The increased vulnerability of those bereaved by suicide to mental health illness is well known.

The Executive’s own suicide prevention strategy states that families and friends bereaved by suicide are at a greater risk of depression and future suicidal behaviour, requiring specific supportive measures and targeted treatment to cope with their loss.

In September 2016, the Mental Health Rights Campaign (MHRC) launched the SAFER campaign, calling for timely and adequate support for those bereaved by suicide. One of the core asks of this campaign was for a system of automatic referral to bereavement support for family members who lost someone through suicide.

Working with people with direct experience, the Mental Health Rights Campaign found that the current process involves families making immediate decisions about support – offered by police service personnel, at the scene of the incident. Familes have found this to be traumatic and erected barriers to families getting support.

Precedents

The Executive has recognised the importance of automatic referral in other areas: for example, if you are a victim of a crime, the PSNI will automatically pass your details on to Victim Support for any post-incident support that may be required.

Research and Freedom of Information requests have illustrated serious problems with the level of uptake of bereavement support through the current process. Levels of uptake have varied between Health Trusts: in 2014 & 2015 areas such as the Western Trust had extremely high levels (83%), whereas the South East Trust was an extremely low 36%. Most of the other Trust areas were around 50%. These figures effectively mean that in most areas large numbers of vulnerable people are not receiving support.

SD1 (Sudden Death 1) Process

After raising the issue of post-bereavement support with the health and police authorities, the MHRC  found that that the form for the SD1 process – the process by which the police service can arrange support for family members who have lost a loved one  to suicide –  states that it would be reviewed on an annual basis.  

However, information received under Freedom of Information legislation shows that this is not the case.

In April 2017 freedom of information requests were submitted to four relevant departments – in health and policing – who have responsibility for aspects of the SD1 process. The requests asked for the following information:

Question asked: All documentation (reports, evaluations, briefings, etc.), meeting minutes and emails/correspondence (internal and external) referencing the annual reviews of SD1 Forms held by the [relevant public body] from years 2013 – 2017.

Response (May 2017):

Department of Health – “I have been reliably informed this information is not held in the Department of Health (DoH). It may be held in the Public Health Agency and you should re-submit your request to the address below.”

Department of Justice – “The request was forwarded to the Northern Ireland Courts and Tribunals Service (NICTS) for consideration and reply. We have conducted a search of our records and can confirm that the information you have requested is not held by NICTS. You may however wish to redirect your request to Police Service of Northern Ireland (PSNI) as they may hold some of the information you are seeking.”

PSNI – “PSNI, Custody Healthcare has advised there is not an annual review or any formal review of the SD1 form.

There are regular forums in relation to the SD1/Community Response Plan, coordinated by the Public Health Agency (PHA), this forum is intended to review how the referral mechanism is working and to address shortcomings; however the SD1 form is not regularly reviewed at this forum.”

Information was then sought from the Public Health Agency (PHA) about this forum. The PHA confirmed that forum started in 2013 and meet once every six months and stated that one of the Forum’s key roles is to:

“Promote effective working relationships between relevant agencies involved in Sudden Death 1 Forms (SD1) Process in the local 5 Health and Social Care Trust areas as well as implementation of the Protect Life Strategy”.

In addition, the forum is tasked with “addressing any concerns in relation to SD1s in the 5 Health and Social Care Trusts.”

Despite these responsibilities, the minutes of the eight meetings that have taken place show very little discussion about the SD1 process.

Any discussions relating to problems with referrals did not lead to actions and were not carried forward to subsequent meetings. Issues about levels of uptake were noted in the April 2016 meeting, with the forum noting the 'significant' drop in people agreeing to support in the South Eastern, Western and Belfast trust areas. Yet no significant actions were put in place to address this.

Evaluation of the SD1 process

Given that “monitoring the SD1 process” is a key role for the forum, and given the recognised low uptake and problems with referrals, it is extremely alarming that regular reviews of the SD1 process are not undertaken.

While the PHA confirmed that there is an ongoing evaluation of the SD1 process that will be completed by March 2018, the minutes from the meetings indicated that this started four years ago in April 2014.

Focus groups carried out by the Mental Health Rights Campaign raised questions about the appropriateness of being asked for consent for follow-up support at the scene of death.

Information received under Freedom of Information furthermore shows that the forum itself noted evidence by suicide prevention expert Professor Siobhan O’Neil that suggests a more appropriate follow-up should be considered noting:

“It’s acknowledged that with high emotions at the scene, it can be difficult for a PSNI officer to gauge when the best time to talk to the family about follow-up support is."

However the PSNI representative claimed that under data protection automatic referral is not possible (despite this not being an obstacle for victims of crime), and the discussion did not progress.

This key suicide prevention issue has been kicked into the long grass for too long.  SAFER Campaigners are calling on the Chief Constable to prioritise and   take action on this issue.