Jan Roberts recently started work as the first Powys Suicide and Self Harm Prevention Co-ordinator. She previously headed up the Crisis Resolution & Home Treatment Team in South Powys which she originally joined in 2012. Jan recently spoke at a meeting with some of the individual reps who champion improved mental health services in Powys and we found out more about her role.
The new post is funded for 18 months by Welsh Government alongside three regional Suicide and Self-harm Co-ordinators for Wales. Shaun Morris recently stepped into this role to cover Mid & West Wales. The lead within Welsh Government is Claire Cotter - National Co-ordinator for Suicide & Self-harm Prevention – NHS Wales Health Collaborative. The driver behind much of this work is the government strategy on suicide prevention – Talk to me 2: suicide and self-harm prevention action plan for Wales 2015 – 2020.
One of Jan’s first tasks is to understand the Powys picture so that an intelligence led service can be developed in response to identified needs and gaps. This level of intelligence gathering and research into suicide and self-harm has never been done within the health board or the council before.
Jan is working closely with colleagues at Powys Teaching Health Board, including Andrew Mason - the Harm Prevention & Reduction Officer for Substance Misuse, and Freda Lacey - the Mental Health Partnership Officer.
1. Analysing Coroner data for Powys residents who have ended their lives by probable
suicide between 2015 and 2019
This provides 5 years’ worth of data to understand if there is any particular demographic, or any particular geographical area in Powys, where these suicides may have happened, with the aim of trying to target services to prevent suicides in future, and in particular looking at gaps in service provision.
Powys wavers between the highest and second highest county in Wales for suicides (taking into account population size). The initial findings are interesting as they highlight a difference from the rest of the UK in that there were more deaths in the over 60s in 2019, whereas UK wide there were higher numbers of deaths from the 35 – 49-year-old age group. It will be interesting to see if this trend is also reflected in the analysis of the data from other years.
2. Improving the support available to those bereaved by suicide in Powys
In her previous role Jan had looked for 1:1 or face to face peer support for those bereaved by suicide and discovered that the nearest available group was either Cardiff or Chester. She is now working with colleagues to consider a support pathway which starts within 48 hours of the suspected suicide.
The proposal is that individuals bereaved by possible suicide would be linked in to both the practical advice they might need, as well as the emotional support. This will be in line with the suicide surveillance work being done in both Wales and England currently, which will enable the sharing of information on deaths by suicide at the time, rather than retrospectively, thus enabling appropriate responses to need and prevention being enacted both locally and nationally.
The idea is in its early stages, but the intention is that the family or person would be offered practical and emotional support with regular check ins, where they have consented; it’s about checking in and asking what support they need at that particular time. Peer led support is another option being considered in conjunction with the voluntary sector. Health board staff and partners in the voluntary sector are receiving suicide bereavement training to better equip everyone to work together to progress this in Powys.
Finally, Jan is undertaking a data collation project in order to build an understanding regarding self-harm and self-injury in Powys, looking at prevalence, trends, pockets of particular need, and understanding the various pathways encountered to access support. It is hoped that this data will provide intelligence that will inform service development to maximise early intervention and prevention and reduce any barriers to accessing the right support at the right time.
It is more complex in Powys because of the distance people can travel to receive support, and further complicated due to the fact there are no district general hospitals or psychiatric liaison teams in Powys. Powys residents use approximately 5 or 6 different psychiatric liaison teams if they self-injure or self-poison and seek support, two of which are outside of Wales, so data collection is a challenge.
Many studies on self-injury and self-harm focus on the data from psychiatric liaison services but it’s difficult to get a full picture. A 12-year study from Swansea University into young people under 25 who self-harm in Wales showed only 50% had ever been to a psychiatric liaison service. Jan is looking at how we can source the best data to capture the trends and areas of need.
There is also a need to understand the pathways to service provision across Powys. For example, someone may live an hour and a half away from their nearest psychiatric liaison service and have no way of getting there so they could decide not to attend. Jan will be working with patients and staff to understand the pathways to receiving the right support at the right time – what works well and what could be better.
It is important that Powys residents are offered what is recommended by the NICE (National Institute for Health & Care Excellence) guidelines: a mental health assessment, a psycho-social assessment and referral on to an appropriate service.
Sarah Dale, a mental health rep, has recently delivered some awareness training on self-injury with the Minor Injury Units’ staff which was really well received and further training is indicated for MIU staff, in particular focusing on referral pathways.
Another area of work taking place is the harm reduction programme from a substance misuse perspective. Harm Prevention & Reduction Co-ordinator, Andrew Mason, is focussing on the non-fatal drug overdoses across Powys, looking to learn lessons and identify areas for improving services with the ultimate aim of providing targeted support and intervention for people.
For more information on this ongoing work please contact Jan Roberts, Powys Suicide & Self-harm Prevention Co-ordinator, by emailing jan.roberts3@wales.nhs.uk
Bereaved by suicide – support organisations & resources
