Suicide Prevention – a partnership approach Mark Smith Head of Suicide Prevention and Mental Health

Fundamental Issues Mental Health and Vulnerability Vulnerability and Risk Risk and Consequence –Victimisation –Criminality & criminalisation –Danger to others –Danger to self –Impact on families & communities –Impact on resources –Economic impact –Liability issues

The Rail Network A draw for the vulnerable Transient population Equality Issues (access to services) –Immigration status –Homelessness –Learning difficulties –Alcohol & substance misuse –Race and culture

BTP National Analysis 350 fatalities a year 84% believed to be suicides 41% of deceased had a mental health history 1700 incidents a month which involve mental health issues 2700 incidents of suicidal behaviour per year 680 suicide prevention plans opened in one year Evidence of vulnerable people travelling great distances to attempt suicide and importing demand for services In a 3 month period only 5 out of 11 people involved in suicidal incidents in Camden lived in the Borough London North hotspot area with 30% of suicides & 37% of all related incidents

Suicidal Incidents 01/04/ /03/ incidents 296 suspected suicides 89 injurious attempts 313 non injury attempts or life saving interventions 44 reconnoitring 796 threats with no attempt 630 third party reports 570 Para-suicide events

BTP Approach 2010 new Suicide Prevention Policy and SOP Vulnerability assessment tool & structured suicide prevention plans Public Protection Units & Mental Health Liaison Officers Close working with Rail Industry Partners and the Voluntary sector However barriers to effective working identified - –Unfamiliarity with local Health & Social Care services and structures –Reluctance of many agencies to share information –Lack of medical oversight of police decision making –Differences in local Health and Social Care service provision –Inconsistency in clinical judgements –Detention under S136 often ineffective in reducing risk Need for a new approach to overcome these barriers Need to secure appropriate diversions & free up police officer time

New Partnerships January - BTP & Network Rail (NR) agree a 3 year project to better coordinate activity in relation to Mental Health and Suicide Prevention which includes closer working with Samaritans February - BTP, NR and NHS London agree 3 month funding to provide a pilot joint health and police intervention capability – ‘Operation Partner’ April - NHS England (London) agree further 6 month funding for Operation Partner April - BTP and London Underground agree a 12 month project to join and enhance Operation Partner September - BTP join ‘Street Triage’ programme funded by Department of Health and will seek to re-create Operation Partner outside London

Operation Partner Combined Public Protection Unit BTP operational & analytical resources Supported by Mental Health Professionals Key elements; –Medical operational review of BTP interventions and PIER plans –Support to BTP custody –Outreach interventions & assessments –Fast access to data –Transition from Crisis to Care 689 people reviewed in 2013 – Only 1 later completed suicide on the railway and 1 away from the railway

A New Model Identifying Vulnerability Assessment tool Custody Screening Analysis – people & places Joint Intervention Team Managing Risk Intervention Diversion Situational solutions Providing Care Care Plan Family support Information sharing Escalation process

A life saved – Op Partner 09/03/13 - Male seen acting strangely at station by rail staff 13/03/13 - Male returns – rail staff report to BTP who attend, gain CCTV images & circulate to rail staff 14/03/13 – PPU circulate Image to all local GPs and local police. MHP circulate to all local Mental Health Units 15/03/13 - Male returns - rail staff call BTP who detain him under S136. Suicide note found in subject’s pocket and he tells officers he was going to do it ‘today or tomorrow’ MHP liaised with hospital and after assessment he is further detained MHP have maintained contact with hospital re ongoing treatment and status One life saved – one railway fatality prevented Suicide Prevented at Twyford Railway Stn 15/03/13

Key Benefits Early access to relevant information More informed and robust decision making Support to frontline officers assisting them to access places of safety/services Better outcomes for vulnerable people Savings in police officer/staff time within the PPU Savings in Officer/PCSO time on the front line Defined progression from Crisis to Care Up-skilling of PPU staff Many examples of MHP intervention being invaluable in breaking down organisational boundaries

Life Saving Interventions

Key Issues Funding challenges Transport Health Needs Assessment – transient demand Most people presenting in mental health crisis or with suicidal behaviour are not offenders Commissioning – strategic fit Care Bill requirements for vulnerable adults Concordat commitments S136 improvement plan for London