In West Sussex a comprehensive set of interventions are commissioned by the council and NHS partners across the pathway, from prevention, through to early intervention and then on to more specialist clinical services. However, the evidence suggests that many population level approaches do not specifically relate to self-harm but are around promoting positive mental and emotional wellbeing.
As the indicator only measures activity at the upper end of the pathway it is difficult to assess the effect of preventative interventions which may impact downstream. To improve performance in this area we are:
- Producing a rapid health needs
assessment to identify key local drivers and priority areas for action.
- Recruiting two dedicated posts, one
addressing whole school approaches to emotional wellbeing and the other
specifically focussed on self-harm.
- Ensuring that West Sussex and
Sussex and East Surrey STP suicide prevention activity is
coordinated with other activity in this area.
Self-harm is defined as any act of self-poisoning or self-injury carried out by a person, irrespective of their motivation”. In 2016/17 there were 1,714 emergency admissions for self-harm, this represented a rate of 220.3 admissions per 100,000 population. This was significantly higher than the England rate.
The Public Health led refresh of the Joint Health and Wellbeing Strategy which is now open for consultation highlights this as a ‘Starting Well’ issue and identifies transformational initiatives to bring about system level change. Suicide and self-harm are one of the four featured areas in the forthcoming Annual Public Health Report outlining actions at individual, community and population levels.
Targeting people before they start to self-harm and promoting mental wellbeing across the population (with greater intensity to those groups at high risk of poor mental health or self-harm) may be the most effective approach to reducing self-harm. This includes ‘whole school approaches’ to build positive cultures and ethos around mental and emotional wellbeing. WSCC is currently developing its offer around ‘whole school approaches’ which following successfully bidding for the Anna Freud Foundation to deliver two workshops on young people’s emotional wellbeing in West Sussex in the summer, resulted in a November hothouse workshop for WSCC senior leaders to build on the identified themes.
March 2018 performance
For 2016/17, the rate of emergency hospital admissions for self-harm (all ages) was significantly higher in West Sussex than England (and has significantly exceeded the national rate for the past 5 years):
The data briefing for self-harm is available locally to identify the extent of self-harm within our community. It is important to note that the data within the briefing represents the incidents that are severe enough to warrant hospital admission, but it is acknowledged that much more self-harm occurs within the County that does not result in hospital admission.
Actions within WSCC to reduce self harm in 2017/18
There are a number of core teams within WSCC who feed into the self-harm work stream, including Public Health, the Intervention, Prevention and Early Help teams (IPEH) and the Healthy Child Programme teams. Actions include approaches to promote, support and protect people’s emotional wellbeing, targeted services to those needing more support and partnership work across West Sussex to reduce rates of self harm.
Universal approaches (including those to improve emotional wellbeing) include:
- The Health and Wellbeing Board’s Resilience and Wellbeing work stream has a focus on improving the resilience and wellbeing of people and aims to incorporate the promotion of wellbeing and resilience across services and settings e.g. schools.
- The Healthy Child Programme and IPEH programme support children, young people and families with their emotional wellbeing.
- The West Sussex Time To Change programme aims to reduce stigma and discrimination and encouraging people to talk about their mental health – WSCC works in partnership in the hub with Coastal West Sussex Mind acting as the hub coordinator.
- There are a number of resources designed with young people for young people, including from Your Space.
- Support for emotional wellbeing through West Sussex Wellbeing Services, e.g. by promoting physical activity, reducing social isolation.
Examples of targeted initiatives and services
West Sussex County Council staff are involved in the provision and facilitation of services and programmes that support the emotional wellbeing and resilience of people at risk of self harm. Examples are:
- Youth Emotional Support (YES) – providing one to one intensive emotional support and group work for young people aged 11-18 years.
- Support accessed through Find It Out services.
- Supporting the production and availability of resources for specific groups
- Publications of a card for children and young people to use, to highlight their need for support with their emotional wellbeing
- Let’s Shout About It - Video made by Free Your Mind Group for children and young people made available to schools across West Sussex
- Shout - video made by children and young people on self-harm prevention
Approaches as systems leaders influencing partners
The West Sussex Suicide Prevention Strategy, that includes a focus on self harm, has been developed to present a set of priority areas for action in West Sussex for 2017 -2020 that are aligned with national strategic priorities. They are supported by an action plan and actions by partners include:
- Focus on reducing self-harm, particularly in young people
- Increase confidence and skills of paid and volunteer workers to support people at risk, maximising the use of existing resources and support
- Reduce access to the means of suicide and self-harm
- Emergency Department (ED) Liaison Service as part of the Mental Health Transformation Plan - Mental Health Practitioners based in the ED departments within the south of the county (with commissioners and local providers continuing work to pursue the roll out of the ED liaison service to Sussex and East Surrey Hospital in Surrey) provide support to children and young people who present with a range of mental health issues, including self-harm or suicidal ideation. This support includes a full psychosocial assessment and care planning, incorporating a strengths and difficulties questionnaire, that assesses mental state, safeguarding concerns, physical health, social circumstances and risk of further self-harm and suicide. A long-term plan is provided where CYP are referred and engage with the Child and Adolescent Mental Health Service (CAMHS), Youth Emotional Support (YES) or Dialogue services, all of which offer a programme of support that lasts for between 6 and 12 weeks.
- Training of frontline staff: Coastal West Sussex Mind are delivering training to the children and young people workforce which includes mental health first aid, Assist, Safe Talk and Self-Harm training.
Plans for 2018-19
The West Sussex Suicide Prevention Strategy was based on evidence drawn from the West Sussex Suicide Audit (2017) which provided unique insights into local patterns, engagement with front-line workers via an online consultation to determine the needs and views of front line workers in and local level analysis of emergency hospital admissions for self-harm.
The multi-agency Suicide Prevention Steering Group membership, are working together to take forward the nine areas for action within the strategy, develop and maintain the Action Plan and disseminate and implement any relevant evidence based national guidance, such as NICE or Public Health England (PHE) guidance. The Action Plan includes initiatives and actions to reduce rates of self-harm. As well as this specific focus on self-harm, the Action Plan will also have broader actions relating to substance misuse (including drugs and alcohol). A detailed workshop exploring areas for action - Focus on reducing self-harm, particularly in young people; and reducing access to the means of suicide, focusing on self-poisoning, railways and other public places is planned to take place in the summer of 2018. This will focus on and coordinate actions to reduce self harm, share progress with actions and other relevant strategic work, such as with the Mental Health Transformation Plans and the Sustainability and Transformation Partnership work and identify areas for collaboration and further action.