organise and deliver an online, AWP-wide suicide prevention stakeholder event on 28 April 2021.
5. High-risk service users
What we said we would do:
• We will work hard to ensure that all high-risk service users have their needs assessed
with a focus on suicide risk and suicide prevention.
• We will improve our electronic documentation to ensure it supports the most effective
level of risk assessment.
• We will work to develop and implement a safe and effective care pathway for people
with personality disorder.
• We will develop and improve our guidance and support for staff caring for people with a
history of self-harm.
What we have been doing throughout 2020:
1. Developed and submitted a high-level business case for supporting and implementing a clinical lead for personality disorder
pathway – this was delayed due to our COVID-19 pandemic response priorities.
2. Organised and delivered a one-day conference on providing safe and effective care for people with a personality disorder.
3. Introduced revised and updated electronic documentation with the aim of improving the quality of risk assessment and
management practises by our staff.
4. Sharing and promoting guidance regarding the management of self-harm with our staff.
What we plan to do during 2021:
• Developing further guidance and resources for staff about working with high-risk service users, specifically those
at risk of suicide.
• Implement a quality improvement project with access teams across BSW, which focuses on improving the
engagement and post-assessment support offered to high-risk individuals who do not necessarily meet mental
health service treatment thresholds.
• Re-commence work on securing a treatment and clinical management pathway for people with personality
disorder; this work will be a collaboration with our commissioners and other local stakeholders, who have
already committed to prioritise work in this area.6. Medicines safety
What we said we would do:
• Our medicines safety work plan will be overseen by our Chief Pharmacist.
• We will maintain a Medicines Safety Group, chaired by our Medicines Safety Officer.
• We will develop a medicines safety plan focusing on the ‘high risk’ drugs lithium
carbonate, clozapine, and sodium valproate.
• We will ensure that learning arising from medicines incidents is disseminated and
implemented across all clinical services.
What we have been doing throughout 2020:
1. Regular meeting of the trust-wide Medicines Safety Group. This forum focuses on medication-related incidents and hazards,
as well as identifying learning from these.
2. Some of our plans were delayed due to the impact of COVID-19 pandemic response priorities, as well as the need to replace
our former Medicines Safety Officer (MSO).
3. Medicines safety work plan has been developed and addresses polypharmacy and deprescribing, focusing on antipsychotics,
antidepressants, benzodiazepines and gabapentinoids.
4. AWP a member of the BNSSG systems-wide group addressing the safety of opioids.
5. Publication of internal ‘red top alerts’ regarding risks and learning associated with lithium. carbonate and of dose
What we plan to do during 2021:
• Complete a national POMH audit for clozapine prescribing and monitoring mapped against national standards
and identify QI and practice development work as a result.
• Appoint a new Medicines Safety Officer who will progress our 2020 action of developing and implementing a
review and learning process for all adverse incidents involving lithium, clozapine and sodium valproate.7. Environmental safety
What we said we would do:
• We will continue to monitor and address environmental risks in all inpatient areas.
• We will implement a new approach for assessing ligature risks within our inpatient units.
• We will implement a three-year programme of improvement work to ensure that all
inpatient areas meet new national standards.
What we have been doing throughout 2020:
• Ligature Reduction Group have developed a plan for ligature reduction across the AWP inpatient estate.
• Monitoring of high-risk settings and buildings, including sharing learning and improvements across the inpatient network.
• Implemented a revised environmental and ligature risk assessment tool.
• Ensured annual environmental risk audits are undertaken and relevant improvement plans are implemented, where
appropriate.
• Developed reporting metric for all reported inpatient ligature incidents as part of the suicide prevention dashboard.
What we plan to do during 2021:
• Continual monitoring and assessment of all ligature and other environmental risks within inpatient settings.
• Undertake a detailed review of incident cases and identify key themes and associated learning and
recommendations for improving ligature safety.
• Use the intelligence arising from ligature incident reporting to complete an audit and analysis of a sample of
incidents in order to identify learning in relation to prevention.8. Staff competency
What we said we would do:
• We will review our suicide prevention and risk training and professional development
programmes, ensuring all of them meet the national competencies regarding suicide
prevention.
• We will ensure all staff, in both clinical and non-clinical roles, have completed a
programme of suicide prevention awareness.
What we have been doing throughout 2020:
• Revised and updated our mandatory e-learning module on suicide prevention and risk assessment, specifically so the it
includes:
o Exploration of Joiner’s Interpersonal Theory of Suicide;
o Expanded section on Structured Professional Judgement;
o Identifying and understanding the nature of suicidal thoughts;
o Ensuring family and carers are part of the risk assessment and management process;
o Personal safety planning.
• Moved from face-to-face delivery to online and other methods to maintain team-based suicide prevention and risk
assessment training.
• Included monthly performance monitoring regarding team compliance with mandatory suicide prevention awareness.
• Secured funding from Health Education England (HEE) to develop the role of Advanced Clinical Practice Development
Facilitators (ACPDF) for suicide prevention.Staff competency
What we plan to do during 2021:
• Implement the revised and expanded suicide prevention mandatory e-learning module.
• Monitor and report performance regarding staff compliance with mandatory training as part of our suicide prevention dashboard.
• Develop the role of the ACPDF for suicide prevention in order to provide support, guidance, role modelling, reflection and other
learning for clinical teams.9. Working with families and carers
What we said we would do:
• We will develop a post for someone with lived experience of bereavement by suicide, so
that they can work with us to ensure that the needs of this group are at the centre of all
our suicide prevention activity.
• We will seek participation and input from people who have survived an attempt to end
their life to the review, monitoring and delivery of staff training.
• We will constantly review the support we provide to people who have been bereaved
following suicide.
What we have been doing throughout 2020:
• Appointment of people with lived experience of coping with suicidal thoughts and of bereavement following suicide, to be
part of our Experts by Experience programme.
• Sharing ideas for updated suicide prevention training through local networks.
• Ensuring that the role and needs of family members and carers are a fundamental element of our mandatory suicide
prevention and risk training.
• Participation in local systems discussions regarding the development of:
o A robust and secure alert system for those families bereaved following a suspected suicide;
o Discussing how to progress the development of a postvention suicide response/support service with local stakeholders
and partners.
o Making Families Count have delivered specific workshops for staff across AWP to strengthen the offer from AWP to
bereaved families following a suspected suicide.
• Postvention refers to a systematic and coordinated support programme for people bereaved by suicide.Working with families and carers
What we plan to do during 2021:
• Re-establish a dedicated suicide prevention group which reports to the DoN-led Safe Sub-Group.
• Ensure both experts by experience and service users and carers are included in the membership of the new suicide prevention
group.
• Ensure input from experts by experience into the emerging QI suicide prevention project.
• Take forward the ambition to develop a specific post of family liaison practitioner following suspected suicide – this will now form
part of the upcoming Nursing & Quality Directorate structure review during 2021.10. Learning
What we said we would do:
• We will develop a post for someone with lived experience of bereavement by suicide, so
that they can work with us to ensure that the needs of this group are at the centre of all
our suicide prevention activity.
• We will seek participation and input from people who have survived an attempt to end
their life to the review, monitoring and delivery of staff training.
• We will constantly review the support we provide to people who have been bereaved
following suicide.
What we have been doing throughout 2020:
• Trailed an amended incident investigation template to support quality investigations following a suspected suicide of a service
user – new national serious incident review templates were expected in 2020, but were delayed.
• Developed and implemented a revised Incident Management Policy. The new policy and associated procedures have been
shaped from the learning from consultation with internal and external stakeholders and the NHS Patient Safety Strategy
(2019).
• Reviewed, discussed and disseminated learning arising from reviews of suspected suicides at the AWP-wide Learning From
Experience governance group.
• Consulted with Making Families Count, who contributed as a stakeholder to the development of the new incident policies and
procedures.
• Scoped the role of Family Liaison Officer to support families following bereavement. Work being reviewed by the Director of
Nursing.
What we plan to do during 2021:
• Schedule a further review of our incident policy and associated procedures once the new national Patient Safety
Framework has been launched by NHS England/Improvement.
• Ensure learning forms a key part of the content of our online suicide prevention stakeholder event in April 2021.
• Make as much information regarding suicide and suicide prevention available publically, within the limits of
confidentiality and the need to avoid the inadvertent promotion of suicide.You can also read
