Forum Workshop

15th January 2019

Agenda

1. Welcome & Introductions 2. Sub-group updates;

– Comms & Engagement – Frequently Used Locations

3. Other developments; – GP Lead update – WSPD 2019 activities – Adverse Childhood Experiences (ACEs)

4. Share & Learn; – 2 year pilot – Becki Barrow (2gether Trust) – Self Harm Pathway Review – Beth Bennett-Britton – Stay Alive app – Nicky Maunder – ASIST training – Nicky Maunder – GloW – Vikki Clarke

5. Close

Communications & Engagement • Feeds into the Action Plan • GCC website set up including;

– Wellbeing information – Template documents (sample wording) – Social media ‘assets’ – Posters, leaflets – Statistical information – Signposting information – Sensitive language – Leaflet

• Reconvene to plan out targeted campaigns https://www.gloucestershire.gov.uk/health-and-social-care/public-health/gloucestershire-suicide-prevention-partnership/

Sub-group Updates

Sub-group Updates

Frequently Used Locations

• Last meeting focussed in woodlands/forests/open areas

• Representative from Forestry Commission attended who can link into Woodland Trust, Natural England, Gloucestershire Wildlife Trust

• Suggestion raised to place “Hope Notes” by Sunflowers – if you have any suggestions on positive words that can be used let us know

• Actions from meeting have fed into the Action Plan Log

• Next meeting to focus on highways

Other developments

GP Lead

• Put together training pack for GP practice non-clinical staff

• Attending ASIST course in January

• Will be attending Steering Group meetings going forwards

• Meeting with Karl Gluck in February

Other developments

WSPD 2019 activities

Several suggestions so far;

1. Gloucester Royal Hospital Chapel – 10th Sept

GSPP members attend scheduled session to lead a reading/talk about their work & provide leaflets (Trish Thomas)

2. Gloucester Cathedral’s Social Responsibility group event – 10th Oct

Showcase Mental Health, Housing, Homeless Support and Suicide Support to raise awareness about what they do and the support they offer (Helen Jeffrey)

Any other suggestions?

Volunteers for a working group/sub-group?

Other developments

Adverse Childhood Experiences (ACEs) • specific events that occur before the age of 18 years and

can be grouped into three types: abuse, neglect and household dysfunction. The ten most commonly measured ACEs are: physical, sexual or emotional abuse, emotional or physical neglect, mental illness, substance misuse, an incarcerated relative, domestic abuse, and parental separation

• Lead to a higher risk of social and economic disadvantage and poorer health outcomes, inter-generational cycle of adversity

ACEs

• Early intervention to prevent ACEs, building resilience to buffer against ACEs, showing compassion and building trust to enable people to talk about their ACEs

• https://www.actionaces.org/

• Resilience film screenings: – Wednesday, 23rd January, 2019 at 6pm, Sundial

Theatre, Cirencester

– Wednesday, 13th February, 2019 at 2pm,

Dean Academy, Lydney

Share & Learn

Integration and personalisation of delivering social care within a

secondary mental health service

- Becki Barrow (2gether Trust)

Improving pathways for people who self

harm within Gloucestershire

Frances Clark-Stone – Commissioning Officer

Public Health Commissioning - Prevention,

Wellbeing and Communities Hub, Gloucestershire

County Council

What we will cover today

• Background to the review

• Deep dive into countywide data on self harm

• Interviews with partners and those with lived experience

• Workshop

• Action Plan

Context for the review

• Gloucestershire has a higher

rate of hospital stays for self-

harm (254.3 per 100,000) than

England (196.5 per 100,000)

• This is equivalent to 1,527 stays

in 2015/16

• The Gloucestershire rate is

similar to the South West rate

Headline Indicator: Hospital stays for self-harm (all age)

Context for the review

Describes the extent of fatal and

non-fatal self-harm in adolescents

in England in terms of the three

levels of the iceberg model

• Suicide

• Hospital presenting self-harm

• Community-occurring self-harm

The Iceberg Model of Self-Harm (Geulayov et al, 2017)

Context for the review

Gloucestershire Online Pupil Survey (2016)

15% of young people report ever self-harming – low/mid-range in context of national estimated prevalence

Young People: Self-reported self-harm

Context for the review

Gloucestershire has a recent

history of a higher rate of deaths

by suicide than the national

average

Gloucestershire Suicide Audit,

2013-2015 (published 2017)

• 28-35% of people who died by

suicide had a known history of

self-harm

Self-harm and the link to suicide

Our methodology

1. Review of mental health needs assessments and data available on self-harm

2. Semi-structured interviews with key stakeholders – thematic analysis

3. Online survey of people who have self-harmed or are self-harming (run by a local user led organisation)

4. Light touch review of Gloucestershire’s adherence to NICE quality standards

5. Stakeholder workshop to ‘check back’ findings

Our methodology

VISION: people have alternative ways of coping,

elimination / reduction of self

harm

1. Access to support before

self-harm

2. Access to help:

community, primary, and

secondary

3. Quality of care and

treatment

4. Recovery, staying well

and prevention of further self

harm

‘The Full Iceberg’ Building on the success of our work on the Mental Health Crisis Care Concordat, we chose to focus on the whole pathway

Interview Questions

1. What works well in Gloucestershire?

2. What are the gaps/what needs improving?

3. What are your 3 key priorities for improvement?

4. Which policies and procedures do you follow?

5. Any quick wins?

6. What training do you access/need?

Interviewees and self harm

• Psychiatric liaison team – SH 49% of all referrals 2017

• S136 detainees for CYP – high % SH

• Paediatric ward – 10 CYP per week

• ED – 15 people per day

• GP surgery – 2 per week

• TIC+ - 15 – 20% all referrals

• Women’s centre – 50-60% of clients

• Home group – daily issue, increase in severity

Interview findings - prevention

Strengths Needs improving

• Attitudes and awareness

• Training (MHFA, ASIST, self harm)

• Curriculum support • VCS support • Counselling

• Consistency of offer in schools

• Clear specific advice for parents/carers

• Supporting people to manage emotional distress

Interview findings – access to treatment

Strengths Needs improving

• Accessibility of services inc VCS and CYPS liaison

• Safeguarding procedures • Emergency department

MH liaison • Improved attitudes in ED • Training for ED staff

• Timeliness of assessments

• Suitable place to be • Communication

between ED, MIIUs, GPs, school nursing

• Access to non urgent emotional health support for CYP

Interview findings – quality of treatment

Strengths Needs improving

• Improved timeliness of acute care

• Liaison around CYP • CYPS schools

support • Attitudes • Physical care • DBT offer

• Assessments – quality and timeliness

• Pathways – between ED/CYPS/MIIU/GP/ school

• Consistency of attitudes • DBT offer • Alternatives to MH

pathway for emotional distress

Interview findings – recovery and staying

well

Strengths Needs improving

• Crisis plans

• Keeping the door open to services

• Improving self esteem

• Consistency of recovery/stay well plans across agencies

• Specific reference to coping techniques

• Shared understanding amongst wider circle of support

Interviews - Key priorities

• Improve what happens when people present to

ED – timeliness of assessments; place to be;

listen properly; all age services; adolescent unit

• Strengthen prevention – primary and secondary

• Make it easier for CYP to get help

• More people who can listen with empathy

• Join up what we already have

People with lived experience – Key priorities

• Tackle stigma and improve attitudes particularly

in acute services

• Specific support – counselling, psychological

therapies, emotional support, trauma support

• More people who understand self harm and can

listen in schools, MH services

What helped this work?

• Driver – red indicator of hospital admission data

• Senior buy in – support of HWB

• Building on previous work on self harm and suicide prevention

• Holistic approach – looked at the whole iceberg

• In depth interviews – people had a lot to say, and were engaged by

the process

• Timeliness

• Evidence-based - including light touch review of NICE QS

• Identification of strengths as well as areas for improvement

Benefits and outcomes

• Senior support for action plan

• Links with STP and urgent care transformation

• People working in discrete areas aware of the bigger

picture

• Function of public health – to facilitate communication

and joint working, informed by this overview

What could we have done better?

• Heard more voices from people with lived

experience of self-harm

• Given more focus to the possible unique needs

of men and boys and older people who self-

harm – limited evidence and knowledge base

• Held more than one workshop / or ways of

engaging to enable a wider range of people to

attend and take part in action planning

Action plan

• Improving specific information for

parents/carers

• School based disclosure platform “Toot toot”

• Mental health e learning package for schools

• Broader access to face to face counselling

Prevention and early intervention

Action plan

• Targeted trauma informed support (pilot)

• Build capacity within supported housing workforce and

specific VCS organisations

• Access to emotional support for CYP with physical

health conditions

• G care improvement

• Strengthen pathways for MIUs and ambulance services

• Adapt “Harmless” tool for Gloucestershire

Improving access to care and support

Action plan

• Mental health liaison – move towards all age service

• Review of multi agency self harm policy for CYP

• Develop an alternative place to be for adults in emotional distress

Improving quality of care and support

Action plan

• Review existing recovery plans for adults

• As above, for children

• Health and social care working together

• Everyone supporting the person knows what

they need to do to stay well and avoid self

harming

Helping people recover and stay well

Action plan

• Training and awareness plan – trying to achieve

a coordinated approach

• Pilot – train and support VCS and primary care

to jointly run DBT skills on referral

• Rolling programme of specific self harm training

for MIU staff, ambulance staff, public health

nurses

Improving knowledge and skills

Update on the #StayAlive

app October - December

2018

Presentation to Gloucestershire Suicide Prevention

Partnership Forum (GSPPF).

Summary

The total number of app downloads (Dec 2018) = 75.1k (May 18 = 57.3k)

Android: 33.5k (May 18 = 24.7k)

ios: 41.6k (May 18 = 32.6k)

5,698 active app users

159,252 screen views in the app

Daily user engagement 2min 25 secs

Male = 60.4% Female = 39.6%

Rest of stats are Android only (“which represents just under half the downloads”)

Mental health literacy

“Find help now” section

12, 849 events* in this section, 8.07% total user

engagement

Safety Plan

14,272 events, 8.9% total user engagement,

average time in this section 21 secs

* Events can be described as actions or activities through the

app, such as: opening the app, a page, a link or using a

feature.

Reduced stigma associated with

help-seeking behaviours “Worried about Someone” section

11, 034 event* counts for all screens in this section, 6.93% total user engagement

Average time in each screen Worried About Someone = 4 secs

Practical Steps to Help = 28 secs

Things to Avoid = 21 secs

In a public Place = 13 secs

Potential Warning Signs = 28 secs

Supporter Resources = 8 secs

“Myths about suicide” section

22, 209 events or 13.5% total user engagement

* Events can be described as actions or activities through the app, such as: opening the app, a page, a link or using a feature.

Increased help-seeking

behaviours for mental health

AND understanding of

suicidality “Myths about suicide” section

22, 209 events or 13.5% total user engagement

“Find help now” section

Gloucestershire resource area - 81 events, average time 4 secs

2gether resources (Gloucestershire & Herefordshire) Crisis Helpline - 327 events, average time 33 secs

Let’s Talk – 29 events, average time 7 secs

“Stay Alive” section (36, 279 events, 22.9% total user engagement)

Stay Alive 7,806 events

Thinking About Suicide 8, 372 events

Reasons For Living 11, 725 events

Staying Safe For Now 3, 759 events

Self Help Ideas 608 events

Breathing Exercises 3, 023 events

Counselling 987 events

* Events can be described as actions or activities through the app, such as: opening the app, a page, a link or using a feature.

Increased psychosocial

protective factors

Safety Plan - 14,272 events*, 8.9% total user engagement,

average time in this section 21 secs

Reasons For Living - 11, 725 events

LifeBox – 8, 420 events, 5.29% total user engagement

Wellness Plan – 10, 922 events, 6.85% total user

engagement

* Events can be described as actions or activities through the app,

such as: opening the app, a page, a link or using a feature.

Stay Alive app

Updates to sources of support information;

• Local crisis support – – 2gether Crisis Helpline

– Let’s Talk

• We can update with other localised support information – who else should we include?

• Since 2016, 395 people have attended ASIST

• Variety of people trained; police officers, nurses, GPs, counsellors, clergy/pastoral, DWP/Jobcentre staff, family support workers, housing support, youth workers, probation, social workers

• 94% said it had a practical use in their work life

• 78% said it had a practical use in their personal life

• Delivered through the HLS (info@hlsglos.org)

“I feel more confident to work and support people with suicidal thoughts.”

“Good mix of people with different range of skills, knowledge and experience.”

“The training was awesome. As someone who has been actively suicidal in the past, I feel that people who are ASIST trained would have been the most beneficial support at the time. Would recommend.”

“Informative, really made you think about the issue of suicide and how possibly you could help make someone safe for now.”

“Course was great as I have had little to none training regarding suicides and this course helped me a lot since I will/may have to deal with vulnerable customers.”

“Wish this training could be made mandatory for everyone in health and health and social care sector, especially when working/supporting service users at risk of suicide.”

HLS - info@hlsglos.org

GloW: Gloucestershire Wellbeing Positive Actions for Better Mental Wellbeing

• The aim is to create a countywide movement promoting good mental health for all.

• Shifting the emphasis from treatment to prevention by

increasing the focus on all the things that contribute to our wellbeing, i.e. the determinants.

- Social connections - Employment/financial security - Physical health - Access to green space - Transport - Physical Security

• Local response to Public Health England’s Prevention Concordat for Better Mental Health; which has been rolled out across the country.

• Developed the Gloucestershire Commitment; a consensus statement of our intention to promote positive change for better mental health and wellbeing for Gloucestershire.

• Local organisations invited to sign up to GloW and make a pledge of an action they will do to put the principles of the Gloucestershire Commitment into practice.

• Since it’s launch in July 2018, 27 organisations have become GloW signatories and made pledges.

www.gloucestershire.gov.uk/glow

Next steps

• Following successful launches with the public sector and third sector; GloW to be launched with the private sector.

• Actions for Good Mental Health group:

- Project stock take to identify gaps

- Action plan under new Mental Health and Wellbeing Strategy.

How can I get involved in GloW?

• Sign up to the Gloucestershire Commitment and become an official GloW signatory.

• Contribute to the Project Stocktake.

www.gloucestershire.gov.uk/glow

Vikki Clarke, Outcome Manager for Public Health

Vikki.clarke@gloucestershire.gov.uk

Break, refreshments and networking