The Zero Suicide Policy challenges

The Five Year Forward View for Mental Health called for the Department of Health, Public Health England and NHS England to support all local areas to have multi-agency suicide prevention plans in place as part of major drive to reduce suicides in England by 10 per cent by 2020/21.

Dr David Fearnley, Medical Director at Mersey Care NHS Foundation Trust and the recently-appointed Associate National Clinical Director for Secure Mental Health at NHS England, talks about the Zero Suicide Policy introduced at the Trust in 2015, the role the NHS can play in suicide prevention, and the impact that deaths from suicide are having.

Suicide is the biggest killer of men under the age of 45.

Yet prevention remains difficult – so many times people will say that it was a complete surprise when someone they knew died by suicide.

The reluctance to talk about our emotional life is perhaps one of the toughest issues for men to tackle – how do we cope if we become aware of thoughts of suicide in others and perhaps even ourselves?

The stigma is profound. We still use phrases such as ‘committed suicide’, reminding us of the days when suicide was a crime that people ‘committed’.

The concept of ‘zero suicide’ grew out of frustration about the existing approaches to suicide prevention in the US. It challenges to some extent the prevailing wisdom that suicide is inevitable for some people when they hit rock bottom.

The idea of ‘zero suicide’ provokes debate about how much more we might be able to do in the future to avoid such tragedies. It is very hard to look back and think that perhaps something was missed, and the ‘zero suicide’ approach recognises up front that such ambition has no place at all for blame.

However, the evidence base for achieving ‘zero suicide’ is limited. That is why it is so important to measure any ‘zero suicide’ initiative, any such innovation, to quickly identify whether or not it helps prevent suicide.

Perhaps the best known example of a ‘zero suicide’ programme is that of the Henry Ford Hospital System, Detroit. They pioneered a perfect depression care pathway, with zero suicide as the key outcome measure. Their data show a dramatic reduction in suicide over a ten year period, eventually reaching zero.

Dr Ed Coffey led this work and visited Mersey Care in 2013 and 2014 to share the insights and lessons learned from the programme. This was an inspirational moment for Mersey Care, leading to a strong desire to emulate the ambition and success of the Detroit pioneers.

Mersey Care’s Board approved a Zero Suicide Policy in 2015, the first mental health trust to state such ambition. The Board would not accept in principle that suicide was inevitable or unavoidable for anyone within its care. On the contrary, it recognised that only by learning from every tragedy, the likelihood of further suicide would be reduced.

It created a Zero Suicide Programme Board, chaired by the Medical Director, and established a plan focused on using proven quality improvement techniques, co-production with experts by experience, universal staff training, psychologically informed safety planning, support for those affected following a death, and high quality evaluation by academics. Further innovation is being developed, using a smartphone app to improve outcomes.

The ‘zero suicide’ policy is aligned to the Cheshire and Merseyside Suicide Prevention Network ‘NO MORE’ suicide prevention strategy – aiming for zero as the only acceptable outcome. This integration of partners is essential to create communities that are able to promote well-being and a greater awareness of mental health distress and ill health.

The Mersey Care ‘zero suicide’ programme uses a scientific model – the evaluation is being conducted openly and our results will be published for others to scrutinise and test.

We hope others will join us and learn from our approach.

David Fearnley

Dr David Fearnley was appointed Consultant Forensic Psychiatrist in 2001, at Ashworth Hospital, one of three high security hospitals in England.

He was appointed Medical Director for Mersey Care NHS Trust in 2005, where he was also seconded as Medical Director for Calderstones Partnership NHS Foundation Trust (May 2015-July 2016).

A former Psychiatrist of the Year (2009) by the Inaugural Royal College of Psychiatrists, David also received the Healthcare Financial Management Association (in association with the Academy of Royal Colleges) ‘Working with Finance – Clinician of the Year’ award (2013).

He was named in HSJs “100 Clinical Leaders List” (2015) as Mersey Care Trust’s driving force behind an international partnership with The Risk Authority, Stanford, and Lockton insurance brokers to manage and predict risk in mental health.

In 2016, David was appointed Associate National Clinical Director for Secure Mental Health and Chair of the Adult Secure Clinical Reference Group, NHS England.


  1. Briar Redgrave-Plumb says:

    My son has repeatedly threatened to commit suicide but this week the sudden and unexpected death of his beautiful 2 year old golden retriever send him over the top.I managed to get him down when he was hanging from my stairs.He has been refused mental health support because he uses cannabis as he feels it is the only thing he can trust.

  2. David Greenwood says:

    I would like to suggest that the deeply entrenched view that men find it difficult to talk about their feelings is not correct; in fact it is a load of bolony. Especially as I have twice in my life felt that life was not worth living. (I am now 85).
    What is correct is that men would never ever talk to a medical practioner (in the widest sense). Nor would they talk to a social service worker. ( I cannot answer for women). The simplest way I can express this is that medical and social service staff DO NOT CARE. Working as a (non-medical) volunteer befriender in an NHS mental health trust hospital in an in-patient ward I can say that the staff quite simply did not connect with their patients. If they cannot connect, who can?
    But few men do not talk to some one. If family relationships a are the problem they will talk to friends. Most important they need someone who will LISTEN. When the patients I worked with realised I would listen to them, they couldn’t stop talking.
    In a more general way failure to listen is a very common failure in health and social services.

  3. Francesco Palma says:

    The Henry Ford Hospital System did reduce suicides over a two year period to Zero for a population of 200,000 that paid into a medicare plan, the other 700,000 of the total population of Detroit of 900,000 had no such plans so the stats are not convincing.
    The John Ford Hospital System covered Primary and Secondary Care, Both physical and Mental Health Care.
    Take the South West Zero Suicide Collaborative of which I am a member covers a population of 5 million, it has different CCG’s, different Local Authorities,GP Practices, different Mental Health Trusts etc etc,unlike the joined up Henry Ford Model, funding for the collaborative is not assured for the future with NHS England and the Academic Health Science Network not committing funds.
    If Preventing People Dying Prematurely (Domain 1, NHS Outcomes Framework)along with the Five Year Forward View to reduce suicide by 10% by 2020,is the ambition then is will this be the fall back position for those Trusts with a Zero Suicide Policy.