Suicide Prevention Transformation Partnership – Kent and Medway STP – Winners #MHAwards19

In early 2018 Kent County Council (KCC), Medway Council, 8 CCGs and Kent and Medway Partnership Trust (KMPT) came together under the banner of the STP to form the Kent and Medway Suicide Prevention Transformation Partnership. The STP Partnership worked with the existing multi-agency suicide prevention steering group (which includes 130 members including the Police, Samaritans, Network Rail, Mind, academics, individuals with lived experience) to secure funding (£660,000)  from NHS England to develop a multi-level, multi-faceted suicide prevention programme with co-production and evaluation built in. It was designed following a stakeholder workshop to develop a driver diagram which highlighted that middle-aged-men were a primary target.

suicideprevention@kent.gov.uk

Winners - #MHAwards19

Co-Production

  • From start: No
  • During process: Yes
  • In evaluation: No

Evaluation

  • Peer: Yes
  • Academic: No
  • PP Collaborative: Yes

Find out more

Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference

141 people died by suicide in Kent and Medway in 2017. To reduce that number would take a partnership approach, particularly because 67% of those individuals were not known to secondary mental health services.

In early 2018 Kent County Council (KCC), Medway Council, 8 CCGs and Kent and Medway Partnership Trust (KMPT) came together under the banner of the STP to form the Kent and Medway Suicide Prevention Transformation Partnership.

The STP Partnership worked with the existing multi-agency suicide prevention steering group (which includes 130 members including the Police, Samaritans, Network Rail, Mind, academics, individuals with lived experience) to secure funding (£660,000)  from NHS England to develop a multi-level, multi-faceted suicide prevention programme with co-production and evaluation built in. It was designed following a stakeholder workshop to develop a driver diagram which highlighted that middle-aged-men were a primary target.

The Partnership agreed the following objective and aims;

Objective

A minimum 10% reduction in suicide rates across Kent and Medway by 2021

 

Mission

To harness all available resources in Kent and Medway in a united, evidence based and co-ordinated effort to reduce suicides

 

2018/19 Aims

•       Key high-risk groups (particularly middle-aged men) given extra support

•       At least 1000 individuals trained in suicide prevention and mental health

•       Greater public awareness of suicide warning signs and how to respond

•       Greater system understanding about individuals who die by suicide

 

A range of initiatives were built into the programme, each one reliant on partnership working throughout the health, local authority, and charity sector. Elements included;

 

  • The innovative Release the Pressure social marketing campaign and 24 hour support line
  • Suicide prevention training
  • An Innovation Fund for community level projects
  • Qualitative research and co-production with men who had attempted suicide

 

The first year of funding covered April 2018-March 2019 and the reach and impact of the programme has exceeded expectations and has received recognition from national suicide prevention experts, local politicians, media and most importantly local individuals and families with experience of suicide and self-harm.

A second year of funding has been secured and delivery is continuing to positively impact lives across Kent and Medway.

What makes your service stand out from others? Please provide an example of this.

Our Programme of work is exceptional because of the range of ways we have been able to drive change, deliver services, undertake research and most importantly save lives.

We have undoubtedly benefited from securing the funding from NHS England, however the strength of the Programme has been its partnership approach and its ability to spread investment widely and still achieve tremendous results.

This illustration summarises the nine key areas where we invested our funding during 2018/19.

While we can demonstrate that each of the elements has delivered strong results, we would like to highlight two which we believe are unique in England.

1) Release the Pressure campaign

The Release the Pressure social marketing campaign was launched as a response to two main factors.

•           Approximately three quarters of people who die by suicide are male

•           Approximately 70% of people who die by suicide are not known to secondary mental health services

 

Release the Pressure was designed to use a social marketing approach to reach individuals not in touch with other services, and encourage them to start talking about whatever is bothering them before the pressure becomes too great.

The campaign highlights that talking to anyone (eg friends, family, clinicians) is likely to help, but for those people that don’t have anyone they feel that they can talk too, then trained and confidential support is available 24 hours a day, 7 days a week.

The campaign uses social media channels, and advertising online, on radio and on digital TV to raise awareness of the issues and the help available.

 Paying for Google adverts has been particularly effective, with the Release the Pressure advert being shown when anyone in Kent searches for terms such as “suicide”, “feeling suicidal” or “I want to die”.

As an illustration in 2018/19 the Release the Pressure advert was displayed 1307 times to Kent and Medway residents who had googled the term “I want to die”. On 176 occasions the individual clicked on the advert and visited the website where they could access immediate help either via phone or webchat. In total nearly 7000 individuals clicked through to the website from a Google advert in 2018/19.

In total the helpline received 21,956 calls during 2018/19 (1829 a month). This represents a huge number of individuals receiving support in a timely and cost-effective manner. (It also reduces the workload for other services in the system such as A&E attendances and ambulance call-outs).

In addition to the calls, the service is answering approximately 100 webchats a month and hundreds of people are visiting the website for information every week (there were 25,339 total visits during 2018/19).

Perhaps more importantly than the quantitative measurements is the testimonials that we have received from people who have used the service.

We are particularly proud of this unsolicited facebook post on a local charities facebook page after they advertised Release the Pressure.

 

2) Saving Lives Innovation Fund

We wanted to use part of the funding that we had secured from NHS England to uncover and test new ideas. So we launched a £100,000 Innovation Fund and received over 60 bids from grassroots and community level partners.

After a thorough evaluation process we were able to fund 29 projects. We will go into more details about the projects later in this application but this slide demonstrates the range of partners that we were delighted to be able to support.

From using hip hop to reaching men in deprived parts of Folkestone, to horse care for self-harming teenage girls in Dartford, to supporting dads going through difficult relationship breakups, we believe that this spread of innovation projects is giving us valuable insight which we can transfer and use in future programmes.

 

 

How do you ensure an effective, safe, compassionate and sustainable workforce?

None of the three full time members of the team are clinicians and therefore do not have access to clinical supervision. However, given the nature of the stories that they hear and read as part of their work (including listening to over 200 hours of coroner’s inquests which resulted in suicide verdicts in 2018), it was felt important to ensure that they are properly supported. Therefore regular access to a counsellor was secured to provide supervision and talking therapies to the team.

An important part of the wider programme was the development of a menu of suicide prevention training that is free to access for anyone in Kent and Medway.

During 2018/19 over 1900 people attended this training including hundreds of NHS and public sector staff (GPs, nurses, social workers,police, teachers), but also hundreds of individuals from private businesses (taxi drivers, barbers, leisure centre staff, hotel staff) and local charities (domestic abuse, debt support, volunteering). This reflects our view and commitment that suicide prevention requires the whole Kent and Medway workforce to be upskilled, not just the NHS workforce.

Another very good example of the partnership leading to excellent value of money is that the e-learning that Partnership has developed is now being offered to all NHS, public sector and private sector partners in Kent and Medway to host on their internal training platforms free of charge.

 

Who is in your team? 

Band/gradeNumberWhole-time equivalent
Suicide Prevention Programme Manager8b11
Suicide Prevention Project Officers522
    

 

 

How do you work with the wider system?

Identifying and reaching individuals who maybe at risk of suicide is difficult, therefore it has been necessary to combine the resources and reach of a variety of local authority, NHS, charity and private sector organisations. Here are a few examples…

·       Release the Pressure materials have been promoted by a variety of organisations including pharmacies, GP surgeries, bars, libraries and village halls. Gillingham Football Club gave the partnership a pitch side hoarding free of charge and the major Bluewater Shopping Centre (with 27 million visitors a year) put up posters in all 57 of its bathrooms free of charge.

 

·       The innovation fund gave grants to 29 community level projects including a riding stable working with youngsters to reduce self-harm, a wildlife charity who partnered with MIND, a local university to wanted to do more to protect students, a charity supporting men going through family breakdown as well as established charities such as the Samaritans, Citizens Advice and SOBS.

·       We provided a strategic grant to local Samaritans who worked with Kent Police to review and update (with the new freephone Samaritan number) all the Samaritans signage on the road network in Kent

·       We have started working with local Domestic Abuse charities to review the link between domestic abuse and suicidality. This will certainly lead to DA workers undertaking suicide prevention training and may lead to a behaviour change action research project looking at how victims of domestic abuse can be better supported

·       We have worked with the University of Kent and Canterbury Christ Church University to develop a Suicide Safer University Project

 

 

Do you use co-production approaches? 

There has been an ethos of involvement, openness and consultation throughout the design and delivery of the programme. The innovation fund for instance came about precisely because the leaders of the partnership realised that they didn’t have all the answers and they wanted to encourage frontline staff and community groups to develop and test new ideas. All 29 of the innovation projects were either partly or entirely co-designed by people at risk of suicide or self harm.

Likewise, the qualitative research and co-production of services with men who had attempted suicide was designed following the recognition that the system can’t design effective interventions without truly understanding the deeply held feelings and experiences of individuals who had been in very dark places. Eight men were interviewed individually to understand their stories, but instead of that being the end of their involvement it was just the beginning. Three co-design workshops were held where the men were able to shape future interventions on an equal footing with system leaders and commissioners.

Finally, frontline staff and people with lived experience have been crucial in designing the next year’s programme through feedback reports and consultation events.

 

 

Do you share your work with others? If so, please tell us how.

Learning is being shared in a variety of ways including presenting at national and local events, boards and committees and a monthly newsletter to stakeholders. We presented at the National Suicide Prevention Alliance national conference in Feb 2019 and two months later we held our own major conference where learning was shared with 230 delegates.

We were particularly pleased that we ensured that the key messages from the conference were shared with the wider public as we were able to secure strong TV https://www.itv.com/news/meridian/2019-05-17/spotlight-on-mental-health-and-large-number-of-suicides/ and press coverage https://www.kentonline.co.uk/kent/news/suicide-prevention-conference-held-on-mental-health-awareness-week-204584/

 Although this is a Kent and Medway STP programme the Partnership is also spreading learning and resources across the South East. This includes allowing the City of London Corporation to use the Release the Pressure imagery for their own suicide prevention campaign and providing research materials and videos to be used in the training of GPs in Surrey.

 The campaign website www.releasethepressure.uk was visited over 25000 times in 2018/19.

 

 

What outcome measures are collected, how do you use them and how do they demonstrate improvement?

 Each element of our programme is evaluated as much as possible. Metrics that we are using include;

 ·       Number and rate of suicides (broken by age, gender, location, method, known to services etc)

·       Number of callers to our 24/7 helpline (broken by age, gender, nature of call, outcome of call)

·       Individual feedback to helpline

·       Website visitors

·       Media coverage

·       Number of people at training / events / presentations

·       Pre / post and 3 month post training evaluations

·       Case studies and bespoke evaluations from Innovation Fund

·       Stakeholder surveys

We included detail about the impact of Release the Pressure earlier in the application, these two slides summarise the impact of the two suicide prevention workshops that we commissioned.

 

Has your service been evaluated (by peer or academic review)?

 The programme is currently being externally evaluated by NHS England (through a research company called NICHE). We are awaiting the full report, but we have already received the following feedback.

“Kent and Medway are right at the vanguard of progress in relation to the eight STP areas which received suicide prevention funding. Their programme is multi-faceted, multi-level and with evaluation designed in.” National Confidential Inquiry for Suicide and Homicide, University of Manchester (28th January 2019)

 “The feedback from the national expert panel about your proposal was extremely positive to the extent they held it up as an exemplar of a good proposal” NHSE/PHE South East Regional Suicide Prevention Transformation Programme Manager (22nd Feb 2019)

“This was a good proposal which clearly built on the progress of year one, and focussed on wider system change and had an understanding of local needs. If the STP gives their permission, this plan could be used as an example for wave 1 and 2 sites.” NHS England Suicide Prevention Expert Panel (22nd Feb 2019)

 

 

 

How will you ensure that your service continues to deliver good mental health care?

We have secured additional funding for the 2019/20 financial year to ensure that the funded elements of the campaign continue, but the relationships with partner organisations, charities, networks and individuals will be even more important in ensuring the future of the work. These relationships will be formalised in the development of a new five-year Kent and Medway (multi-agency) Suicide Prevention Strategy that is currently being developed.

Under this strategy there will be no reliance in individual relationships as all roles and responsibilities will be agreed at senior level within each organisation.

Through 2019/20 in addition to the delivery of the paid for elements of the programme, we have committed to a number of system leadership projects (including reviewing the depression pathway and reviewing the role new Primary Care Networks can play in suicide prevention. This will also sure that change is embedded rather than ending when the money runs out.

 

What aspects of your service would you share with people who want to learn from you?

1)    Having funding helps to get people round the table – but the partnership and system leadership elements are where long term changes can be secured

2)    You don’t need a lot of money to unlock the creativity at a community and grassroots level. We distributed 29 grants of less that £5000. Each one of those projects has turned around the lives of many individuals

3)    Don’t forget the power of traditional media (tv, radio and newspapers) to get to a large audience. A couple of good case studies are often all it takes to secure strong media interest

4)    Service user or lived experience is vital in ensuring services and projects are co-designed effectively. But it must be meaningful and throughout the life of the project (including the evaluation) to ensure it is not tokenistic.