Health Department

Dear Colleague

SAFETY FIRST - FIVE-YEAR REPORT OF THE NATIONAL CONFIDENTIAL INQUIRY INTO SUICIDE AND HOMICIDE BY PEOPLE WITH MENTAL ILLNESS

Introduction

1 . This letter is to inform Health Boards, NHS Trusts and Social Work Departments about the publication of "Safety First", the five-year report by the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. A summary version of the report is attached. (The Inquiry Team's previous report, "Safer Services" was published in 1999).

2. Safety First was published on 16 March 2001 and was given a limited circulation by the Department of Health and the Inquiry Team. Many of you may, therefore, already have seen a copy of the report and be aware of the Inquiry's findings and recommendations.

Background and Aims

3. The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness was established at the University of Manchester in 1996. It was originally funded by the Department of Health in England. From 1997 additional funding was provided by the Scottish Executive (formerly the Scottish Office), the Welsh Office and the HSS Executive in Northern Ireland.

4. The overall aims of the Inquiry are:

• to collect detailed clinical data on people who die by suicide or commit homicide and who have been in contact with mental health services;
  
  
• to make recommendations on clinical practice and policy that will reduce the risk of suicide and homicide by people under mental health care

24th July 2001

______________________________

Action

5. The Scottish Executive is currently developing, in consultation with local agencies, a National Framework for the Prevention of Suicide and Self-Harm which will aim to further support the development of effective services for, and support of, those at risk of suicide, including people with mental illness. The Confidential Inquiry's findings and recommendations are being fed into the developing Framework.

6. We propose to issue a draft of the Framework for consultation later this year. In the meantime Health Boards, NHS Trusts and Social Work Departments will wish to have regard to the findings and recommendations contained in "Safety First" when developing their procedures for the appropriate care of people with mental health problems. These procedures should sit within the local clinical governance structure in primary care trusts. You are reminded of the Safety Action Notice SAN (SC) 98/49 Suicide Risk from Point of Ligature on Curtain Tracks and Similar Equipment. The Mental Health Reference Group publication Risk Management (2000) (HDL (2000) 16) gives a useful background for service providers and managers, and sets out the procedure for a Critical Incident Review, which should be held after any serious incident such as a suicide or 'near miss'. The purpose of such a review is not to attribute blame, but to allow individuals and organisations to learn from experience, and to set in place changes in practice which minimise the risk of a recurrence.

7. Related guidance on reporting possible suicides to the Mental Welfare Commission for Scotland is attached as an Annex. Again, clinicians' practice should take place within a local clinical governance framework.

Further Copies

8. Copies of the full 'Safety First' report (or further copies of the summary report) are available by contacting the Department of Health Publications, PO Box 777, London, SE1 6XH (Fax 01623 724524 E-mail address doh@prolog.uk.com please quote reference 23425 when ordering). The full report is also available on the Department of Health website: www.doh.gov.uk/mentalhealth/safetyfirst

Yours sincerely

GODFREY ROBSON
Director of Policy

ANNEX

Reporting a Possible Suicide to the Mental Welfare Commission for Scotland

As part of its responsibilities under section 3(2)(a) of the Mental Health (Scotland) Act 1984, the Mental Welfare Commission for Scotland seeks information on deaths where suicide is suspected. The Commission is interested not only in such deaths occurring amongst detained or in-patients, but also amongst out-patient or day-patients, users of local authority and independent services, indeed in all those known to mental health services even if not currently in care. Notification should be given to the Commission as soon as possible after a patient's death. Thereafter a full report should be prepared and submitted to the Commission. The full report should include the following information:

a brief background, emphasising any of those factors known to increase the risk of suicide (e.g. non-married status, drug or alcohol abuse);

a brief psychiatric history and diagnosis;

any past history of self-harm or threats of self-harm;

evidence of suicidal ideation;

significant events in the period before the patient's death;

current treatment and care plan at the time of death and recent changes;

if the patient was in hospital, the observation status at the time of death;

the circumstances and method of suicide;

information/concerns from relatives, carers or outside agencies;

actions taken by the Procurator Fiscal; and

significant outcomes of the suicide review or audit by the hospital or other parties, of which the Commission should be aware.

In its 1992/93 Annual Report the Commission issued guidelines to the Health Service for reporting possible suicides. In November 2000 it issued guidelines for local authority and independent services, indicating that reports can be made in the format already used by the reporting body for its supervisory authority.