A spate of suicides in the Welsh town of Bridgend prompted local services to work together to pre-empt a repeat. Andrew Mickel reports on the strategy and the lessons learned
For all of the acres of newspaper coverage and hours of TV output on the spate of suicides in Bridgend County, what we actually know about what happened is sparse.
From what little research has been done into suicide clusters – and it isn’t yet certain that what happened in Wales can even be classed as a cluster – there are few concrete conclusions about how or why they form.
What is certain, though, is that in situations like this a rapid response has to be put in place to stop more deaths from happening.
“Clusters of suicides are not entirely uncommon but the cluster at Bridgend was unique, particularly with the media,” says Phill Chick, mental health director for the Welsh Assembly government at the time of the spate. “What the services had to cope with at the time was very unusual.”
The series of events put the local authorities in the difficult position of trying to build a response to something of which they had no experience.
By January 2008, the number of apparent suicides over the previous year stood at 13 and the world’s media were starting to draw links between some of the deaths.
What the authorities did have at their disposal, however, was strong community engagement with which to identify the young people who needed support and respond to their needs.
Finding those young people entailed going well beyond those already in touch with mental health services and using the eyes and ears of statutory services, the voluntary sector and the public.
Engaging local people
Although the area’s services were already trying to engage with local people to tackle the issue, at the start of 2008 the area’s local service board – similar to an English local strategic partnership board – created a suicide management group to help co-ordinate effective multi-agency action.
“One fact I’ve often quoted is that 73% of people who commit suicide haven’t been in touch with mental health specialist services a year before their death,” says Chick.
“The success of the local service board as a place for bringing together services was that it brought together health, social care and community groups to provide a platform for a very broad community response.”
“We made sure we were capturing everybody,” says Bridgend chief executive Jo Farrar, who chairs the local service board.
“Young people might come through health or the police, and the public too were worried and reporting more vulnerable young people until we had 300 people identified. From there we strengthened services such as the youth offending and after-care teams; we helped people in the community. We were able to provide more support for young people and help them more effectively.”
For many young people, there were already many services available whose existence just needed flagging.
The youth counselling service was given extra resources, as were two counselling services in the voluntary sector. There are at least a dozen youth centres available with qualified youth workers on the staff.
The board’s efforts were bolstered by the Bridgend street pastors who worked hard to make contact with young people.
“They are brilliant in Bridgend anyway and they set up a Solid Rock café and the young people love it,” Farrar says. Now lottery money is targeted at the local voluntary sector.
For the list of 300 people identified as being more vulnerable, a sub-group of the suicide management group worked together to tailor services individually.
As well as planning when they needed support – often around key birthdays and anniversaries – on-going services were funded.
The local child and adolescent mental health service relaxed its age criteria to ensure all vulnerable young people were seen by the service, while an additional nurse and doctor were recruited. Adult mental health services were bolstered with weekend and evening drop-in clinics.
On top of all this, a lottery-funded £1m Let’s Talk initiative has been set up, including two Asist (Applied Suicide Intervention Skills Training) co-ordinators to help train people to identify those at risk of suicide in the community.
Another lesson learned from Bridgend, however, is that having services alone is not enough: people have to feel like they have ownership of services.
“We had an occasion where a small community suffered a series of tragedies and we were considering how to put a response in,” says Chief Supt Tim Jones, who was divisional commander of Bridgend police at the time.
“They said, don’t just bring youth outreach workers to young people on the streets, come to the youth club on a Tuesday at 7.30pm. And it worked. We did that successfully and, after we’d moulded a response in the community, it helped us to create a template to engage.”
With health and social services providing more out-of-hours services, the work did not come cheap.
A small grant from the Welsh government helped, but the principle of out-of-hours payments needs greater clarity, according to a review of the suicides response.
“We had to do it on top of the day job so we had to move our resources around,” says Farrar.
“We tried to free up people – the council [including children’s services], police, health [including mental health services], police, the voluntary sector. It was difficult because we also had business as usual.”
The emergency response in Bridgend has now been integrated into ordinary services, and is responsible for the 300 vulnerable people on the operations sub-group list passed back to the agencies. But the group would be started up again should a pattern of suicides re-occur.
Making effective support networks a normal reality is now a priority. Farrar flags up as a good piece of work a project by some GCSE students involving the use of social networks to help support young people.
The Welsh government has also unveiled a consultation on a national suicide strategy, in part informed by what happened in Bridgend. In the county itself, the number of suicides fell from August 2008 to more typical levels. The challenge now is to make sure it stays that way.
● Quickly put a multi-agency structure into place with clear leadership and clear responsibilities for all parties.
● Identify the most vulnerable people in order to focus resources where they are most needed, and prevent small problems growing larger by supporting lower-level need.
● Liaise with community leaders to ensure the response makes the most of resources.
● Involve all groups that have contact with a client group, and make sure all professionals know what other services are available.
The Bridgend case
The apparent cluster of suicides in Bridgend County started in January 2007, but first came to national attention after being linked together in the media in January 2008.
Although the Centre for Suicide Research at Oxford University has suggested that irresponsible media coverage can lead to further deaths, it was variously claimed in the press that everything from social networking sites to phone masts could be responsible.
Coverage of the town, meanwhile, painted Bridgend as an area with high unemployment and long-term sick levels, and daubed the town as the suicide capital of Britain, despite the fact most deaths took place in the wider county.
This article is published in the 23 July issue of Community Care magazine under the heading Suicide Watch