Suicides in England, Wales and Scotland: a real-time monitoring system

The UK Government identified the need for real-time monitoring of suicide deaths in the Suicide Prevention Workplan.26 One way of fulfilling this ambition is to use police records of potential suicides, an approach that has been successfully implemented in several other countries.1 Led by the National Police Chiefs’ Council, and coordinated by British Transport Police (BTP), a new national real-time system for monitoring suicides across Great Britain (England, Wales and Scotland) has been developed and is now operational.

The police have a legal obligation to attend all sudden, unexpected deaths, including those occurring in prisons, hospitals and the armed forces. They subsequently complete a report which is submitted to the local coroner as information for the inquest. These data are already being used in some areas as the basis for real-time monitoring of suicides.27 Data from 10 established local real-time monitoring systems in England were used to monitor the effects of the COVID-19 pandemic on suicide rates.28 A real-time surveillance system for suicide has recently been established in Wales, through a partnership of Public Health Wales, all Welsh police forces and the NHS Wales Health Collaborative.29 The new Suicide Prevention Strategy for Scotland, currently in draft, refers to the importance of close monitoring of real-time data compiled by the police and Public Health Scotland.30 While these initiatives represent excellent progress, a consistent, country-wide approach to unify the methods adopted in local areas and the home nations would enable a more coherent and strategic approach to suicide prevention at a national level.

Since April 2021, a standardised method of reporting has been implemented across police forces in England, Scotland and Wales. Each force uses the standardised template to record all suspected suicides in their area which they then send to a central BTP team using a secure email. The data are compiled and analysed by the central police team to create a national monitoring system for suspected suicide deaths. The proportion of forces returning data has gradually increased, such that by December 2022 it had reached 98% coverage of the population of Great Britain (figure 1). Reports are compiled with a time-lag of one calendar month. This makes the system the most timely and comprehensive overview of suicides currently available in the UK.

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Figure 1

Suspected suicides in Great Britain (England, Scotland and Wales) April 2021 to December 2022. *One police force did not submit data until December 2022. For this force, estimated deaths are calculated in proportion to the area’s population. In some months, some areas’ returns are missing a small proportion of their data (eg, from one contributing force). In such cases, missing data are calculated on the basis of an average of the previous returns for that force’s area, and revised when actual data become available.

Content of the police-led suicide surveillance system

Police submit data on all deaths judged to be suspected suicides. In determining whether a death should be recorded as a suspected suicide, they refer to a standard definition and detailed assessment guidance, based on the ‘Ovenstone’ criteria.31 The data collected by individual forces include demographic information, such as age, gender and nationality, as well as life events, mental health problems and previous police contact. The police also record the details of the circumstances of the death, such as the time, date, location and method. The full list of categories is set out in table 1. The availability of information at the time of death will vary from case to case but there is the provision for the data to be revised at a later stage, if new details become available.

A recent analysis indicated that the completion rates for age and gender, and the date, location and method of death were at 98% or above (table 1). A higher proportion of data was missing across other variables. This is likely to improve as the system becomes more embedded in police processes, or if more resources become available to dedicate to data collection.

Insights, opportunities and challenges

One of the advantages of a standardised system is that it facilitates comparison between geographic areas. In addition, the police-led RTSS system records both the location of death as well as the home address of the deceased. The official statistics in the UK, in contrast, are based only on ‘usual place of residence’ and may therefore miss opportunities to identify high-risk locations. For example, analysis of the first full year of data from the new system revealed that the highest suicide rate per 100 000 population occurred in one specific local authority area in England which includes a known location of concern. Here, the rate was over double that of the area with the next highest rate, and further analysis indicated that this was due to the high number of people who had travelled from outside the area. Such insights are vital in order to target suicide prevention resources effectively, and for timely postvention efforts to support affected communities.

Another advantage of the police-led real-time system is that suicides are recorded according to the date of the death. In contrast, official statistics in the UK are based on the registration of a death, which cannot occur until after the inquest has taken place. The Office for National Statistics (ONS) calculates that around half the registered deaths reported in 1 year actually took place in the previous year.31 This means that it is not possible to identify whether specific events, such as the suicide of a high-profile person, or a change in national policy, had an effect on suicide rates. Any changes in suicide rates in the immediate aftermath of a time-specific event would, however, be observable in the police-led system, which is based on the date of death. For example, 2 of the 8 days with the highest recorded daily number of suspected suicides in the year from April 2021 occurred in the week following the withdrawal of a time-limited increase in the level of means-tested benefit payments in the UK. While no direct inference can be made from such an observation, it provides a pointer to a possible risk factor which can be explored in more depth in subsequent research.

In terms of data quality, strengthened guidance given to individual police forces has helped improve consistency; for example, around the definition of suspected suicide. Quality assurance audits will be carried out to monitor the robustness of the data, and to increase reporting to reach the target of 100% population coverage.

While the system allows for the collection of data relating to the demographics and life circumstances of the individual, these fields inevitably contain a proportion of missing data due to the availability of such information at the time of death. Such fields therefore need to be analysed and interpreted with caution, to ward against the unintended consequences of drawing too robust a conclusion based on incomplete and unverified data (eg, regarding sexual orientation, cultural heritage or historical risk factors). Some real-time systems address this problem by linking to other data sources, such as medical or criminal records. However, such a process takes time, possibly delaying publication, and reducing the main benefit of a real-time system. In addition, for data protection reasons, individually identifying information is not currently recorded in the national police monitoring system. The data collected cannot therefore be subsequently traced back to specific individuals in order to supplement the information with data from other sources. This also prevents subsequent review and validation of individual cases after coronial inquest, which can improve data quality, completeness and sensitivity.3 It may be that in the future the advantages of data linkage may outweigh data protection concerns. In the meantime, it will be necessary to be transparent in the reporting of fields which are based on fewer than 100% cases. It is important to emphasise, however, that the main fields of age and gender, plus the time, method and circumstances of death, have so far been at least 98% complete. The timely availability of this information alone, on a consistent national basis, represents a major step forward in real-time monitoring of suicides in Great Britain.

Ethical considerations

The association between the police and suicide is not without controversy, given the history of the criminalisation of suicide,32 and more recent concern over police involvement in mental health interventions.33 However, most of the data described here are already routinely collected by the police when they attend a sudden and unexpected death to investigate if it may be suspicious. It also already forms the basis of most established real-time systems used by local areas.28 The standardised system will allow individual forces to engage with partners to respond to local trends, where they occur, as well as to compare their own data with other geographic areas.

Alternatively, while the police have led the initial work on this initiative, and continue to collect information at a local level, it would be possible for a different organisation, outside the police, to compile, analyse and publish the data. Indeed, it may be considered more appropriate for the analytical work to be conducted by one or more independent organisation, such as an academic institution (for research) or a public health agency (for surveillance and preventive action). Whoever is responsible for the system long term, the main priority must be to share timely and accurate data on a regular, need-to-know basis to inform rapid prevention initiatives at national and local levels. Automated notification processes for new trends and emerging clusters are also recommended best practice.3 Currently, the aggregated data are only accessible to authorised BTP staff, and used by them to contribute to national and local reviews relevant to suicide prevention.

The reporting of suicide statistics, even in an aggregated, anonymised way, needs to be done in a way that is respectful of the individuals that have died and their loved ones, and that does not sensationalise or promote suicide. The police are working with partners such as Samaritans, Zero Suicide Alliance34 and academics in the field to ensure sensitive data reporting, in line with Samaritans media reporting guidelines.35 Importantly, further discussions with people with lived experience and partners in public health and other sectors will need to take place to decide how and in what way the results should be disseminated.