All Age Suicide Prevention

Joint Strategic Needs Assessment

Suicide prevention is a systemwide priority. Each instance of suicide is a tragic event that profoundly affects families, friends, and communities. The risk of suicide is closely linked to broader inequalities, with significant variations in suicide rates based on people's social and economic conditions, with higher rates observed in economically disadvantaged communities. However, it's important to recognise that suicide is not inevitable and can be prevented through appropriate support and strategies. Suicidal incidents typically involve multiple contributing factors, emphasising the need for a comprehensive, systemwide approach to prevention. Engaging multiple partners and addressing various risk factors are crucial components of effective suicide prevention efforts. In more recent times, key policy drivers such as the national suicide prevention strategy and NHS Long Term Plan have acted as enablers for local action to preventing suicides.

Local Context

Wolverhampton is home to 263,7001 residents, the population is proudly diverse with over 40% from ethnic minority communities. The city has many positives with nearly 80% of the population stating their health is good, or very good, and score of happiness, as measured through the Annual Population Survey, being above the England average 2 .

However, Wolverhampton faces numerous challenges, including significant levels of deprivation, currently ranked as the 24 th  most deprived local authority. When compared against national benchmarks, using several indicators, people in Wolverhampton have a lower life expectancy, earn a lower wage, are less likely to be in paid employment and therefore more reliant on benefits. Furthermore, against national averages, residents of Wolverhampton are more likely to be a victim of crime, obtain lower qualification levels and experience higher levels of housing related issues such as fuel poverty. This context is especially relevant considering that individuals residing in more deprived communities are at a heightened risk of being exposed to factors that contribute to suicide.

Suicides in Wolverhampton

Despite these challenges, suicide rates in Wolverhampton have declined over the past two decades and is currently at its lowest point. The current rate is significantly below the national average and the lowest among all areas in the West Midlands region. Nevertheless, it is important to acknowledge that over 50 suicides occurred within the city during the most recent three-year reporting period which serves as a reminder to system partners that additional efforts are necessary to address the issue effectively.

Graph 1: Suicide rates, per 100,000, comparing Wolverhampton to West Midlands and England from 2013-15 to 2020-22. Graph 2: Suicide rates, per 100,000, in Wolverhampton comparing the differences between genders from 2014-16 to 2020-22.

Suicide prevention work in Wolverhampton is aligned with the priorities set out in the City of Wolverhampton Council’s ‘Our City: Our Plan’ and the ‘Public Health Vision 2030’, as well as priorities set out through the Integrated Care System. Furthermore, many partners who take a key role in this agenda, progress suicide prevention efforts within their respective organisation to ensure policies are adopted in various settings including education, voluntary community sector and statutory services. The Wolverhampton Suicide Prevention Stakeholder Forum is an established network of partner organisations who lead this agenda locally supported through the Public Health team at City of Wolverhampton Council, the forum feed into the Health and Wellbeing Board and One Wolverhampton, which forms part of the Integrated Care System.

Evidence Review

A death by suicide usually follows a period of distress that can be caused by a significant life event, a period of adversity and long term poor mental wellbeing. A death by suicide does not occur when someone wants to die, but because they feel they can no longer live the life that they are currently living.

Research has found that there are some sections of the population who are disproportionately exposed to a range of factors that could increase the likelihood of suicide.

Being male does not inherently mean increased suicide risk, however, the prevalence of suicide has been significantly higher in men when compared with women, globally and nationally. This suggests risk factors of suicide are managed differently by men and therefore requiring tailored approaches to prevention.

According to research the five risk factors with the strongest evidence predicting suicidal behaviour in men were:

  1. Alcohol and/or drug use/dependence.
  2. Being unmarried, single, divorced, or widowed.
  3. Having a diagnosis of depression.
  4. Low levels of education.
  5. Previous suicide attempts.

People with a diagnosed mental health condition or those with poor mental health that are not known to local services.

A study by Bachman (2018) suggests that between 60% and 98% of deaths by suicide are in people with a psychiatric disorder.

Men with mental illness are at an increased likelihood to engage in behaviours that are harmful to both them and others compared with men without a mental illness. These behaviours include substance abuse, excessive alcohol intake, recreational drugs, anger, violence, or other risky behaviours.

The existence of long term physical health problems is a risk factor in both men and women, in particular when this co-exists with depressive symptoms. Often the depressive symptoms are due to the actual or perceived impact of the physical condition such as loss of agility or mobility, and chronic pain that impacts negatively on the quality of the individual’s life.

There are examples of conditions where there is a higher risk of depression associated with a physical illness: respiratory diseases such as chronic obstructive pulmonary disorder (COPD) and asthma; cardiovascular diseases such as coronary heart disease and stroke; degenerative diseases such as osteoporosis and multiple sclerosis.

Evidence suggests that the risk of suicide and self-harm is higher in people who are unemployed, which indicates that targeted preventative interventions for those not in employment.

However, evidence shows there are certain occupational groups who are at higher risk due to many factors such as work related stress, workplace culture or access to means of dying by suicide. These groups include:

  1. Doctors.
  2. Nurses.
  3. Veterinary workers.
  4. Farmers and agricultural workers.
  5. Skilled and manual workforce.

However, it is understood suicide risk by occupational groups may vary locally, and it is vital that local partners are alert to this and adapt their suicide prevention interventions accordingly.

Whilst suicides in children and young people are lower than the adult population there is an increased risk of exposure to factors that contribute to suicide in some groups, such as looked after children, care leavers and those in the youth justice system, this is generally synonymous to risk of worse mental wellbeing in children and young people as recognised in various strategies published to direct improvements in mental health of this group.

There is also an increased risk of suicide in people where the following risk factors are prevalent:

  • Problem gambling
  • Excessive alcohol consumption
  • History of self-harm
  • Chronic loneliness and isolation

Local Services and Professionals

Tackling suicide requires a systemwide multi-agency approach, there is a professional and personal duty of care in all professionals to support someone in distress. To enable the workforce to recognise those at risk of suicide, it is important to facilitate training in recognising the signs and symptoms someone in distress may display and for them to be able to respond. There are a number of services within the city that people in distress can be encouraged to access. However not all local professionals are aware of these services and how they can be accessed. It is therefore important to ensure that all local professionals and local services are better connected.

To understand the needs of the local population there is a need to improve the quality of data recorded where individuals are accessing support. This includes better recording of demographic data and reasons for presentation to services. It is however recognised that presentation to services may not be explicitly related to suicide ideation making it difficult to provide systematic recording of data.

Recommendations for local action

Roll out training in Suicide prevention awareness to local professionals, communities to build awareness and confidence in supporting someone who may be at risk.

To develop suicide prevention interventions for groups at increased risk such as men, migrant communities, people exposed to domestic abuse, those affected by gambling related harm and those with chronic physical health conditions.

To recognise the link between financial hardship and suicide risk through embedding routine enquiries about financial hardship into mental health services and to ensure that services have appropriate resources for signposting and referring for specialist support and advice.

To work with providers on improving awareness of support services amongst the workforce and wider community and to ensure that services are equitable and accessible for those who are digitally excluded, have sensory impairments and language barriers.

To work with commissioners and services to improve the quality of information available locally such as data recorded on reasons for accessing services and the demographic profile of those accessing services.

To monitor incidence of suspected suicides through the regional real time surveillance system and ensure timely multi-agency action is taken as appropriate, including work with media, reducing risk of further associated suicides and ensuring bereavement support is offered to those affected.