Aiming for ‘zero suicides’

1 October 2015

An evaluation of a whole system approach to suicide prevention in the East of England

Lawrence Moulin

Centre for Mental Health was commissioned by the East of England Strategic Clinical Networks to evaluate activity taking place in four local areas in the region through a pilot programme to extend suicide prevention into communities.

The ‘zero suicide’ initiative is based on an approach developed by Dr Ed Coffey in Detroit, Michigan. The approach aims to prevent suicides by creating a more open environment for people to talk about suicidal thoughts and enabling others to help them. It particularly aims to reach people who have not been reached through previous initiatives and to address gaps in existing provision.

Four local areas in the East of England (Bedfordshire, Cambridgeshire & Peterborough, Essex and Hertfordshire) were selected in 2013 as pathfinder sites to develop new approaches to suicide prevention. Centre for Mental Health evaluated the work of the sites during 2015.

The evaluation found an impressive range of activities that had taken suicide prevention activities out into local communities. They included:

  • Training key public service staff such as GPs, police officers, teachers and housing officers
  • Training others who may encounter someone at risk of taking their own life, such as pub landlords, coroners, private security staff, faith groups and gym workers
  • Creating ‘community champions’ to put local people in control of activities
  • Putting in place practical suicide prevention measures in ‘hot spots’ such as bridges and railways
  • Working with local newspapers, radio and social media to raise awareness in the wider community
  • Supporting safety planning for people at risk of suicide, involving families and carers throughout the process
  • Linking with local crisis services to ensure people get speedy access to evidence-based treatments.

The report noted that some of the people who received the training had already saved lives:

I saved a man’s life using the skills you taught us on the course. I cannot find words to properly express the gratitude I have for that. Without the training I would have been in bits. It was a very public place, packed with people – but, to onlookers, we just looked like two blokes sitting on a bench talking.

The report finds that there is both an economic and a humanitarian case for improved suicide prevention work in communities. The economic and social cost of one suicide is estimated at £1.5 million. Effective suicide prevention activities are therefore likely to be highly cost-effective.

The report concludes that:

  • With a clear and shared vision, a challenging objective (zero suicides), and the right capacity, local groups can develop and deliver creative and effective local approaches to suicide reduction.
  • A real partnership between community groups, the third sector and the statutory sector can unlock previously unrecognised social capital and local knowledge.
  • Integrating services with web and social media communication can be a core part of any such programme, and can play a more central role than simple information sharing.


The evaluation explored ways in which the benefits of this initiative could be made more widely available. Its recommendations include:

  • Health Education England should ensure that effective suicide prevention training is included in core professional education and within Continuing Professional Development for all NHS staff.
  • Training bodies for other public service staff (eg police officers) should build suicide prevention into the core of their professional training and development.
  • Public Health England should work with coroners to carry out regular suicide audits.
  • Timely, accurate and reliable data are vital to carry out evaluations of the effectiveness of suicide prevention programmes.

The projects reinforce the importance of implementing the principles of the ‘zero suicide’ approach and using evidence-based interventions. This includes greater use of safety planning instead of risk assessment, working with families and carers, for people at risk of taking their own lives, and of removing the means of suicide from ‘hot spots’.

It is also recommended that local mental health Crisis Care Concordat action plans incorporate suicide prevention methodology and training.

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