1. Priority Groups for Choose Life Overview

2. Children (especially looked after children): Deaths of children aged 0-14: < 5 per year (GROS) Highest in males No discernable increase / decrease BUT child suicide is mercifully rare

3. Deaths of looked after children (SWIA) Deaths of looked after children (SWIA): 2006-07: Seven children aged 13-16 died of intentional self harm / undetermined intent – all but one were boys Some of the children were living at home, other were in residential units Most had self harmed in the past and the majority of the reports received did not specifically discuss the risk assessment or management process for the children Many of the children in this group had long histories of disrupted care, patterns of alcohol and substance misuse amongst parents and relatives and other family members who had died through violence or suicide.

4. Young People (especially young men) Young People (especially young men): Deaths of young people 15-19: between 28 –42 persons per year (average 35 ) Most youth suicides are male – ¾ male ratio consistent each year (and replicated almost everywhere else) Significant fall in rate for young men but may be rising again Middle age suicide appears to be the dominant age group 70% of male suicides are by hanging – strong association with more lethal means Males less likely to seek help until crisis time

5. People with mental health problems: Across all age groups, genders and in a wide range of geographical locations Several diagnoses of mental illness, including affective disorders, schizophrenia, personality disorders and childhood disorders, and a history of psychiatric treatment in general have been established as risk factors for completed suicide. In schizophrenia and borderline personality disorder suicide risk appears to be elevated around the time of first diagnosis.

6. For bipolar disorder and schizophrenia the elevated risk of suicide is further exacerbated by other risk factors, such as a history of suicide attempts, other psychiatric diagnoses, drug or alcohol misuse, anxiety, recent bereavement, severity of symptoms and hopelessness NCI – high suicide rate after discharge and missed first appointment in community Falling rate of inpatient suicides due to improved safety procedures

7. People who attempt suicide: Those who self-harm have a much greater risk of dying by suicide compared with those who do not engage in this behaviour Association with family history of suicide and many other risk factors Those (hospital in-patients) with a history of severe self harm are at significantly higher risk of suicide (Hawton) Wider social and other factors are not well understood i.e. life crisis Date on hospital admissions patchy but could serve as a proxy indicator (rec from Phase One evaluation)

8. People affected by the aftermath of suicidal behaviour or completed suicide (and people who are recently bereaved) Family history of suicide appears a significant risk factor Clustering of suicides can raise risk for some people Media reporting is a risk and protective factor – explicit reporting of means can lead to contagion effect Lack of support services in the aftermath of suicide for some people i.e. remote and rural

9. People who abuse substances: Substance misuse increases the risk of suicide attempt and death by suicide 23% of drug related deaths are suicide / undetermined – drd’s are rising steeply (574 in 2008). Poly drug use is a significant factor Possible ‘cohort’ effect associated with increased death in middle aged males The risk associated with opioid use (disorders) and mixed intravenous drug use is greater than that for alcohol misuse Alcohol a significant risk factor in: a) population suicide and b) those with alcohol dependency The risk of suicide from alcohol misuse is greater among women than among men

10. People in prison: Prison suicides have decreased via Act 2 Care and other safety procedures Increased risk post release may be a factor for some (as in drug related deaths) SPS keeping a watching brief on prison suicides

11. Other Groups: People who have recently lost employment / unemployed:People who have recently lost employment / unemployed: Unemployment is linked to elevated risk of suicide People in isolated or rural communities:People in isolated or rural communities: Highest proportional mortality rates for suicide are found in medical doctors and farmers, with female doctors having a higher risk of suicide than male doctors – access to means may be a significant factor

12. People who are homeless: People who are homeless: Higher risk for homeless people due to poor physical and mental health, substance misuse / dependency and other risk factors LGBT: LGBT: High risk group due to sexual orientation and other factors Women: Women: No discernable increase but ¼ of all suicides are female – rise in older women and BME women from Indian / Asian background

13. BME BME :Asylum seekers / isolation / language barriers and increased mental illness for some Older people: No discernable rise but suicides of 50+ age group represents 32% of all suicides in the last 5 years. Older male suicides may be associated with alcohol dependency. Older people tend to opt for more lethal means with far fewer attempted suicides compared to younger people

14. Poverty / Inequalities: Not a priority group as such but poverty and deprivation are linked to suicide risk at an ecological (area) level. Areas with greater levels of socio-economic disadvantage (lower SES) have higher suicide rates Higher concentration of risk factors in areas of deprivation and for lower socio-economic groups?

15. Lastly: People who are not involved or in contact with helping services (NCI 2/3 not in contact with MH services in the year before death) Risk factors are multiple – including risk times for some i.e. first diagnosis, recovery from drug / alcohol dependency; loss of child custody, etc Anyone can be at risk of suicide – priority groups are limited in their ability to identify and target those at most risk Suicide Register may help illuminate other factors