Zero suicide cities: learning from Detroit in the UK

Suicide is the biggest killer of men under the age of 45. Yet people still experience stigma when seeking help for mental illness, despite high-profile discussions of mental health issues such as those by members of the royal family and sportspeople. And a report into the Government’s suicide prevention strategy in March 2017, suggested that although 95% of local authorities now have a suicide prevention plan, there is little or no information about the quality of those plans, or whether adequate funding is available to implement them.

The lack of progress made on improving suicide and general mental health provision has led to a growing frustration among professionals and resulted in attempts to create new approaches to tackle mental health issues, and in particular to improve access to support for people in crisis or at risk of suicide.

The idea of a “zero suicide city” was first adopted in Detroit in the late 2000’s, with others following its lead in subsequent years. With reports finding that around 14 Londoners a week took their own life in 2015 (735 in total), an increase of a third from the 2014 statistics, a report in February 2017 by the London Assembly Health Committee suggested that London too should take this approach.

So what can London, and other areas of the UK, learn from Detroit’s approach? And how can services act to reduce the number of people taking their own lives?

Zero-suicide cities

Poverty and high unemployment in Detroit are contributing factors to high levels of depression among city residents. As a result of these high rates of depression and very high suicide statistics, Detroit-based mental health professionals adopted a new approach to tackle the stigma around mental illness and use identifiers to highlight cases of crisis, or potential crisis. The focus is on preventative care, encouraging professionals to act upon signs of mental illness before a suicide or attempted suicide takes place.

Patients attending health clinics for other illnesses, including diabetes or heart failure, are also now screened for depression and other mental health issues before they are released. This allows people deemed to be ‘at risk’ to be identified as soon as they come into contact with medical professionals, who can then refer the patient to a mental health specialist if needed, rather than reacting to mental illness once it reaches crisis point.

In order to support this approach, a centralised IT system was created which means results are traceable, and surveys and information are standardised so they can be used and accessed across clinics throughout Detroit. Coordination with non-medical practitioners, including social workers, employers and family members, has also been key in identifying people at risk and signposting them to help at every possible opportunity. There has also been additional training for staff to improve recognition of identifying factors. Patients can email their clinicians or liaising staff directly and attend regular drop-in appointments. Up to 12,000 patients using mental health facilities are tracked each year in the city and some statistics suggest that the clinics reduced suicides by over 80%.

There have been some criticisms of the system however, despite the reduction in the number of suicides in the city. Critics highlight the fact that many of the poorest and most severely in need of help are not reached as they do not have health insurance and so do not attend those clinics involved in the scheme.

Ultimately, however, the scheme seeks to provide better preventative, coordinated and targeted care to those who are at risk or show some signs of mental health crisis. And some in the UK have suggested there are lessons that could be learned from this approach.

Whole system approach to suicide prevention in the East of England

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 based in part on the Detroit model.

Since then, Mersey Care, Cambridge and Peterborough Clinical Commissioning Group and Teesside councils have also become aligned with the programme and are continuing with their approach towards improved suicide prevention. The Centre for Mental Health evaluated the work of some of the sites during 2015.

The evaluation found there were a 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 relating to promoting positive mental health and signposting to help services
  • 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.

However, subsequent research also highlighted some of the challenges. The marketing of the pilots was seen to be damaging and misleading with regards to creating “zero suicide areas”, rather than suicide prevention areas. It has also been suggested that although the campaigns serve to raise publicity and awareness, there is little evidence that the schemes actually reduce the number of suicides in an area any more than “traditional campaigns” to better signpost people to available support.

In addition, many of the projects struggled past the initial implementation stage to have long-term impact, as the buy-in from local GPs and other service professionals was not as high as was expected.

Final thoughts

Widening and improving access to support and services for people at risk of mental ill health or suicide is a big challenge for health and social care professionals. Identifying those people at risk is one of the key barriers and taking inspiration from schemes like those trialled in Detroit is one way for professionals in the UK to adapt their approaches in order to overcome these barriers.

Providing more opportunities for people to get help, and better training for professionals who may come into contact with people with mental illness are some of the ways that current schemes are trying to address mental health and suicide in particular.

However, as many of the evaluative studies from test sites in the UK have found, going beyond that to take mental health into the community, in order to create whole system pathways of care across multiple settings and professions, remains a challenge.

As the London Assembly report pointed out, another key aspect is creating an open environment for people to talk about how they are feeling. This week is Mental Health Awareness Week 2017 and the theme is ‘surviving to thriving’ – and emphasising that good mental health is more than the absence of a mental health problem. Whether in the workplace or in the home; with friends, family or colleagues; it’s important that everyone feels that they have a space where they can talk, and to cultivate resilience and good mental health.


If you enjoyed this blog, you may also be interested in our other articles on mental health in the workplace.

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Supercouncils: questions raised about new powers for England’s combined authorities

town hall photo

Image: James Carson

Just over a year ago, Manchester began blazing a trail for devolution in England. Ten local authorities in the Greater Manchester Combined Authority (GMCA) signed a deal with George Osborne, the Chancellor of the Exchequer, for the transfer of powers in areas such as transport and skills from central to local government.

Since then, the English devolution bandwagon has picked up speed. After the general election in May, the newly-elected Conservative government introduced a Cities and Devolution Bill , creating a framework for the transfer of powers to the regions, and making provision for directly elected mayors.

During the summer, the Chancellor invited cities, towns and communities across the UK to submit their own devolution proposals, and by September 38 submissions had been received (including a number from Scotland and Wales).

Meanwhile, further deals have been announced, giving greater autonomy to local authorities in Sheffield, Cornwall, the North East of England and the Tees Valley. In November, two further deals were announced for the West Midlands and Liverpool.

As its momentum gathers pace, questions have arisen over the nature and implications of devolution for England’s cities and regions.

The devolution time frame

In October, a survey for Local Government Chronicle (LGC) highlighted concerns about the devolution timetable. 69% of the 45 chief executives and deputies responding to the survey indicated that the seven-week timeframe given to put a proposal together had been too tight. Of those councils which had not submitted a bid, 38% said they could not arrange a partnership with another authority, while 8% said they could not convince politicians in their area to agree.  However, the survey also indicated that 15% of councils were holding back on bids to see how other authorities fared first.

Accountability, transparency, public involvement

Some of the key governance issues surrounding devolution were considered in a report by the Centre for Public Scrutiny.

The report was critical of the secrecy of the deal-making process, noting that details were only being released when agreements had been reached:

“Local people – anyone, indeed, not involved in the negotiations – need to understand what devolution priorities are being arrived at and agreed on. Increased public exposure in this process will lead to a more informed local debate. At the very least, the broad shape and principles of a bid for more devolved powers should be opened up to the public eye.”

The report argued that governance arrangements for the work that combined authority areas will be doing in future need to satisfy three conditions:

  • Accountability: decision-makers must clearly take responsibility, and engage with those seeking to hold them to account (non-executives, the public, and others)
  • Transparency: it must be clear (to professionals, elected councillors and the public) who is making decisions, on what, when, why and how
  • Involvement: a commitment to public involvement should be seen as central to good governance.

Directly elected mayors

In 2012, plans to replace local council cabinets with directly elected mayors were rejected by voters in nine English cities, including Manchester, Newcastle, Sheffield and Leeds.

However, the government has insisted that devolving powers to English regions is now conditional on the inclusion of directly elected mayors. In May the chancellor explained why he thought this was so important:

“It’s right people have a single point of accountability; someone they elect, who takes the decisions and carries the can. So with these new powers for cities must come new city-wide elected mayors who work with local councils. I will not impose this model on anyone. But nor will I settle for less.”

George Jones, Emeritus Professor of Government at the London School of Economics, has asserted that the concentration of power in one person is undesirable:

“…the advantage of collective leadership is it enables exploration of policy from different perspectives. Colleagues can consider possible impacts of policy in a variety of contexts, spotting pitfalls ahead and the consequences for different people and groups. A single person is unlikely to represent the diverse complexities of a large urban, metropolitan or county region area better than can collective leadership.”

The journey to greater autonomy for England’s regions has only just begun, but it’s already clear that the path to devolution will not be straightforward.


Read more about English devolution in our previous blogs:

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Grey men dreaming of vibrant cities?

Image by Neil Howard under Creative Commons

Image of MediaCity, Manchester by Neil Howard under Creative Commons

By Morwen Johnson

They control combined budgets of over £10bn, deliver 24.4% of the combined economic output of England, Scotland and Wales, and are home to over 21 million people. What are they? The Core Cities of the UK – and as pre-election lobbying ramps up a gear they are at the forefront of the devolution debate.

Last week I attended the Core Cities Devolution Summit. This event, hosted in Glasgow, marked the launch of a modern charter for local freedom. It also gave those interested in the current cities agenda a chance to hear from the city leaders on the potential benefits of reform.

I won’t summarise the charter, or the main recommendations of a new report from ResPublica which argues for the fullest possible devolution of public spending and tax raising powers to the UK’s largest cities and city regions. Instead, here are a few reflections on the day.

Bespoke devolution

The hype over Manchester’s recent devolution agreement with the Treasury shouldn’t distract from the fact that devolution is not a one-size-fits-all model. The idea isn’t to try and mimic Manchester’s journey – what’s on the cards is an approach that takes account of local circumstances.

I’m not sure that the end result of this – potentially radically different priorities in revenue generation, service delivery and spending between neighbouring metropolitan areas – is being communicated in a transparent way. Ben Page from IpsosMori shared some interesting survey results which suggest that public opinion also lags behind the political agenda:

ipsos survey 1

ipsos survey 2Leadership not bureaucracy

Mention devolution and one of the immediate responses of naysayers is to complain it’s just yet another layer of governance – more costs, more staff, more vested interests. This was raised during Q&A and the panel responded by saying that what they are proposing doesn’t require massive reorganisation – it’s about effective leadership. The same pots of money are used but funds can be accessed in different ways for different purposes.

This was only half-convincing. Repeated reference to place-based decision-making (breaking down functional /organisational silos to ensure services are focused on outcomes and those residents with complex needs) didn’t really explain how you build the trust and political capacity that’s needed to roll out transformation across multiple agencies/workforces at the same speed and scale.

Equalities

Presenting a different perspective on the day was Professor Lesley Sawers, who highlighted the risks of unintended consequences from devolution in terms of social justice and inequalities. She argued that so far localism has led to an approach to investment that has not been particularly effective in tackling equalities issues.

Cities should be great agents of social reform but the rhetoric around growth has a tendency to focus on infrastructure and macroeconomics – ignoring social challenges such as skills, poverty and under-achievement. And it may seem an easy point to score, but running an event with only 3 female speakers out of 25, didn’t really send a great message to observers. Don’t even mention the lack of ethnic diversity on the platform.

What now?

The devolution agenda may be the ‘only show in town’ but whether the core cities can take advantage of this to benefit and engage their own populations remains to be seen.


The Idox Information Service has a wealth of research reports, articles and case studies on governance and city regions. Members receive regular briefings as well as access to our Ask a Researcher enquiry service.

Putting the “Smarts” into Smart Cities

Liverpool Albert Dock

by Rebecca Riley

Last week I attended a workshop organised by Red Ninja Studios, bringing together a wide range of place based organisations, to explore what a technologically integrated future for Liverpool would look like. We spent the day exploring the three main domains of economy, health and transport, what the issues were in the city, what data was available and what innovative ideas we had to solve the issues through technology.

The discussion was interesting and lively but throughout the sessions I kept coming back to ‘why?’. Technology seemed to be the answer but what was the question, what were we trying to achieve?

Smart Cities is the latest policy buzzword – our briefing earlier in the week highlighted the wealth of research and development which is going on in this area and how great leaps in technology are changing the way we live and work in cities. The danger with looking at developing Smart Cities is that the opportunities and options are boundless, and this came through in the workshop. Smart travel systems, integrated health care, environmental measurement, technology development, graduate retention, high quality jobs, access to learning –  all could be tackled through integrated next generation technology. So how do we prioritise and get the highest impact we can in a city such as Liverpool?

One of the participants asked “what connects all these ideas, what integrates them?” the simple answer is people, not technology.

So on returning to my desk (or rather my kitchen as I am one of the nation’s 4.2m home workers) I started to think about what ‘people’ would want from a technology driven environment, rather than what the technology will deliver to the people.

A guide on service design in smart cities highlights that we have to start with the ‘business proposition’; people have to be willing to ‘buy’ the service on offer. It highlights two reasons for improvement:

Improving customer service

  • Increasing the take up of services among key groups to achieve targets
  • Making it easier to access services
  • Giving a better service
  • Giving a service targeted to individual needs
  • Giving access to a broader range of services

Improving efficiency

  • Increasing take up among key groups to increase income
  • Increasing early take up and reducing more expensive interventions later
  • Improving processes to streamline services and reduce costs
  • Switching customers to more cost efficient channels

These business imperatives should be at the heart of any technology implementation and technology can impact across all these goals but, form should follow function.

When people were asked by Steer Davies Gleave what words describe a ‘Smart’ city their response was surprising. Although there were a wide range of answers (reflecting the diversity of the term), ‘clean’ and ‘technology’ came out top, followed by ‘transport’, ‘friendly’, ‘connect’, ‘internet’ and ‘eco’. Overall people said smart cities should aim to be ‘a pleasant place to live, work and socialise’ with a ‘healthy, vibrant economy’, and sustainability was at the bottom of the list. When answers were normalised for population, Oxford, York, Bath and Cambridge were seen as the most ‘smart’ cities – all areas with higher ‘smart’ populations as well as ‘nice’ places to live. The priorities for making cities smarter were seen as availability of facilities and services (shops, places to eat and drink, sports and entertainment), modern public transport and safe, secure travel. People want good quality of life experiences.

Future Everything presented a series of essays aimed at shifting the debate on future cities towards the central place of citizens and open urban infrastructures. The essays focus on how cities can create the policies, structures and tools to engender a more innovative and participatory society. Dan Hill discusses the idea that “smart citizens make smart cities” and a city cannot be ‘managed’– it’s a living organic response to people’s lives, where people are often invisible in the management of transport or infrastructure systems. As Hill says, smart cities do not exist, but smart citizens do. The city is its people and technology should enable people to come together.

Can we harness the power of the citizen as an ‘organic sensor’ to improve services, drawing them in to actively engage with improving society? Can a ‘smart city’ be one where active, participatory, citizenship becomes central to the development of infrastructure? If a cities’ smart citizens applied their Instagram, TripAdvisor and Twitter engagement to the transport network or the health centre they use would it drive more responsive services? The answer is yes, but only if those services are listening or care. How can technology help citizens reclaim their space; would we all share information if it improves our quality of life?

The challenge for technology is to respond to the smart citizen, the millennials and generation Alpha will have very different demands, ones we cannot conceive of now. The challenge for government and large technology firms is not to emphasise top-down solutions but to respond to the issues, aspirations and abilities of individuals and make personal and civic responsibility core to a Smart City Vision.


Further reading

Smart cities – the who’s, what’s, where’s?

Accenture Survey 2013: What Travellers Want from Public Transport Providers

Smart Cities and Smart Citizens

Understanding Smart Cities: An integrative Framework

Smart Citizens

The Smart City Market: Opportunities for the UK