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NOBODY LEFT BEHIND: GOOD HEALTH AND A STRONG ECONOMY

THE ANNUAL REPORT OF THE DIRECTOR OF PUBLIC HEALTH IN LEEDS 2017/18 3

CONTENTS

A summary of this report can be made FOREWORD 5 available in large print, Braille, on audiotape or translated, upon request. Please contact the public health intelligence team STEERING IN THE RIGHT DIRECTION 7 [email protected] The Inclusive Growth Priority 9 The Health & Wellbeing Priority 13 This report is available online at Infant mortality and life expectancy 14 http://www.leeds.gov.uk/residents/Pages/Director-of- What other trends should concern us? 16 Public-Health-Annual-Report.aspx

Past reports can be accessed at http://observatory.leeds.gov.uk ALCOHOL-RELATED MORTALITY IN WOMEN 17 What is the story? 19 Further information on health statistics for Leeds is available online at What is happening in Leeds? 20 http://observatory.leeds.gov.uk What are we doing to tackle alcohol harm in Leeds? 20

We welcome feedback about our annual report or any of our other documents. If you have any comments please WOMEN’S MENTAL HEALTH 27 speak to Kathryn Jeffreys, Business Partner Manager on Self-harming and mental health 27 0113 3789221 or on [email protected] What is the picture for Leeds? 28 Editing: Barbara MacDonald What are we doing in Leeds? 28 [email protected] Design: Leeds City Council Communications and DRUG-RELATED DEATHS IN MEN 33 Marketing team [email protected] What’s happening in Leeds? 34 Print: Leeds City Council Print Management Forward Leeds – the local drug and alcohol service 36

© The Ordnance Survey mapping included within this publication is provided by Leeds City Council under licence from the Ordnance Survey in order to fulfil its public function to make available Council SUICIDES IN MEN 39 held public domain information. Persons viewing this mapping should What is the picture for Leeds? 39 contact Ordnance Survey copyright for advice where they wish to license Ordnance Survey mapping/map data for their own use. What are we doing in Leeds? 40 What do we need to do more of? 44 © Copyright Leeds City Council 2018 Rise High 46

CONCLUSIONS 48 RECOMMENDATIONS 2017-18 49 ACKNOWLEDGEMENTS 50

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FOREWORD

Welcome to my latest Public Health austerity”. We still are. I see Leeds We are also seeing more women, Annual Report for Leeds. City Council working hard to especially young women, self- I am very aware how privileged I am minimise the negative impacts on harming. So my report will focus to have the opportunity to produce Leeds residents of huge nationally on these four areas, recognising an Annual Report. Last year, in determined budget cuts, including the need to better understand the celebration of 150 years of Medical regrettably to public health. I see importance of gender. However, Officers of Health (now Director of partner organisations in Leeds faced before that, my report will also Public Health), I told the story of with similar difficult challenges. consider the worsening deprivation Public Health in Leeds through the Taking this into account, my report statistics and how Leeds City Annual Reports of my predecessors, this year focuses on what lies Council’s new Inclusive Growth going all the way back to 1866. I’m beneath these disappointing life Strategy must contribute to grateful for the level of interest that expectancy figures – and asks the reversing this position. resulted. I hope the filmed lecture question, should we be concerned? As always there are specific and resources will help future Perhaps surprisingly, the big killers recommendations for action, but generations and my thanks go to the – cardiovascular disease, cancer, I wish also to ensure a continuing Thackray Medical Museum for their respiratory disease – don’t play a close eye on our life expectancy Public Health Trail. significant part. We will therefore be figures, for men and for women. However, I am also privileged in that continuing with the huge amount For those who wish to see a Ian Cameron I am able to decide the content of of work going on across the city to broader range of health statistics, Director of Public Health my report. To be frank, this year’s reduce the impact these conditions whether for the whole city or just report is not the one that I started have on health and health inequalities. their local area, please go to out writing. I decided to change So what has emerged? Firstly, http://observatory.leeds.gov.uk direction because the most recent an increase in infant mortality I am indebted to many people who life expectancy figures for women accounts for about half of the have supported and contributed to showed a decline while those for worsening position. After 10 years my report. They are listed at the end men have stayed the same, rather of significant progress we have gone of the report. I would particularly than improving as we would have from being a city of concern to a like to thank Kathryn Jeffreys, hoped. This followed on from a city with an infant mortality rate project manager, and Barbara worsening picture for deprivation in below that of England as a whole. A MacDonald, editor. Leeds. I have become concerned. remarkable achievement. However, I also want to thank all my Public Some of my colleagues believe that the recent rise highlights the need, Health staff for their hard work and I should wait till there is a clearer despite these difficult times, for a support. Many thanks go to Catriona picture of the trends in our city. continued city-wide focus on giving Slade, my personal assistant. Perhaps they are right. Perhaps I am children the best possible start in I hope you find my report of interest. over-concerned and the next set of life. A small change here has had a As always, I would welcome your health information will show that all disproportionate effect. feedback, comments and suggestions. this has been a temporary blip. Of even more concern is that we On the other hand, there is the are seeing increasing number national context. Nationally, there of deaths as a consequence of has been a slowing down in the changing health trends – and this is improvement of life expectancy. There having a significant impact on life have been only slight improvements expectancy. More women are dying in recent years both for males and through alcohol harm, more men females. Also, in 2009, the Prime are dying from suicide, more men Ian Cameron Minister declared we are in an “age of are dying through drug overdoses. Director of Public Health

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STEERING IN THE RIGHT DIRECTION

Leeds has a strong economy that has enabled the city to recover well from the recession. We have a diverse talent pool, world class assets, innovative businesses and beautiful countryside. The Council, universities, schools, innovators and entrepreneurs have all played their part in creating growth. There is much to be proud of in Leeds and we have a great story to tell.

(Leeds City Council’s new Inclusive Growth Strategy)1 Trinity Leeds opening 2013

Leeds is doing well. The evidence Annual Reports. So how are we based on the information we had, I is there for all to see – the opening doing now? believed we would continue to see of Trinity Leeds in 2013 and Victoria Since the 1970s the government a gradual decrease in the number Gate in 2016, the £4bn of major has calculated local measures of neighbourhoods in Leeds falling developments over the last ten of deprivation across England. into the worst 10% of deprived years, the largest increase in average They do this by using the Index of neighbourhoods nationally. earnings anywhere in the UK. We are Multiple Deprivation (IMD). The Alongside this, we expected to see proud that Leeds has been named IMD is measured across the country a drop from the 150,000 people the best city in Britain for quality of by neighbourhood. Each of these living in such neighbourhoods. In the life. All of this positive progress is neighbourhoods typically represents intervening years we have seen that testament to the hard work and co- around 1,500 people.2 This is not an gradual progress and I had hoped operation of organisations, sectors easy task but it is a very important that this would lay the foundations and individuals over many years. one. Measuring deprivation enables for faster progress to reduce the However, as is well known, Leeds is also us to see what is happening – good health inequalities in our city. a city marked by inequalities, including or bad – across different areas of However, the latest release of the health inequalities. Is the economic Leeds over periods of time. IMD paints a worrying picture for growth in Leeds benefiting the many Just as important as identifying Leeds. Put simply, we now have or just the few? Are inequalities areas of deprivation is assessing 100 neighbourhoods that fall in narrowing or getting wider? change over time. In 2009, Leeds the worst 10% nationally. This is We know that improving the socio- City Council and the NHS produced compared to 88 in 2010 – in other economic position of individuals, its first Joint Strategic Needs words, a worse position. This new communities and neighbourhoods Assessment (JSNA). This looked figure represents around 164,000 is central to reducing the health at unmet needs and the future people in Leeds. inequalities in our city. This has been health, social care and wellbeing a consistent theme in my previous needs of the city. At the time,

1 Leeds City Council (2017) Leeds inclusive growth strategy 2017–2023: consultation draft http://www.leedsgrowthstrategy.com 2 Department of Communities and Local Government (2015) The English indices of deprivation 2015 6 https://www.gov.uk/government/statistics/english-indices-of-deprivation-2015

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One city... everyone plays a part

Provide leadership and Provide and commission services direction to help and Support the priorities which support the priorities of the influence everyone to of the Leeds Health and Leeds Health and Wellbeing Strategy achieve the 5 outcomes Wellbeing Strategy Make plans with people, Provide a public forum Create plans and strategies understanding their needs and for decision making and which help achieve specific designing joined-up services around engagement across priorities and outcomes of the needs of local populations health and wellbeing the Leeds Health and Provide the best quality services Continually ask what we Wellbeing Strategy possible, making most effective are all doing to reduce Promote partnerships use of ‘the Leeds Pound’ - our health inequalities, create wherever possible, working as collective resource in the city a sustainable system and one organisation for Leeds improve wellbeing

Health Other and Care Leeds Boards and Organisations Health and Groups in Leeds Wellbeing Indeed, 16 of these neighbourhoods On the other hand, we have the good Taking these figures together, we Board In other words, the inequality gap Local are in the most deprived 1% nationally news that we have increased the now have a city with a greater Communities in Leeds is getting wider – we are ‘Leeds will be a healthy Inclusive and caring city for all ages, Individuals and fall within nine of our wards: number of neighbourhoods in the 10% concentration of most deprived andSupport vulnerable members of going in the wrong direction. where people who are the the community to be healthy and poorest improve their have strong social connections Take ownership and Growth responsibility for promoting health the fastest’. Take ownership and responsibility Armley; Beeston and Holbeck; least deprived nationally from 27 in least deprived neighbourhoods. personal health and wellbeing for promoting community health and wellbeing Be proactive in accessing services which are available Make best use of community Burmantofts and Richmond Hill; City 2010 to 40 neighbourhoods in 2015. assets and leadership to Get involved in influencing and Commission create local solutions making change in Leeds and Hunslet; Chapel Allerton; One health and care system... Making our Gipton and Harehills; Hyde Park consistently asking Can I get effective Leeds Health and Economy Work and Woodhouse; Middleton Park; Can I get the right testing and treatment care quickly at Can I live well in my as efficiently as Wellbeing Strategy times of crisis or community because the possible? emergency? Wetherby 2016-2021 Killingbeck and Seacroft. INDEX OF MULTIPLE DEPRIVATION – LEEDS people and places close for Everyone by enable me to?

1 Walton

The Leeds Health and Wellbeing Strategy 2016-2021 11 Leeds Health and Wellbeing Board Leeds Health and Wellbeing Strategy 2016-2021 Draft for approval by H&WB Board CS15250LDPM

Health and Wellbeing PRINT setup.indd 1-3 Linton 06/05/2016 15:08

Thorpe Arch The aim of the Leeds Health and 3 The Inclusive Otley Collingham Boston Spa Wellbeing Strategy 2016–2021 is to Pool Harewood improve the health of the poorest Growth Priority Arthington Weardley fastest. This latest information about our neighbourhoods shows What does ‘Inclusive Growth’ Bramhope Bardsey the foundations to do this getting Bramham actually mean? There are a number weaker rather than stronger. Leeds of similar phrases in circulation. may well be experiencing strong Inclusive Growth has been defined Guiseley economic growth, but our increasing as ‘enabling as many people as Scarcroft number of deprived neighbourhoods possible to contribute and benefit Yeadon shows that we are not seeing a Alwoodley from growth’. This was the definition Cookridge Thorner trickle-down effect from our recovery Holt Park used by the Inclusive Growth Rawdon Moor Allerton Shadwell from recession. A rising tide has not Commission led by the RSA (Royal Adel Tinshill lifted all boats.4 Society for the Encouragement Moortown Leeds City Council will continue to take of the Arts, Manufactures and

Decile 1 MOST Horsforth the lead in determining the future of Commerce) in 2017.6 deprived 10% in Roundhay Barwick in Elmet our city. As part of that role, Leeds City Aberford The Inclusive Growth Commission England Chapel Allerton Calverley Scholes Council is now focusing on how it can Whinmoor called for a new look at economic work with partners to tackle deep-rooted Decile 2 Headingley Oakwood growth because, it said, too many Kirkstall Seacroft and long-standing problems in six of the Rodley families, communities and places are Potternewton most deprived neighbourhoods in the Decile 3 Bramley Woodhouse Chapeltown being left behind in our economy. Gipton Burley city. These include Holdforths and Clydes; In the past unemployment was Harehills Decile 4 Lincoln Green Stratfords and Beverleys; Recreations, the key problem, but a staggering CITY CENTRE Burmantofts Halton Whitkirk Armley Crosby St and Bartons; Boggart Hill and 55% of households living in poverty Decile 5 Pudsey Osmondthorpe Micklefield Clifton; Nowells; Lincoln Green. This will nationally now are in work.7 To get a Wortley Colton Tyersal Garforth require a new transformational approach. job, any job, is no longer a route out Decile 6 Farnley Holbeck In taking forward its vision for Leeds to of poverty. Low-paid, low-status jobs Hunslet be the ‘best city in the UK’, Leeds City with poor job security, coupled with Decile 7 Beeston New Farnley Council will shortly publish its Best low productivity and a proliferation Swillington Kippax 5 Decile 8 Cottingley Council Plan 2018/19-20/21. The Plan of low-skilled jobs, make a potent Stourton states an intention to address poverty and toxic mixture. Decile 9 Belle Isle Gildersome Woodlesford and inequalities by maintaining a long- Cuts to council budgets as a result of Churwell term strategic focus on strengthening Decile 10 LEAST Drighlington Rothwell the government’s policy of austerity the economy whilst supporting the deprived 10% in Middleton Allerton Bywater have heightened the challenge by Oulton England most vulnerable. There are seven producing a focus on the short Morley priority areas in the Plan. One of these Carlton term and crisis management at the is Health & Wellbeing and this is to be Methley expense of prevention, early action welcomed. Another priority is Inclusive and a focus on the long term. Growth. I hope to show why we need to East Ardsley give equal attention to both.

Proportion of neighbourhoods © The Ordnance Survey mapping 2017 3 Leeds health and wellbeing strategy 2016–2021 http://www.leeds.gov.uk/docs/Health%20and%20Wellbeing%202016-2021.pdf in each decile 4 https://en.wikipedia.org/wiki/A_rising_tide_lifts_all_boats 5 Leeds City Council, Best council plan 2018/19-20/21 for IMD in Leeds 6 RSA (2017) Inclusive Growth Commission: making our economy work for everyone https://www.thersa.org/discover/publications-and-articles/reports/final-report-of-the-inclusive-growth-commission 7 Joseph Rowntree Foundation/New Policy Institute (2016) Monitoring poverty and social exclusion 2016 8 https://www.jrf.org.uk/report/monitoring-poverty-and-social-exclusion-2016

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In contrast to the past HOLDFORTHS AND CLYDESwhen unemployment

Holdforths and Clydes is the The figures below highlight the scale of Furthermore, what these figures don’t the challenge for Leeds. While this might show is the disproportionate impact for pathfinder for the new approach. be familiar, the importance lies in the particular groups who face exclusion This is a neighbourhood facing direction of travel. To repeat, in terms of from the labour market, for example improving the levels of deprivation being disabled people, women and ethnic many challenges. It is ranked ninth experienced by some of our communities, minorities. most challenged neighbourhood we are now going in the wrong direction. in Leeds. Over 43% of its residents experience income deprivation and 36% are unemployed. POVERTY AND DEPRIVATION IN LEEDS – THE FACTS Unemployment amongst younger (Leeds City Council Executive Board Report 2016) people is double the city average. Out-of-work benefits payments are three times higher than across the CONTRACT city as a whole. Men are more likely 0 HOURS to be unemployed than women. The loss of heavy industry and manufacturing means that men are now taking on work within the service industry as opportunities for full-time, permanent physical work disappear. Women

often balance several part-time, insecure jobs, as well as providing the main caring role 8,000 are classified as being in households affected workers are on zero at home. In Holdforths and Clydes, 41% of residents have no qualifications and 82% of low- 36% ‘absolute poverty’ by in-work poverty hour contracts (around a quarter of our population) income families earn less than £15,000 per year. One in four residents lives in a flat, and a high of residents are unemployed proportion of residents rent. This is a diverse population, with 14% of residents born outside the UK. There is significant anti- social behaviour linked to community tensions and the growth of new communities. Under-reporting of crime remains an issue. There are significant health challenges too, particularly around drugs and alcohol. The male suicide rate is the highest for the city, linked to high levels of mental ill health. There are gaps in community infrastructure and 28,000 24,000 38,000 community engagement, and social isolation is a problem. 41% Leeds children are in poverty full-time workers earn less households are in of residents have (around 20%) - than the Living Wage fuel poverty However, there is positive change emerging. A new community centre has been built no qualifications of those alongside the existing one. New Wortley Community Centre was announced as Leeds City ... Council Partner of the Year at an awards ceremony in November 2017. The four tower blocks have received major investment to improve the physical environment and safety, as well as providing social support to the most vulnerable tenants (see later case study, p.46). There is potential to harness surrounding council land and assets to drive economic investment in the area. There is also scope for significant infrastructure changes at Armley gyratory to improve connectivity to the city centre. It is hoped that these changes 14% ...64% 80,000 will help to drive forward an improvement in health and wellbeing. of residents born are estimated to be in jobs paid less than Real payday loans accessed by outside the UK from working families Living Wage Leeds residents (2013) CASE STUDY 10

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Leeds as a whole

The Inclusive Growth Commission to participate more fully in economic There is growing public concern argues that a ‘grow now, re-distribute growth and in society. about the values of big business. For The Health later’ approach is failing to support Getting back to Leeds, we need to example, Starbucks only reported & Wellbeing adequately those who are out of ensure that the Inclusive Growth a taxable profit once in the 15 years work or in low-paid jobs. Economic Priority in the Best Council Plan not up to 2013 in the UK. Despite annual Priority growth has become de-coupled from only powers the whole city forward UK sales of £400m, Starbucks poverty. In other words, the nation is but also reverses the worsening didn’t pay any corporation tax at all getting richer but many individuals to the government for four years I have expressed my concern socio-economic position in many of about the deteriorating are finding themselves worse off than our neighbourhoods. We must adopt prior to 2013. The Public Accounts Female life expectancy Male life expectancy ever. To tackle this, we need a new Committee of MPs ‘found it hard to position for many of our a perspective that includes quality neighbourhoods. And I hope (2103-2015) (2103-2015) approach that combines social and of growth as well as dry numbers. believe Starbucks was trading with I have made the case that down by static economic policy. We need to find out what people are apparent losses for nearly every year of its operation in the UK’. Perhaps we need Inclusive Growth So yes, there needs to be investment experiencing in terms of opportunities, to help reverse that. in business development and, barriers, skills, employment and living we should be grateful that the 13 2.5 mths yes, there must be investment standards – and make sure that our Starbucks outlets in Leeds survive! in high-class transport, housing actions reflect this. Alongside the need for greater and digital infrastructure such as partnership working to help foster faster broadband to connect labour social responsibility on the part of markets to economic opportunity...... businesses, we need to seek out But what is the value of this opportunities for enterprise, innovation investment if particular places or RECOMMENDATION and support to local communities neighbourhoods are not able to – and find ways of connecting the Leeds City Council to identify connect to its benefits? This might be commercial economy, the public sector a broad range of indicators to because the skills base is too low, or economy and the social economy. However, assess progress on Inclusive because health and complex social This is what we need to see happening my second Growth through the new issues act as barriers to participation. in our most deprived neighbourhoods: concern is Economic investment alone is Inclusive Growth Strategy, • Inclusive Growth that consciously whether the not enough. We need to develop reflecting different geographies focuses commitment and resources deterioration the capacity and capabilities of and populations within the city. on deprived neighbourhoods identified individuals, families and communities ...... around the priority growth sectors through in the city e.g. digital, culture. the IMD is already Least deprived having knock-on • Development of the physical consequences for Most deprived infrastructure to ensure that the health of our transport, housing and digital population. The simplest services connect to job growth. way to start is to look at life Most deprived Leeds • Development of the social expectancy. The latest figures The council’s leadership role will be of critical importance. infrastructure to ensure that (2013–2015) tell us that female life In February 2017, Cllr Judith Blake, leader of Leeds City Council, early years support, education, expectancy has dropped to 82 years 1 said this to the Inclusive Growth Commission: skills, life-long learning, month – a drop of around 2.5 months. careers advice and community Leeds has been working in a new way as a city, asking This is not where we want to be as a development enable individual city. Now, it must be said that this drop local government to become more enterprising, families and communities to is not statistically significant. It may be participate more fully both in that this drop is a blip and the figures business to be more civic and citizens to become society and in economic growth. will improve next time around. I will • Provision of family-friendly, then have been proved to be alarmist. more engaged. This – as Ofsted has recognised quality jobs that offer fair pay, However, I am very concerned at – has transformed our Children’s Services. We’ve security, job progression and a what lies beneath this apparent step The result of this is that life health-promoting workplace. backwards in the health of females in expectancy for both males and established our open ‘Leaders for Leeds’ network ...... our city. I am also concerned that the females in our city is falling further gap for women living in the deprived behind England a whole. The to address major challenges across our city. The parts of Leeds and the rest of Leeds challenge now is to understand RECOMMENDATION has worsened by about six months, what lies behind this gloomy picture. next step is to see this approach from the basis of The call for business to be more Leeds City Council to ensure to 4 years 8 months. The figures tell us that the decline civic is to be welcomed. Businesses even more productive city partnerships that have that its new Leeds Inclusive Male life expectancy has levelled off in female life expectancy and the should be concerned not just with Growth Strategy improves at 78 years 4 months. However, here stagnation of male life expectancy is profit, but with promoting and the power to work together, without creating new the socio-economic position also the gap between those living not down to our major killers of cardio- contributing to the quality of life of of the most deprived 10% in deprived Leeds and the rest of vascular disease, respiratory disease the communities around them. bureaucracies and management boards. communities in the city. Leeds has worsened by about three and cancer. We must look elsewhere...... months, to 5 years 5 months. The first stop is infant mortality. 12 15

reflects the national trend. However, the city was becoming increasingly Infant mortality over the course of the last 10 years, mobile, complex and vulnerable, and life the Leeds rate has been falling faster is a testament to the energy and than the national rate until the most commitment of all the partners. expectancy recent period (2013–15), when it has The recent upturn in Leeds figures risen for the first time in many years is very disappointing. The figures Infant mortality is the death of a – to those 48 deaths in 2015. show a similar trend in some of live-born baby before their first Why has Leeds been so successful the other core cities, although not birthday. There has been a dramatic in addressing infant mortality to nationally. We can only speculate reduction in infant mortality in date? In 2002, the government on the reasons for the overall rise Leeds over the last 150 years. Indeed, set a national target to reduce and the widening of the gap, despite the decline in infant mortality is the inequalities in infant mortality: our ongoing efforts. Very likely it is clearest evidence of the progress the effect of recession. Economic we have made in improving the Starting with children under recession makes families more health of our population. We went vulnerable and also impacts on from more than one in five babies one year, by 2010 to reduce the quantity and depth of public dying before the age of one year in by at least 10% the gap in and third-sector services. This is the 1870s to one in 250 babies. We despite continued attempts to focus had a record low infant mortality, mortality between the routine services on those in greatest need. even below the England rate. We and manual group and the In recent years, Leeds has broadened were also able to narrow the gap its approach to infant mortality. between the most deprived and population as a whole. We have adopted a Best Start least deprived communities. priority which spans the period However, the latest figures show an Sadly, despite this target, a national from conception to the child’s increase in infant mortality. There review in 2007 showed that big second birthday, also known as were 48 infant deaths in 2015 – our differences still existed across the the first thousand days. Best Start highest number since 2009. country, and Leeds was identified is a priority in the Leeds Health & Infant mortality has a relatively big among 43 local authorities with a Wellbeing Strategy. The Leeds Best 8 impact on life expectancy. This is higher number of infant deaths. Start Plan 2015–19 builds on the because that child, tragically, has Leeds rose to the challenge, previous evidence-based actions, lost so many years of potential life. bringing together partners from but extends this to consider key INFANT MORTALITY RATE LEEDS Although the actual number of Leeds across sectors, under Public Health aspects of early life that will promote babies who die in their first year leadership, to launch the Leeds social and emotional capacity and 9 may seem small at 48, this recent Infant Mortality Plan in 2008. cognitive development, such as increase accounts for about half the Drawing on published evidence parenting, attachment and bonding, 8 decline in life expectancy for females about identifiable actions to and communication. Once again, and is a significant contributor reduce the gap, Leeds collectively strong city-wide partnerships lie at 7 to the stagnation of the male life focused its efforts on initiatives the heart of Best Start, including at local level in our Best Start Zones. expectancy. Although it is important such as: reducing smoking during 6 to understand the contribution pregnancy and in households; These will determine whether we can successfully deliver the huge return of infant death to life expectancy, increasing breastfeeding; addressing 5 given the small numbers I have not child poverty; reducing teenage in potential outcomes for future selected infant mortality as a major generations of children in our city. pregnancy and supporting teenage 4 theme of this report. However, I parents; improving maternal would like to say something about ...... nutrition; actions to reduce 3 the work that Leeds has been doing sudden infant death – and many in this key area before moving on to more. This preventative agenda RECOMMENDATION Deprived 2 the themes I have chosen to explore was widely embraced across the The Leeds Best Start Strategy Not Deprived in more detail. city by the public sector, the third Group to help ensure that 1 Leeds has a very active programme sector and by communities at parents are well prepared for Leeds 48 of work around infant mortality. local level in two highly successful pregnancy and that families infant deaths This work began nearly 10 years ago, ‘demonstration sites’ in Chapeltown Rate – Per 1000 live births 0 with complex lives are identified 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 in Leeds and Beeston Hill. The narrowing of when the number of babies dying early and supported. 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 (201 5) each year was approaching 60. The the gap in Leeds, at a time when the 3-year aggregate periods decline in infant mortality in Leeds population of women giving birth in ......

8 Leeds City Council, Leeds best start plan 2015 –2019 http://democracy.leeds.gov.uk/documents/s126845/10%202%20Best%20Start%20Plan 14 %20long%20version%20FINAL%20VERSION%20for%20HWB%20Board%204%202%202015.pdf 17

ALCOHOL-RELATED MORTALITY IN WOMEN

More years of life are lost in England as a result of alcohol-related deaths than from cancers of the lung, bronchus, trachea, colon, rectum, brain, pancreas, skin, ovary, kidney, stomach, bladder and prostate combined.10 It therefore comes as These are the four areas that I shall Now, we already know that men no surprise that the World Health What other cover in the following sections of have a poorer life expectancy than Organization (WHO) places alcohol this report. women as well as higher rates of the as the third biggest global risk for trends should 11 Readers will have noted that all ‘big killers’. Accordingly, Professor burden of disease. Alcohol has concern us? four of the public health trends Alan White and Amanda Seims from been identified as a causal factor in 12 mentioned above show a gender Leeds Beckett University, along with more than 60 medical conditions. If infant mortality accounts for Tim Taylor (Leeds City Council) and Let’s pause and think about that for half the poorer position around life difference. Yet how often do we properly acknowledge gender when myself, have reviewed all 44 plans a minute. It seems mad to think that expectancy, and if cardiovascular to check whether men’s health is a substance that can cause so much disease, cancer and respiratory we consider unmet needs, access to services, interventions or follow-up specifically highlighted. We made harm is still widely available – but it disease are not responsible for the the shocking discovery that only is, and this is unlikely to change. other half, then what is? support? The answer is, not often enough. 15 of these 44 major plans even The UK has a long history with The evidence suggests that we need mention that men have higher Here in Leeds, we have identified a alcohol. As far back as 1751, the to focus our concern on: death rates. Fortunately, the British nationwide failure to acknowledge artist William Hogarth was making Medical Journal has recognised the • a rise in deaths in men from drug gender differences in health. a visual connection between alcohol overdose importance of the gender gap in and poverty, crime and urban NHS England has established public health by publishing our work squalor, and the harmful effects • a rise in deaths in women from 44 Sustainable Transformation to a wider audience.9 of commerce and taxation on the alcoholic liver disease. Partnerships across England to meet We will now look in more detail at poor, in his satirical images Gin Lane There are two additional trends that the enormous challenges faced by the four areas of concern, beginning and Beer Street. All of this still rings should concern us. Although they are the NHS. Leeds falls within the West with what is happening around the true today. Public health has made not statistically significant in terms Yorkshire and Harrogate Sustainable rise in alcohol-related deaths in huge progress since the eighteenth of mortality, we also need to look at: Transformation Partnership. Each women. century, but alcohol harm is still Partnership has developed plans • a rise in deaths in men from with us. Unlike 200 years ago, to improve health and wellbeing, suicide though, we now know a lot more improve care and address the • a rise in the number of women about what causes these harms. who self-harm. financial problems in the NHS.

9 Cameron, I, White, A, Seims, A and Taylor, T (2017) Missing men when transforming health care, British Medical Journal 357: j1676 10 Public Health England (2016) The public health burden of alcohol: an evidence review https://www.gov.uk/government/publications/the-public-health-burden-of-alcohol-evidence-review 11 Mathers, C et al (2009) Global health risks: mortality and burden of disease attributable to selected major risks, Geneva: WHO http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf 16 12 Alcohol Concern (2016) Statistics on Alcohol https://www.alcoholconcern.org.uk/alcohol-statistics

1919

The Office for National Statistics The number of adults consuming What is the story? (ONS) reports that of those who alcohol at a level putting them at drank alcohol in 2016, 27% of adults increased risk or above rises with Evidence demonstrates a clear (around 7.8 million people) ‘binged’ age, peaking at 55–64 for both men relationship between the volume on their heaviest drinking day prior and women. of alcohol consumed and the risk of to interview. Young drinkers are a given harm. As the alcohol dose Socio-economic status is a key more likely than any other age increases, so does the risk. The factor in drinking behaviour, with group to binge-drink.15 This not frequency of drinking also influences important differences between only has health implications but the risk of harm. Repeated heavy increased-risk drinking and social and economic consequences drinking is associated with alcohol higher-risk drinking. Let’s look at too. However, frequent and most dependence,13 whereas a single bout of increased-risk drinking first. The harmful drinking tends to be among heavy drinking – so-called binge drinking NHS Digital Health Survey 2015 middle-aged people, with this age – is associated with alcohol-related reported that adults in higher- group of both men and women more crime, physical injury and increased risk income households are more likely 3rd 93 likely to drink every day.16 biggest contributor female deaths in of cardiovascular disease.14 to drink weekly at levels that put to disease burden Leeds were from them at increased risk than those in globally is alcohol alcohol-specific conditions lower-income households. Women (2013-15) THE UK CHIEF MEDICAL OFFICER’S GUIDELINES in the highest-income households ON ALCOHOL CONSUMPTION (2016) are over twice as likely to be drinking at levels presenting an increased risk of harm than women categorise consumption as follows: in the lowest-income households. ‘low risk’ – men or women who do not regularly drink However, higher-risk drinking is more than 14 units of alcohol per week greatest in the lowest-income ‘increased risk’ – for men, 14–50 units per week; One 750ml households, with the most of these deaths for women 14–35 units per week 12.5% bottle of severe alcohol-related harm ‘higher risk’ – for men, over 50 units per week; wine = 9 units being experienced by those in the were from alcoholic 60+ liver disease for women, over 35 units per week lowest socio-economic groups. medical conditions ‘higher risk’ – for men, over 50 units per week; This is called the ‘alcohol harm have alcohol as a 9 units 18 units 27 units 36 units 45 units 54 units 63 units 17 for women, over 35 units per week paradox’. It has been estimated causal factor that females (and males) in the most socio-economically deprived neighbourhoods are two to three times more likely to die from an 2x alcohol-related condition than those as many women living in the least deprived areas.18 from deprived Leeds Gender is an important factor. are admitted to Research consistently demonstrates hospital for alcohol- per week gender differences in rates of alcohol specific reasons use. The latest statistics highlight (than women in non-deprived) 9 units 18 units 27 units 36 units 45 units 54 units 63 units that men are both more likely than women to be drinkers and twice as likely to drink at levels that present an increased risk or higher risk, irrespective of age. However, recent decades have seen a narrowing of 2-3x the gap between men and women.19 more likely to die from an alcohol-related per disease if you live in week a deprived area (than those in least deprived) 13 NICE (2011) Alcohol-use disorders: NICE guidelines on the diagnosis, assessment and management of harmful drinking and alcohol dependence https://www.nice.org.uk/guidance/cg115 14 Roerecke, M & Rehm, J (2010) Irregular heavy drinking occasions and risk of ischemic heart disease: a systematic review and meta-analysis, American Journal of Epidemiology 171(6), pp.633–44 15 Office for National Statistics (2017) Adult drinking habits in Great Britain: 2005 to 2016 https://www.ons.gov.uk/releases/adultdrinkinghabitsingreatbritain2015 16 NHS Digital (2016) Health survey for England, 2015: adult alcohol consumption www.content.digital.nhs.uk/catalogue/PUB22610/HSE2015-Adult-alc.pdf 17 Alcohol Research UK (2015) Understanding the alcohol harm paradox, Alcohol Insight 122 http://alcoholresearchuk.org/alcohol-insights/understanding-the-alcohol-harm-paradox-2/ Most deprived 18 Deacon, L et al (2011) Alcohol consumption: segmentation series report 2, North West Public Health Observatory, Liverpool: Liverpool John Moores University 19 Greenfield, S F et al (2010) Substance abuse in women, Psychiatric Clinics of North America 33(2), pp.339–55 18

21

Less is known about problematic Of the 93 deaths in 2013–15, 71 were First, a significantly larger proportion ADMISSIONS TO HOSPITAL DIRECTLY ATTRIBUTABLE alcohol use in women than in from alcoholic liver disease. We are of 18–29 year old women are drinking TO ALCOHOL (FRACTION OF 1) CRUDE RATE: 100,000 men20 but we do know that seeing women dying from alcoholic at increased-risk and higher-risk levels women accelerate from starting liver disease as young as 35–39 compared to other age groups. This Leeds Deprived to drink to problematic use of years, with a peak at 50–54. This is may in part be due to the large number 800 alcohol much faster than men. younger than found nationally. of students in the city who register with 700 Not Deprived This is known as ‘telescoping’. The rate of alcoholic liver disease, a GP on arrival and therefore undertake Women also develop liver disease as with levels of drinking, is higher an alcohol screen. Nevertheless, we 600 more rapidly than their male for men than women across all age shouldn’t ignore this finding as we 500 21 counterparts and generally groups in Leeds. However, whilst know that this age group is more likely 400 present for treatment with a more deaths in men have been reducing, to binge-drink. As well as its health severe clinical profile. deaths in women have been increasing implications, binge-drinking has both 300 social and economic impacts, through since 2012, as noted above. This means 200 that there has been a narrowing of the alcohol-related crime and antisocial 100 What is gap between men and women to the behaviour. For all these reasons we point where numbers of deaths from need to consider targeted interventions 0 with this younger population.

happening in alcoholic liver disease in men and Females women are very similar. The second finding of concern from 2011/13 2012/14 2013/15 Leeds? In Leeds, the most deprived parts of Audit C is that similar numbers of men the city are experiencing the highest and women in the 40–49 age group A worrying picture has started to rates of alcohol harm and mortality. are now higher-risk drinking. PROPORTIONS FROM AUDIT C SCORE CLASSIFIED emerge in Leeds in recent years. When we look at the numbers of These new trends – increased and AS INCREASING RISK (SCORE 1-15) – SEX AND AGE Significantly more women are dying deaths from alcohol-related liver higher-risk drinking at a younger age, because of their alcohol use. and increased higher-risk drinking in disease over the last five years, we 60% see that the most deprived areas are middle age – are potentially starting to ...... Female Alcohol-specific/ experiencing the highest numbers show in our female mortality figures. 50% across all age groups. People Male alcohol-related 40% ...... living in deprived Leeds, both men Alcohol-specific conditions and women, also account for the What are we 30% are conditions caused solely majority of alcohol-specific hospital 20% by alcohol use, for example admissions. Twice as many women doing to tackle cirrhosis of the liver, some in deprived Leeds are admitted for alcohol harm in 10% physical injuries. reasons attributable to alcohol use than women in non-deprived Leeds. Alcohol-related conditions are Leeds? 0 18–29 30–39 40–49 50–59 60–69 70+ those in which alcohol use is a In 2016, 52% of registered patients in Age factor, for example some cases Leeds received alcohol identification The Leeds Drug and Alcohol Strategy of cardiovascular disease, cancer and brief advice, or IBA (alcohol (2016–2018) embeds the 2011 NICE and falls. screening – Audit C), in an attempt to guidelines on the management PROPORTIONS FROM AUDIT C SCORE CLASSIFIED assess people’s drinking levels locally. of alcohol harm. In Leeds, we are ...... This local data reflects the national adopting a holistic approach to AS HIGH RISK (SCORE 16-19) – SEX AND AGE picture. The majority of people ensure that we not only support Admissions to hospital for alcohol- who drink in Leeds drink at low-risk alcohol recovery through Forward 70% specific conditions are high. In levels. Of those who are drinking Leeds, the local alcohol and drug 2013–15, 93 women died from at risky levels, 88% are drinking at service, but also adopt measures 60% Female these conditions and, for the first increased risk and 12% at higher-risk to prevent alcohol harm, identify 50% time, the number of years of life or dependency levels. More men are problems earlier and address the Male lost by women due to alcohol- drinking above the low thresholds impact alcohol has on the family 40% related conditions has significantly than women. However, through this and the economy. We have made worsened. The primary driver alcohol screening data, the Audit C much progress but there is still 30% behind this increase is female scores have revealed two previously much work to do if we are going to 20% deaths from alcoholic liver disease. unseen patterns of alcohol use. achieve our vision for Leeds. 10%

0 18–29 30–39 40–49 50–59 60–69 70+ Age 20 Lancet Psychiatry (2016) Sex and gender in psychiatry (editorial), Lancet Psychiatry 3(11), p.999 21 Hamilton, I (2017) Why women who misuse drugs have different needs, The Pharmaceutical Journal, August 2017 https://www.researchgate.net/publication/318883925_Breaking_the_silence_on_women_and_drug_use 20 23

Prevention ‘Making every contact count’ is about changing behaviour. Health workers and organisations have millions of day-to-day interactions with people and are being encouraged to use every one of these to promote changes in behaviour that will have a positive

22% effect on the health and wellbeing of women drink of individuals, communities and alcohol during pregnancy populations. We are also working to support the national initiative on alcohol identification and brief advice (IBA). This typically involves using a screening tool to identify risky drinking, for example alcohol screening of newly-registered patients at GP practices (Audit C). Once a potential problem has been identified, frontline staff deliver short, structured ‘brief advice’ with the aim of encouraging a risky drinker to lower their level of risk by women attending reducing their alcohol consumption. Forward Leeds successfully complete As well as equipping frontline staff alcohol during pregnancy.22 High alcohol treatment in both the children and adult prenatal exposure to alcohol is (slightly higher than males at 29%) workforce with the skills to identify linked to a high risk of developing alcohol harm earlier through foetal alcohol syndrome – a the delivery of IBA, we have also spectrum of preventable disabilities implemented social marketing including birth defects, behavioural campaigns to improve people’s problems, growth deficiencies and knowledge of responsible alcohol learning disabilities. We don’t yet consumption and alcohol harm, know whether there is a ‘safe’ level ALCOHOL AS PRIMARY SUBSTANCE ON ENTRY TO to enable people to make more of alcohol consumption that carries TREATMENT SERVICE - GENDER & AGE 2016/17 informed choices and to signpost no risk of foetal alcohol spectrum to Forward Leeds, the local alcohol disorder or other health problems, support service. so the message has to be that there 300 Launched in 2014, ‘Like My Limit’ is is no safe level. Unfortunately, as Alcohol Only a local equivalent to the successful in many other areas in the country, 250 national ‘Know your Limits’ there has been a lack of consistent Primary Alcohol messages regarding alcohol For example, the Under 18’s Pocket campaign. It is predominantly a consumption during pregnancy in 200 Guide to Alcohol was developed social media campaign to challenge Leeds. The Leeds ‘No Thanks I’m locally as a tool for frontline the social norm of female drinking Pregnant’ social media campaign 150 practitioners to deliver brief advice at home and raise awareness of the was launched in April 2016 to advise for young people around alcohol effects of regularly drinking over the women that the safest choice is 100 use. Over the last four years, 30,000 recommended guidelines. not to drink any alcohol during pocket guides have been distributed Pregnant women are more than pregnancy. Posters, leaflets and 50 and 300 members of the children’s three times as likely not to drink fact sheets were made available to workforce have been trained in its alcohol at all compared to other health professionals to support this

Number 0 use. It has also been adopted in women, but still 22% of pregnant ongoing social media campaign. Under 18 18–24 25–34 35–44 45–54 55–64 65 or Over other areas of the UK. women in the UK report drinking Females

22 Office for National Statistics (2013) Adult drinking habits in Great Britain, 2013 https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/ healthandlifeexpectancies/compendium/opinionsandlifestylesurvey/2015-03-19/adultdrinkinghabitsingreatbritain2013 22 25

31%, slightly higher than the percentage of males at 29%. PURPLE FLAG STATUS FOR THE EVENING & NIGHT This indicates that women TIME ECONOMY who do access the service for Alcohol treatment – their alcohol use engage with Forward Leeds treatment and are able to Purple Flag is an award which progress towards recovery. recognises the efforts of In 2015, the newly partners in the city working However, the age when women recommissioned integrated together to ensure the city start to enter the service in Drug and Alcohol Prevention is clean, safe and well after greater numbers is from 25 and Treatment Service – 5pm. As a key member of years. There were two cohorts Forward Leeds – began its work this partnership, Public Health is of concern from Audit C scores. in the city. We are now starting working to promote health and These were women aged 18–29 to see the hard work and wellbeing within the night-time and women aged 40–49. The dedication of the staff in this economy, particularly in relation figures show that younger service come to fruition. to responsible drinking. The women are not accessing the The number of clients entering the partnership has developed alcohol service. We therefore need to and drug awareness training for service in 2016–17 with alcohol as review female services and points the primary substance of use was all staff working in the night-time of access to explore how we economy. This is delivered by just below 40% of the total. The can intervene earlier and ensure percentage of clients who have Forwards Leeds, with the aim of that we are doing all we can to reducing the impact of alcohol- successfully completed alcohol provide a service that women feel treatment and who have not related harm associated with they can access for the support evening entertainment in the city. re-presented to the service within they need. In particular, we need six months – a national indicator – to find ways of engaging and has steadily increased over 2017. supporting younger women ...... The percentage of women who to reverse the higher level of successfully complete their harm and mortality that we are alcohol treatment is about currently seeing in the city. RECOMMENDATIONS Leeds City Council, Leeds Clinical Commissioning Groups (CCGs) and Forward Leeds to Public Health cannot achieve alcohol Recently, Leeds was one of use local insight to develop harm prevention work alone. Only by eight local authorities to a social marketing campaign influencing and supporting the wider participate in the health as targeting young women and alcohol agenda and working with a licensing objective (HALO) ‘P’ aimed at reducing alcohol our partners in the city will we be national pilot. Public Health has consumption and promoting able to achieve our vision set out in a strong relationship with the access to services. P is a 42-year-old full-time mum. She had been a drinker throughout her adult life but had considered the Leeds Drug and Alcohol Strategy Leeds City Council licensing team herself a ‘social drinker’. With hindsight she realises that she was drinking more than other people and (2016–2018). For example, we have and is an active member in the Leeds City Council, Leeds for a number of years supported Licensing Enforcement Group. We Clinical Commissioning Groups that her alcohol consumption had steadily crept up over the years. She was ‘drinking on anxiety, primary care in the delivery of the have supported the development (CCGs) and Leeds NHS Trusts thinking it would calm my nerves’. IBA. Through partnership with the and implementation of local to increase identification and three Leeds Clinical Commissioning licensing policies in Inner West, brief advice (IBA) in primary and After a number of events in her personal life, including the loss of family members, P’s alcohol Groups (CCGs), we have supported Inner East and South Leeds. secondary care with a particular consumption increased to the point where she had become physically addicted to alcohol and was the delivery of alcohol treatment in These policies seek to minimise focus on areas of deprivation community primary care settings. the negative impact that new with highest alcohol harm. finding it a problem in her day-to-day life. Her GP recommended Forward Leeds. P had a successful And, through the Leeds health premises may have on the health Leeds City Council and Forward and social care plan, we are of the local area. South Leeds community detox and combined this with cognitive behaviour therapy and other psychosocial therapies Leeds to review alcohol treatment supporting the delivery of brief local licensing policy has been services for females and ensure to become sober. She has now been sober for almost a year. interventions around alcohol showcased nationally as an services are appropriate to the harm within our hospitals. example of best practice and was needs of women. I would like to end this section on recently used as a case study by alcohol harm with two further brief Public Health England in their ...... CASE STUDY examples of our partnership working Alcohol Licensing and Public within the council. Health Guidance.23

23 Public Health England (2017) Reducing alcohol related health harms in Leeds (case study) https://www.gov.uk/government/case-studies/reducing-alcohol-related-health-harms-in-leeds 24 27

WOMEN’S MENTAL HEALTH

In Leeds, as in the rest of England, disorders. Women are twice as and transgender women are also at more women than men have mental likely as men to experience violence higher risk of poor mental wellbeing. health problems such as anxiety and and abuse in the home; the more Finally, the mental health of young depression. These types of problems extensive the violence, the more women is worsening. In England, are called common mental health likely that it is experienced by women aged 16– 24 years have the disorders. A recent national study24 women. Women’s Lives Leeds report highest rates of common mental found that rates of these disorders that about one in every 20 women in health disorders, self-harm and have risen significantly in the last England has experienced extensive PTSD of all groups. It is suggested 10 years, and this is mainly due to physical and sexual violence and that this may in part be due to social the increasing number of women abuse across their life course – media exposure, excessive use of with these mental health problems. that’s over 16,000 females of 15 computers and mobile phones, and In Leeds, there are twice as many years and older in Leeds.25 These poor sleep, although this research is women as men with common women have been sexually abused at an early stage. mental health disorders: that’s over in childhood or severely beaten by 80,000 women. Women’s mental a parent or carer; many have been health is getting worse. raped and suffered severe abuse Self-harming and The percentage of women and men from a partner, including being with more serious mental illness, choked, strangled or threatened mental health with a weapon. It is thought that for example psychosis, is similar ...... overall, although men tend to such abuse may explain, in part, Self-harm develop psychosis at a younger age the higher rates of common mental ...... and women later on in life. However, health disorders seen in women. Self-harm is when someone there are particular groups of Abuse also increases the risk of intentionally causes themselves women who have high rates of other more serious conditions like PTSD injury or harm. It is often seen as serious conditions such as post- and personality disorder. Abuse may a way of coping with or expressing traumatic stress disorder (PTSD). mean that women experience other feelings and emotions that have Self-harming – often a way of coping circumstances that impact on their become overwhelming. Self-harm with mental distress – is thought to mental health, such as drug use, involves a range of behaviours, 16,000 1 in 20 be worsening in young women. insecure work or poor housing. including cutting, self-poisoning women in Leeds have women in Leeds have The reasons why women have poor Certain groups have poorer mental and burning. Broader definitions experienced extensive experienced extensive mental health include financial health than others. Risk factors of self-harm can also include physical and sexual physical and sexual worries such as debt and low-paid for poor mental health, some of alcohol and substance misuse, violence and abuse violence and abuse work and stress associated with which have been discussed above, disordered eating and ‘risk-taking’ caring responsibilities. Women cluster in areas where people behaviours, which increase are more likely than men to be have a low level of income. This a person’s vulnerability and in lower paid and less secure means that women living in poorer susceptibility to harm. Self-harm jobs – on temporary or zero-hour neighbourhoods are likely to is associated with both severe and contracts, for example – and the have worse mental health. Black/ enduring mental health problems, negative impact of welfare reform Black British women show higher for example personality disorders, has been shown to affect women rates of common mental health as well as common mental health disproportionately. disorders, whilst asylum seekers and disorders. It is also associated Experience of violence, trauma and vulnerable immigrants and refugees with an increased risk of suicide. abuse is another significant risk often have poor mental health ...... 80,000 16-24 factor for common mental health associated with trauma. Lesbian women in Leeds with age group women in Leeds common mental health have the highest rates of disorders common mental health 24 McManus, S et al (eds.) (2016) Mental health and wellbeing in England: adult psychiatric morbidity survey 2014, Leeds: NHS Digital disorders, self-harm and PTSD http://content.digital.nhs.uk/catalogue/PUB21748/apms-2014-full-rpt.pdf 25 Scott, S and McManus, M (2016) Hidden hurt: violence, abuse and disadvantage in the lives of women https://weareagenda.org/wp-content/uploads/2015/11/Hidden-Hurt-full-report1.pdf 26 29

Self-harm is not restricted to a one admission, but we do know that Champion programme in order to There are also a number of services particular group. Much self-harming admissions are increasing year on year develop whole-school approaches to support adults who self-harm, behaviour goes undetected, so it and that there has been a general to promoting positive social, including Leeds Survivor-Led is difficult to know with certainty increase in admissions over the last emotional and mental health Crisis Service (Dial House), The how often it happens and to whom. two years for both females and males. (SEMH). This includes subsidised Key and Women’s Therapy and However, we know it is more common Admissions for the youngest age training on topics such as self- Counselling Service. These services THE KEY in younger people than older people group of girls for which self-harm harm awareness. Recognising are facing challenging times. Cuts and more common in women than data is collected (up to 14 years old) and responding to self-harm is to funding, wider reforms across The Key is a local service run by Womens Health Matters, which supports girls and in men. Over twice as many young are nine times higher than those of also embedded within the new welfare and housing services, and young women in Leeds to manage the effects of abuse and domestic violence. The Key women aged between 16 and 24 years boys in the same age group. MindMate curriculum – a SEMH structural barriers to access, all report self-harming compared to men curriculum for all key stages which have a disproportionate impact on helps girls and young women identify and acknowledge violence and abuse, develop Levels of admissions for self- in the same age group. is available to access online.27 We vulnerable communities. harm are closely linked to living coping mechanisms and gain confidence and self-esteem. offer secondary schools support A range of reasons may cause a in deprived areas of the city. This to develop creative anti-stigma person to start self-harming – family is a general trend across all local ‘When I first started at The Key I felt so down. I was self-harming. I campaigns co-produced by young or relationship problems, school authority areas in the Yorkshire people within the school setting. wanted to die. I didn’t even want to go outside. Now I am working and or work pressures, low self-esteem and Humber region but is more This aims to encourage young and body image, misusing alcohol pronounced for Leeds than for any going to college every day. I am also convincing myself, slowly but surely, people to talk openly about mental or drugs, trauma or abuse. Many other city in the region. Someone health and reduce the stigma that is that I am as good as everyone else and I am not left out - I can talk people who self-harm say they do so who lives in one of the most stopping them from accessing help. to relieve feelings of anger, tension, deprived areas of Leeds is twice as to everyone. And yes, I do still get nervous a lot but I feel normal for anxiety or depression. There are likely likely to be admitted to hospital for Selected year groups of primary and the first time in my life. Without the help from The Key I wouldn’t be to be several other reasons that lead self-harm than someone living in secondary schools in Leeds complete someone to self-harm, and these will one of the least deprived areas. This an annual ‘My Health My School’ where I am today... thank you.’ differ from person to person. indicates greater health inequality survey. In 2015, questions were added B was first referred to The Key in 2013 by the charity Basis Yorkshire. She was 15 years old. associated with self-harm in Leeds. about self-harm for Year 7 and above. This provides community-level data B was in an abusive relationship, was experiencing child sexual exploitation and had The stigma associated with self- for young people aged 11–15 that What is the harm often prevents people from been physically abused by her step-father. She experienced anxiety and low mood. has previously been unavailable in seeking help. This stigma also Leeds. For example, 88% of the 2,182 She had been self-harming since the age of eight but had been unable to engage with picture for Leeds? affects the people around those young people who responded to this who self-harm: families, friends, talking therapies. She was struggling with bullies at school and in her neighbourhood. Within Leeds it is estimated that question said that they had hurt acquaintances and work colleagues. there are 16,000 young women aged themselves on purpose. In answer to This had a negative effect on her self-esteem and increased her anxiety levels. The Key Self-harm is a complex behaviour 16–24 years suffering from common a separate question, 7% of the 377 that is widely misunderstood, supported B through both one-to-one and group support. mental health problems at any one responders said they hurt themselves and the stigma surrounding it has time. Nationally, around 1 in 4 young every day; 28% said they had hurt During her first two years at The Key, B found it hard to maintain friendships. She ended serious consequences for those women have reported having ‘ever themselves once or twice in the last seeking help, both within and one abusive relationship and began another that proved equally abusive. Her self- self-harmed during their lives’. In 12 months; 48% said they used to outside of health services. Leeds, this would be an estimated hurt themselves but no longer did so. harming increased during this second relationship. She attempted to take her own life 16,000 young women. The ‘Pink Booklet’28 is a leaflet on at least one occasion. In Leeds, levels of self-harm are What are we produced by Public Health After many intensive sessions around her emotional wellbeing, B felt able to attend measured by collecting data on along with the three Clinical hospital admissions. However, doing in Leeds? Commissioning Groups (CCGs) and therapy. The Key referred her to IAPT (Improving Access to Psychological Therapies). She because self-harm can take many the Leeds Safeguarding Children has not self-harmed for over a year and has come off antidepressants, though she still forms, it is likely to be under-reported. In Leeds, the focus of Public Board. The leaflet offers guidance The local data reflects national Health initiatives is on prevention for staff working with children and has mood fluctuations. trends. In Leeds young women aged by starting work early in the life young people in Leeds who self- In all, B received support from The Key for three years. By her final year, her confidence 15 to 19 have the highest incidence course. We are working to improve harm or feel suicidal. It is used in of self-harm admissions: 297 young the emotional health of children a wide range of settings such as had improved. She was part of the young people’s interview panel during recruitment of women were admitted in 2016–17 and young people as part of schools, youth work or community a new project worker, and she also joined the steering group. compared to 78 young men, i.e. Future in Mind, the Leeds Local groups. The Pink Booklet sets out around four times the male rate. Transformation Plan 2016–2020.26 key principles and ways of working B is now 18 and her time at The Key is coming to an end. The Key has now secured These figures represent episodes and We are supporting schools in Leeds and has been written in accordance three years of Big Lottery funding. B is really interested in the idea of leading sessions so include individuals with more than to become part of the MindMate with NICE clinical guidelines.29 with younger girls, one of the new strands of the project, as she feels this will continue to improve her confidence and self-worth.

26 Future in mind: Leeds 2016–2020 https://www.leedssouthandeastccg.nhs.uk/content/uploads/2017/01/MindMate-Future-In-Mind-Brochure-AW-DIGITAL.pdf 27 MindMate curriculum 2015 responses http://www.myhealthmyschoolsurvey.org.uk/survey-11/webform-results/analysis 28 Self-harm and suicidal behaviour: a guide for staff working with children and young people in Leeds https://www.mindmate.org.uk/wp-content/uploads/2016/05/Self-harm-booklet.pdf 29 NICE (2011) Self-harm in over 8s: long-term management https://www.nice.org.uk/guidance/cg133/chapter/1-Guidance CASE STUDY 28 31

‘We know poverty, abuse and violence are inequalities that are disproportionately suffered by women, which contributes to the picture of poor mental health, insecure housing and work, and disability, combined with high levels of caring responsibilities. Women’s Lives Leeds provides a great opportunity not only to directly deliver positive outcomes for women and girls, but also enables a platform for the partner organisations to influence policy and strategy in Leeds. We are very optimistic about our ability as a partnership to generate the system change needed to achieve improvements to the health of disadvantaged women and girls with multiple and complex needs.’

Gemma Sciré, Chair of Women’s Lives Leeds

The Leeds websites Mindwell30 and MindMate31 provide information about mental health, including self-harm, along with self-help tips and information Women’s Lives Leeds holistic, joined-up support, no ‘M’ about local support services. Women’s Lives Leeds is a unique matter where in the city the women live. They do this by: M was referred to the Women’s Lives Leeds Complex Needs Service in February We are trying to find out more about partnership formed by 12 women’s this complex problem. The Leeds and girls’ organisations from across • developing a co-production 2017. She had problems with mental health, domestic abuse, gendered violence, model to ensure they reach Suicide Audit has enabled a greater Leeds which specialise in dealing poverty and accommodation in a history dating back over 15 years. She had local understanding of self-harm and with domestic violence, mental the most vulnerable women risk in relation to suicide in the city. health, sexual health, sex work, • providing specialist support particular problems in her relationships with her children but was unsure of where Work such as the REACH project32 trafficking, child sexual exploitation for women with multiple and to go to get parenting help and support. She had not been able to engage with with young women has provided and education. The aim is to complex needs valuable insight on high-risk groups. improve the support given to the • supporting the development some of the statutory services in the past. REACH stands for Respect Encourage most vulnerable women and girls. of peer support across the city Through intensive one-to-one support, M has taken positive steps towards her Some members work specifically Active Confidential Help. The • developing a Virtual Women’s REACH self-harm insight project with women and girls from black future. She has had safety features installed at the property and now has housing and minority ethnic groups. Centre – a single point of was commissioned by NHS Leeds to information. band A. address high rates of A&E attendance Experience of physical and sexual Through this work, Women’s by young people in Leeds and to violence and abuse is linked to ...... Her relationship with her children has improved. She engaged with the Children and Lives Leeds seeks to: respond to national guidance on self- mental health problems and Families Social Work Services and attended a Parents and Children Together course. harm. The work was led by Womens physical health conditions • improve and extend access RECOMMENDATIONS Health Matters and The Market Place. including alcohol and drug for vulnerable women and Her daughter has been referred to Targeted Mental Health in Schools. Leeds City Council Public Mental The project was aimed at young dependency. It is also linked to girls to the services and Health team to lead insight By the end of March M was already feeling stronger and taking back control of her women aged 13–19 and was designed poverty and job insecurity. The support they want, when work with local communities to to gain insight into their self-harming greatest disadvantage is suffered and where they choose situation. Workers supported her to go back to her GP and a change in medication explore and understand self- behaviour. The report found that the by those who experience violence • provide holistic responses harm behaviours. has helped M to sleep better at night. young women were engaging in a over their life course, of whom to meeting complex and huge range of activities and risks to 80% are women. multiple needs Leeds City Council Public Health M has gained in confidence and will be attending the Leeds Women’s Aid Staying their wellbeing. The young women Women’s Lives Leeds use their • empower women and teams to review and further Safe Programme. This is a programme where women can support one another to were helped to recognise that combined knowledge, experience develop targeted early interventions girls to support their peers understand domestic abuse, how it happens and how to become safe. situations which they initially thought and networks to reach more and influence service to promote positive mental health were fun, such as getting into cars women, especially those who are development, delivery and and reduce self-harm risk in girls with unknown men, were actually most vulnerable, and to provide design across the city. and young women. risk-taking behaviours in which they ...... had very little control and could become vulnerable very quickly. 30 MindWell https://www.mindwell-leeds.org.uk/ CASE STUDY 31 MindMate https://www.mindmate.org.uk/ 32 NHS Leeds (2012) REACH: A self harm insight project 30 http://www.womenshealthmatters.org.uk/wp-content/uploads/REACH-Final-Report3.pdf 33

DRUG-RELATED DEATHS IN MEN

We have known for many years that All of these opiate or opioid drugs Preventing deaths from drug misuse people who take illicit drugs face a act on the nervous system to has become a national priority. The variety of potential health risks and relieve pain, but can also have a continued rise in deaths from drug contribute to the global burden of euphoric effect. Regular use of misuse led Public Health England disease.33 Whilst the level of drug opioids – even when prescribed by (PHE) and the Local Government misuse in England and Wales has a doctor – can lead to poisoning, Association (LGA) to convene a remained fairly stable for a number overdose incidents and death. national inquiry to investigate the of years, including in the 16–24 year ...... rise and prevention of these drug old population, the incidences of all deaths.35,36 In 2016, the Advisory drug poisoning, drug misuse death Committee for the Misuse of Drugs ...... and opiate-related death are at the Drug-related death (ACMD) advised ministers on how to highest levels in the UK since records ...... reduce opiate-related deaths.37 And 34 began in 1993 (ONS, 2017). The European Monitoring this year has seen the publication 38 In 2016, the number of people who Centre for Drugs & Drug of the new UK Drug Strategy died due to opiates (1,989) in England Addiction (EMCDDA) defines which signals the government’s alone overtook the number of people a drug-related death as a commitment to the prevention and who died in road traffic accidents death happening shortly after treatment of drug misuse. (1,732) across the whole of the UK. consumption of one or more In 2016, 3,744 people died in But what do we mean when we talk psychoactive drugs, and directly England and Wales as a result of about drug poisoning and drug misuse related to that consumption. drug poisoning, an increase of 70 death? What is an opiate or opioid? In the UK, death from ‘drug deaths (2%) from the previous year. And why are so many people dying? poisoning’ includes legal as Of these deaths, 2,593 (69%) were well as illegal drugs, accidental classified as drug misuse deaths, i.e. poisoning and suicides and deaths involving all illegal drugs, not ...... deaths due to drug misuse. just opiates...... Opiates/opioids A ‘drug misuse death’ is a death Nationally, despite fluctuations Traditionally ‘opiates’ refers to arising from drug abuse or from year to year, drug misuse drugs derived from the opium drug dependence and where deaths have shown a ‘persistent 139 background rise’39 since records people died from of the drug misuse poppy, for example morphine and the underlying cause is drug began in 1993. The majority of these drug misuse in Leeds deaths were in men heroin, whereas ‘opioids’ refers poisoning from any substance deaths have been from heroin/ (2014-16) (in Leeds 2014-16) to drugs man-made for use in controlled under the Misuse of medicine – for example, fentanyl, Drugs Act 1971. This includes opiate misuse. oxycodone and codeine – and all drugs which are illegal in In 2016, over half of drug poisoning prescribed by a doctor. However the UK, for example, cocaine, deaths involved opiates. Opiate- the two terms are often used amphetamines and ecstasy. related deaths have risen by 60% in interchangeably...... England and Wales since 2012.

50% 40-49 year age group have the 33 Degenhardt, L et al (2013) Global burden of disease attributable to illicit drug use and dependence; findings from the Global Burden of Disease Study 2010, Lancet 382(9904), pp.1564–74 of drug poisoning 34 Office for National Statistics (2017) Deaths related to drug poisoning in England and Wales: 2016 registrations deaths involved highest rates of drug https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/ deathsrelatedtodrugpoisoninginenglandandwales/2016registrations misuse deaths 35 Public Health England (2016) Understanding and preventing drug-related deaths http://www.nta.nhs.uk/uploads/phe-understanding-preventing-drds.pdf opiates (2016) 36 Local Government Association (2017) Preventing drug-related deaths: case studies https://www.local.gov.uk/preventing-drug-related-deaths 37 Advisory Council on the Misuse of Drugs (2016) Reducing opioid-related deaths in the UK https://www.gov.uk/government/publications/reducing-opioid-related-deaths-in-the-uk 38 HM Government (2017) Drug strategy 2017 https://www.gov.uk/government/publications/drug-strategy-2017 39 Wright, C (2017) Health matters: heroin availability and drug misuse deaths https://publichealthmatters.blog.gov.uk/2017/03/01/health-matters-heroin-availability-and-drug-misuse-deaths/ 32

35

NUMBER OF DEATHS RELATED TO DRUG MISUSE IN LEEDS. ALL PERSONS, MALES AND FEMALES IN LEEDS - REGISTERED DEATHS BETWEEN 2001 AND 2016

140 Male Persons 120 Female Linear (persons) 100

80

60

40

20

Number of deaths Number of 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 3-year aggregate periods

In the last year, for the first time, the Drugs implicated in some of these Preventing deaths from drug misuse Ahead of completion of the audit we 40–49 year age group had the highest deaths, and of concern, include new is a priority for Leeds There is an have already improved the reporting, rate of drug misuse deaths and the psychoactive substances like the urgent need to understand more monitoring and communication with largest increase in opiate-related synthetic cannabinoids (SCRAs), about what is going on in Leeds with Forward Leeds, the local drug and deaths. These were the people pregabalin and gabapentin. There this changing pattern of deaths. Also, alcohol service, about drug deaths who were in their mid to late teens are also continued increases in drug we need to better understand the amongst people actively engaged (the typical age of onset for heroin misuse deaths where cocaine and links to other health issues, including with the service. We have also ‘R’ use) during the heroin ‘epidemic’ benzodiazepines were mentioned on HIV, hepatitis C, sexually transmitted strengthened links and developed experienced in the UK from the early the death certificate. Factors other diseases and mental illness. Among better information-sharing with the R is a 44-year-old former heroin user now on opiate substitute treatment. R began 1980s to the mid to late 1990s. This than the age cohort effect must young people we’ve also noted an Leeds Coroner’s office. using heroin in his late teens when he was prevented by an injury from playing is an example of a cohort effect, i.e. a therefore be in play. increase in infectious endocarditis, We are working in partnership sport. What began as one-off use quickly developed into addiction and R started link between a statistical observation an infection of the heart valve, often with Forward Leeds, NHS Leeds and a particular age group. caused by re-use and sharing of and the health protection team to to engage in low-level criminal activities to support his daily habit. R continued contaminated syringes. All of which There is strong evidence that address factors which increase risk to use heroin for almost 25 years, with breaks when he was in prison. He came to the risk of fatal overdose among What’s will have an impact on the need for to this population. This includes heroin/opiate users increases prevention services and treatment finding ways of improving the Forward Leeds for help when he realised that life was passing him by in a blur. happening in and care services. substantially with age. In the general health and addressing the He is continuing to work his way through a methadone programme until he is short to medium term then, as the Leeds? As part of the Leeds Drug and broader physical and mental health ACMD report highlights, we may Alcohol Strategy (2016–2018),40 and needs of our ageing heroin/opiate ready for a full detox. be observing an increasing rate Although local records only go back in line with Public Health England user population. of opiate-related deaths among 15 years, all the evidence points recommendations, Public Health is a dwindling population of older to Leeds reflecting the national undertaking an audit of drug misuse users. Opiate-related deaths have picture. Leeds too is experiencing a deaths in Leeds in partnership with fallen substantially among people ‘persistent background rise’ in drug the Coroner. The audit covers 102 under 30 since the early 2000s. This misuse deaths. In all, 139 people deaths occurring during 2014–16. suggests that, if no new wave of died in 2014–16 and more men died In line with expectations, men heroin or opiate use occurs, the UK than women (75% in 2014–16). We account for 80% of these deaths, CASE STUDY could see a long-term reduction in are also seeing a rise in deaths in with a peak in the 30-45 age opiate-related deaths. older, long-term opiate users. There group. The audit will give us a Recent evidence suggests that the is good news in that, in line with the better understanding of the risk cohort effect described above is national picture, we are not seeing factors and characteristics that only a partial explanation for the a rise in deaths in younger opiate or have contributed to the story of increase in drug misuse deaths since opioid users. However, we now have each person’s life and their often 2012 because drug deaths are also a new challenge – rising deaths, premature death. The audit should occurring in increasing numbers particularly in men, from other also help us target interventions across other age groups and from drugs where different factors may be to prevent these deaths in ways different types of drug use. involved. that better meet the changing circumstances we now face. 40 Leeds City Council (2017) Leeds drug and alcohol strategy 2016–2018 http://observatory.leeds.gov.uk/resource/view?resourceId=5028 34 37

Since 2016, we have been clients entering drug treatment There are positive signs. As with distributing naloxone kits for use in 2016–17. Men also accounted alcohol, the overall percentage who in the community through Forward for the majority (75%) of those successfully completed their opiate Leeds. This has been shown to be entering treatment for heroin or treatment and did not re-present a cost-effective way of reducing opiate addiction. Of those starting to the service within six months – a deaths from accidental overdose treatment for opiate addiction, 72% national indicator – has steadily of opiates. Naloxone is a drug that had received treatment previously. increased over 2017. Men accounted ‘J’ temporarily blocks the effect of This means that at some point they for 62% of opiate users who opiate and opioid drugs. When it have left or become disengaged successfully completed treatment J is a 40-year-old woman who is a former opiate user with complex mental is injected into a muscle it rapidly from drug treatment services, and did not re-present. These 62% health needs. As she had friends who were also heroin users, Forward Leeds were reverses the harmful effects caused putting them at increased risk of recent improvements are great of opiate users who by the these drugs. This effect lasts harm and of death. news as we know through evidence successfully completed concerned about the risk of relapse and so ensured that she took a naloxone kit for about 20 minutes, allowing more The number of male clients the protective benefit that drug treatment and did not home with her when they were first made available. She had received the relevant time for emergency services to arrive treatment can have.41 re-present were men entering the service in 2016–17 with training and the accompanying instructional leaflet. and for ambulance staff to help save opiates as their primary substance Forward Leeds are working on a life. of use was about 20% of the total. improving their outreach services. On Friday she had phoned in to Forward Leeds in distress and reporting thoughts Since Forward Leeds has been The service has highlighted a steady This will introduce clients to the that alternated between relapse and suicide. Her key worker was able to talk her distributing these naloxone kits, 11 increase in the number of entrants service who will then be more likely kits have been used and returned to who are choosing to inject their to engage with their treatment around but had concerns because this was happening over a weekend. the service. That’s 11 lives saved from drugs to boost the effect. We know and recovery. However, we do still On Monday J’s key worker called her to see how she was feeling. J explained that accidentally overdosing whilst in the that this type of drug use carries need to review treatment pathways community. with it the highest risk. and explore how we can improve she was still distressed. The reason she was upset was that over the weekend a The distribution of naloxone will The most common age for entering them to ensure that we intervene friend had called round and started using heroin in front of her. continue in Leeds. We are also the service over this period was at points of greatest risk to reverse investigating the feasibility of our 35–44 years, closely followed by the the high level of harm and mortality J was able to resist the temptation to use. Moreover, when her friend overdosed in frontline police officers and Police 25–34 year age group. Due to the that we are currently seeing front of her, she had the presence of mind to use the naloxone kit she had been Community Support Officers carrying date when Forward Leeds started amongst men in the city. naloxone. In addition, we need to work in the city we are unable to provided with. She recalled the training, followed the instructions, revived her friend ensure that we make this life-saving compare these figures with previous ...... and called an ambulance. drug available to people at key points years to get a picture of whether of risk, for example when leaving younger people are entering the RECOMMENDATIONS hospital or on release from prison. service. This is something we need to keep an eye on in the future. Leeds City Council to use the The percentage of successful drug misuse death audit findings CASE STUDY Forward Leeds treatment completions for to better target interventions to opiates is the lowest across all of prevent drug deaths in Leeds. – the local drug the substance groups within the Leeds City Council and Forward and alcohol service. However, whilst we want Leeds to review routes of opiate to improve this figure, we need to drug treatment for males and service strike the right balance. It is not ensure that interventions occur just a matter of seeking to improve at times of greatest risk and a particular indicator. We need to that treatment services are My report has already mentioned make sure that the right people appropriate to need. the newly recommissioned are in drug treatment for the integrated Leeds Drug and Alcohol right amount of time to ensure a Leeds City Council and Leeds Prevention and Treatment Service sustained recovery and that service Drug and Alcohol Board – Forward Leeds. As with alcohol users do not increase their risk members to ensure that treatment, we are starting to see of harm, or even death, through partners work collaboratively the benefits of the hard work and disengaging with the service. to address the physical and dedication of the staff in this service. Forward Leeds has been supporting mental health needs of heroin/ The figures from Forward Leeds long-term opiate users with opiate users, enhancing access appear to support the gender aspects of their lives such as secure and support with employment, difference I discussed in the housing, social support networks, housing and other services that introduction to this report. Males employment and resilience to help promote sustained recovery. accounted for the majority of achieve sustained recovery......

41 White, M et al (2015) Fatal opioid poisoning: A counterfactual model to estimate the preventive effect of treatment for opioid use disorder in England, Addiction 110(8), pp.1321–9 36

AUTHORS: Catherine Ward, Vineeta Sehmbi

3939

SUICIDES IN MEN

5 SUICIDES IDENTIFIED BY AUDIT 2011-2013 Suicide prevention is both a national What is the - COUNTS BY POSTCODE DISTRICT priority and a long-standing priority L in Leeds. The national suicide picture for prevention strategy, Preventing Suicide in England: a cross- Leeds? C S P government outcomes strategy to 42 7 save lives (2012, refreshed 2017), There were 213 deaths by suicide in gives councils a local leadership role Leeds between 2011 and 2013. The in preventing suicides. rate of death from suicide was 9.5 2 2 A key recommendation of the deaths per 100,000 people in Leeds. national suicide prevention strategy The vast majority of the people who took their own life were men (83%). 3 7 9 is to undertake a local suicide audit in S order to determine the characteristics, In Leeds, men are almost five times 13 more likely to end their own life than events and risk factors that contribute C 1 women (5:1). This is higher than the P to a person taking their own life. Suicides per postcode district M S 10 The idea of this is to ensure that national average of 3:1. The rate of interventions to prevent suicide are suicide in men has increased slightly 12 to 18 2 to 5 6 M targeted at high-risk groups where since the previous audit (2008–10), 12 whereas the rate in women has 8 to 11 1 to 2 there is most need. In Leeds, the Audit remained stable. C of Suicides and Undetermined Deaths C S 6 to 7 0 0 in Leeds (or Leeds Suicide Audit) The majority of people who took 5 4 has for some time provided ‘gold their own life were white British. In S 13 P 3 standard’ intelligence about high-risk Leeds, white British men are over C 6 groups for suicide in the city. Indeed, twice as likely to end their own life 8 1 7 the Leeds Suicide Audit 2008–2010 than men from black or minority L 1C C (published in 2012) has received ethnic (BME) backgrounds. 13 P 1 national recognition from Public 1 M Over half of the people who took C Health England as an example of their own life lived in the poorest 1 18 best practice.43 or most deprived areas of the Work in Leeds is steered by the city. The map shows that the two 213 areas with the highest number of deaths by suicide multi-agency Leeds Strategic Suicide S C Prevention Group. The city-wide suicides lie slightly west and south in Leeds 11 S Suicide Prevention Action Plan for of the city centre. (2011-2013) Leeds 2017–202044 identifies three 1 C The majority of the people who D 18 0 key high-risk groups in Leeds: took their own life were single, M 6 8 • men aged between 30 and 50 divorced or separated. Nearly half years with risk factors outlined of the people lived alone, and over M C in the most recent Leeds Suicide half experienced problems with a M Audit (2011–13)45 personal relationship. This suggests • people at risk of or with a history that social isolation is a risk factor. 0 6 of self-harm • people in the care of mental 83% 50% 33% health services. of deaths were from were 0 were men deprived areas unemployed © The Ordnance Survey mapping 2017 42 Department of Health (2012, refreshed 2017) Preventing suicide in England: a cross-government outcomes strategy to save lives https://www.gov.uk/government/publications/suicide-prevention-strategy-for-england 43 Public Health England (2014) Suicide prevention: developing a local action plan https://www.gov.uk/government/publications/suicide-prevention-developing-a-local-action-plan 44 Suicide prevention action plan for Leeds 2017–2020 http://www.leeds.gov.uk/docs/Working%20action%20plan%20draft%202017.pdf 38 45 Leeds City Council (2016) Audit of suicides and undetermined deaths in Leeds 2011–2013 http://www.leeds.gov.uk/docs/Leeds%20Suicide%20Audit%202011-2013.pdf 38 41

1. Background 2. Suicide Audit • Recommendations from the National Suicide • Working in partnership with West Yorkshire Prevention Strategy for England Coroner’s Office • Suicide prevention work informs and supports • Undertaken every 3 years as per PHE the wider Public Mental Health agenda Suicide Prevention: recommendations • We have a responsibility to understand and • Analysed all suicides in Leeds between 2011- reduce inequalities in the city 2013 using Coroner’s records • We aim to be a compassionate city that cares The Leeds Approach • A rigorous approach taken to data collection about our communities’ health and wellbeing • Intensive but invaluable: supports focused • Reducing suicide is a priority for Leeds Public Health, Leeds City Council prevention planning and enables targeting of • Chief Executive of • Full Council Leeds City Council Deputation high risk groups and areas • Executive Board DERSHIP AND in support of • Helps to review interventions of what works Member for Health C LEA COM commitment to tailored to local need and Wellbeing GI MIT prevent suicides ATE ME Champion Mental R NT in Leeds Health ST • Essential Risk Factors for Leeds

Insight Local activity and evidence • Welfare Advice

E • Men’s insight • Adopt a Block

N • NUJ National Media • Crisis cards developed H

G Guidelines

by and for men at risk C

A • Wider SP Training: • Green Man Project A

G • Leeds Suicide ASIST, SafeTALK, O

E Bereavement Service GP workshops R

M scoped and delivered The Leeds P

Risk Factors E by those bereaved P (National N

A Evidence) T Approach

D A

A N 4. Action D Leeds Strategic O R I N B • Sharing audit findings as evidence base Suicide Audit Suicide Prevention Group S • Shaping, developing and agreeing the • Partners (Police, Fire Rescue, CCGs, 3. Key findings of the Suicide Audit IG • A tool used to deliver, Leeds Strategic Suicide Prevention Plan inform and evidence need Third Sector, Acute Mental Health H • 213 people were included in the audit T • Sharing findings Trust, Prisons, Coroner’s Office) • Broad ownership of Suicide Prevention • Locally owned • Action Plan • The highest age group was 40-49 years

agenda and disseminating data • Commissioned Services • 82.6% male (n=176) and 17% female (n=37) • Improving robustness of data • National lobbying Male 5:1 Female (National gender ratio for • Reviewing real-time surveillance options suicides: 3:1) • Developing meaningful and targeted local • This means for every 1 female death there action e.g. men’s groups, Adopt a Block were 5 male deaths by suicide. • Commissioning A • 81% of those identified were White British • Action feeds into Suicide Prevention MBITIO ALE US SC • 55% of audit cases lived in the most deprived agenda being valued and prioritised 40% of the city

,

Contact: Catherine Ward - [email protected] Vineeta Sehmbi - [email protected] For more information please visit: www.leeds.gov.uk/phrc/Pages/Suicide-Prevention.aspx

Around a third of the people were For example, the Green Man The West Yorkshire Fire and Rescue unemployed at the time of their initiative for men at risk was led Service (WYFRS) Adopt a Block At the next meeting E showed interest in sports, woodwork, death. This is three times higher by The Conservation Volunteers initiative was initially developed than the average unemployment (TCV, a community volunteering two years ago to prevent fire and THE INSIGHT PROJECT and sessions to help him reduce anxiety. Over the following rate in Leeds at that time. Many charity) at Hollybush with locality other incidents in high-rise blocks six weeks the project worker maintained regular phone people were experiencing partners across the city including in the poorest areas of the city.46 E is a 66 year old man who came to the attention of the Insight increasing financial difficulties. Space2, Barca and Leeds Health for Partnership working with the Leeds Project through outreach work at a local community centre. contact with E, offering him a range of information and Worklessness and money problems All. Each agency had already been Strategic Suicide Prevention Group opportunities for one-to-one support to access activities. He were themes present in a large working with isolated and high-risk identified men living in isolation Having overheard a conversation with a Barca-Community Health proportion of the deaths. men within communities and so in high-rise blocks as a high-risk Education worker in which E made self-deprecating comments did not access any of these during that time, but continued the partnership was well placed to group for suicide. WYFRS and Barca to want to learn about different opportunities, and he did take forward this work in areas of housing officers have identified the about suicide, the project worker asked him if he had been deprivation with high numbers of premises or ‘blocks’ associated with suicidal. E confirmed that he had. He had not spoken to anyone attend a music group at the local community centre. The What are we suicides. The learning from this work the highest number of incidents. project worker referred him to Armley Helping Hands. In a continues to shape local community Each month the nominated WYFRS about it even though it happened about six weeks earlier. E doing in Leeds? action. Men who have identified watch visits the block and inspects described the loss of his partner and home, and a sudden phone conversation a week later, E reported that he had themselves as being at risk at some it for fire safety from top to bottom. relocation to Leeds, as all contributing to his feelings. He was acquired a Leeds Extra Card and said the referral had been The Leeds approach to suicide point in their life have become As they do this, officers try and do a prevention combines successful mental health champions in their home fire safety check at each flat new to the area and felt isolated. The project worker gave him helpful. He spoke positively about wanting to attend walking local community or place of work and meet the occupier. The idea is local partnership working, evidence- a Crisis Card and the PEP (Patient Empowerment Project) phone football, and expressed a desire to work sometime soon, based practice and an ambitious and engage in activity to reduce the that, over time, residents will come scale. Following publication of the stigma of poor mental health and to know and trust the officers, number and booked to meet the following week. At the end of which was a very positive step. He said that he did not feel help raise awareness within their own who may then be able to engage 2008–10 audit, we commissioned the conversation E expressed deep gratitude and said, he needed any more support from the insight project and insight work to target high- communities around men’s mental them in talking about health and risk groups. Much of this was health. This work also promotes and welfare issues and offer guidance ‘God bless you, thank you for caring’. expressed thanks for all the support he’d received. through community development celebrates the positive role men play about getting help, for example by approaches. in their community. providing a Crisis Card. CASE STUDY 46 National Suicide Prevention Alliance (2017) Case study: Adopt a Block http://www.nspa.org.uk/wp-content/uploads/2017/10/NSPA_CaseStudy_AdoptABlock_v2.pdf 40

4343 FEEL LIKE YOU’VE HAD ENOUGH?

If you need emergency food If you’re having problems with money Can help with legal, money and other parcels, contact Leeds Food or need support dealing with debt, Aid Network problems by providing free, independent visit Money Buddies for free, confidential, impartial advice. and confidential advice. www.leedsfoodaidnetwork.co.uk To find out about the different services in 0113 2350276 Finally, Leeds invests in targeted Leeds call 0113 223 4400 www.leedsmoneybuddies.weebly.com 07557 331519 [email protected] delivery of internationally recognised suicide prevention If you are worried about money problems, find help and support at: training. Training is targeted at www.mindwell-leeds.org.uk/money-worries those working directly with high-risk LEEDS HOUSING OPTIONS If you are 19 or under, you can contact ChildLine about anything. Advice service for people who are No problem is too big or too small. Speak groups and at local communities homeless, at risk of homelessness, or MindWell is a single ‘go to’ place in Leeds to a counsellor straight away on simply want advice about for up-to-date information about mental health. 0800 1111 (Freephone). housing options. Get information about support and services where deaths from suicide are 0113 222 4412 available in Leeds and learn some self-help tools LEEDS SUICIDE BEREAVEMENT SERVICE and techniques. MindWell is a city-wide initiative significantly higher. 07891273939* funded by the NHS. *out of hours 5pm - 8 am, emergency only www.mindwell-leeds.org.uk Support, information and counselling for young people in Leeds aged 13-25. 0113 2461659 Are you struggling to cope or feeling overwhelmed? Advice, information and support www.themarketplaceleeds.org.uk In December 2016 my dad took his own life at 51 after if you are concerned about your Talk to someone now about how you are feeling. alcohol or drug use or someone else’s. You can also call to refer YOU ARE NOT ALONE. yourself to services in Leeds. YOU ARE IMPORTANT. suffering with mental health problems for a number of years, If you’re a young person, MindMate can help Postvention 0113 887 2477 AND IT IS OK TO ASK FOR HELP. you understand the way you’re feeling and find the right advice and support. something that no one could ever prepare for. www.mindmate.org.uk When someone dies by suicide, they

Support in times of crisis leave behind the people close to I don’t think you can ever put the grief of someone so close Feeling desperate and need a friendly face? Visitors can access Dial House when they are in CONNECT HELPLINE them: family, friends, colleagues, crisis. It is a place of sanctuary. Open 6pm – 2am on into words, more of just a wave of sadness, heartache and Friday, Saturday, Sunday, Monday and Wednesday. In a medical emergency Emotional support and Need to talk to someone? Call 0113 260 9328 or text 07922249452 on the night you wish to request a and neighbours. For every death visit. Parents in crisis can bring children with them. We can support deaf information for people in Leeds open 6pm-2am every night of the year. CALL 999 visitors using BSL. 12 Chapel Street, Halton, Leeds, LS15 7RW If you need loneliness that hits you when you least expect it. Confidential and emotional medical help in a by suicide it is estimated there are support 24 hours a day. Dial House @ Touchstone 0808 800 1212 non-emergency Crisis service for people from Black and Minority Ethnic groups. between five and ten people who 116 123 (Freephone) Open 6pm – 11pm on Tuesdays and Thursdays. Call Connect if you are feeling anxious, CALL 111 The impact this has had on our family and his friends has lonely, angry or just need to talk. 0113 245 6789 53-55 Harehills Avenue, Leeds, LS8 4EX are severely affected by the death. (local call charges apply) Call 0113 249 4675 or text 07763 581 853 Run by Leeds Survivor-Led Crisis Service on the night you wish to visit. [email protected] This suggests that, in Leeds, there been devastating. My dad was my hero and my best friend www.lslcs.org.uk are around 300 to 600 people too and the reality is you don’t realise how much you need Are you struggling after affected by suicide each year. When the death of someone close? Experiencing If you have been affected by sexual someone is bereaved by suicide the someone until they’re gone. violence in the violence of any kind call home? SARSVL grieving process is often heightened. I’m currently away at university so leaving my family after provides support, information Support and information about all for confidential Evidence suggests that being and practical advice. If someone you were close to domestic abuse services in Leeds. emotional support. 0113 234 4150 has ended their own life you bereaved by suicide has a significant this happened was one of the most difficult things. Knowing can access one-to-one support, 24 hour Helpline CALL 0808 802 3344 0808 808 1677 group support, or counselling. impact on mental health and is in www.cruse.org.uk 0113 246 0401 TEXT 07797 803 211 that I’d be alone if I returned to Leeds was a hard to 0113 305 5803 itself a risk factor for suicide. EMAIL [email protected] ‘Postvention’ describes the range choice to make. Both my Mam and my sister have also of support that can be put in place struggled, emotionally, mentally and financially. My dad had for people bereaved by suicide. Crisis Cards are credit card-sized Alliance document Local Suicide There is increasing national49 and worked hard all of his life and he was always the one we leaflets containing information Prevention Planning47 and for Public international50 evidence to suggest would turn to if we had a problem. Although struggling with about local support services, Health England’s suicide prevention that timely and appropriate support including housing, welfare, debt, resources.48 to people who have lost someone his own battles, he’d always know what to say to make our and emotional support. These are Working with Leeds Strategic Suicide through suicide has the potential to problems go away. distributed through the Public Health Prevention Group, the National reduce their own risk of suicide. I’ve come to terms with the fact that the pain of losing Resource Centre to GP surgeries, One Union of Journalists has developed The Leeds Suicide Bereavement Stop Centres, housing agencies, West media guidelines for local journalists Service was established in someone really doesn’t ever go away, just some days are harder Yorkshire Police and WYFRS. on the reporting of suicides to September 2015. It provides to cope with than others. Fire crews have received suicide help reduce the stigma around the postvention support for anyone CASE STUDY prevention training and have subject. Engaging with media and bereaved by suicide, through established relationships with communications to ensure that counselling as well as group and local providers such as third-sector they report suicides sensitively and one-to-one support. A wide range of community-based organisations responsibly is a key priority area local support services refer into the and frontline NHS mental health in the national suicide prevention service, including the police, mental CASE STUDY services. In October 2017 this strategy, as public messages around health services, and other local work was used as a case study for suicide have a significant impact on organisations supporting people the National Suicide Prevention suicide itself. who are bereaved.

47 National Suicide Prevention Alliance (2017) Local suicide prevention planning http://www.nspa.org.uk/home/our-work/joint-work/supporting-local-suicide-prevention 48 Public Health England (2015, updated 2017) Suicide prevention: resources and guidance https://www.gov.uk/government/collections/suicide-prevention-resources-and-guidance 49 Public Health England (2017) Support after a suicide: a guide to providing local services https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/590838/support_after_a_suicide.pdf 50 World Health Organization (2014) Preventing suicide: a global imperative http://www.who.int/mental_health/suicide-prevention/exe_summary_english.pdf?ua=1 42 42 45

DEREK programme aimed at inspiring and ‘Let me tell you a story’, said encouraging inactive and isolated men What do we need Derek, as he eyed the room of 30 to become more active. Derek is the to do more of? professionals who sat ready to listen jovial anchor man, presenting the comedians, musicians, to his experiences at a Public Health seminar focusing on men’s health. ‘It’s not ‘Turn up and do as I tell you’, it’s ‘Do it if health experts and men’s groups to the audience, and The city-wide Suicide Prevention Action Plan for Leeds 2017–2020 identifies a As Derek told his story of his military past, his slip into depression and his you want.’ You can sit if you want to, but hopefully you encouraging the listener to get out, ‘even if it’s just number of key priority areas. These narrowly failed suicide attempt, the room remained absolutely silent. This group will interact. So when I do get up, I feel part of it.’ for a walk around the block’. include reducing the risk of suicide in high-risk groups, including men of of NHS, council, public health and third-sector employees were being offered This approach pays dividends, with men being able to participate ‘Take that lovely mind of yours for a stroll. It’s working age, and providing timely just one of a great many stories behind the statistics, policies and procedures, in on their own terms and become more involved with activities and always having a good day.’ support for those bereaved or affected by suicide. a city where men are five times more likely than women to take their own lives. peers as their confidence grows. It is only at the end that Derek’s tone changes. As he tells Strong partnerships are central to the Derek’s very real experiences struck through to the heart. Whilst Derek still battles with depression and other health issues, he his story, his integrity, passion and reason for his appearance suicide prevention agenda in Leeds. This That was two years ago. Now Derek is well versed in telling his story of how, having continues to play an active role in the Orion Well Man Programme. on the show becomes clear as he appeals to his audience to includes continuing to engage and work alongside primary care and the wider been discharged from the army, he went from job to job and never really managed to Aside from attending Space2, he has been supported in his passion seek the help they need, as he was able to do. workforce, and supporting local media fit in - and how he slipped into depression before trying to take his own life. to share his story with other men, including appearances on BBC MenFM is available on CD from the Orion Partnership at to develop sensitive approaches to reporting suicides. After an incident at work, he found himself going down the street, ‘hitting Look North, BBC Leeds and at seminars and conferences. [email protected] and also as a download at myself and head-butting lampposts’, until he saw the No 13 bus coming. Most recently, Derek helped to co-produce MenFM, a radio www.soundcloud.com/menfmleeds ...... ‘I was not in control. Nothing anybody said to me made any difference. I thought, enough is enough, I just don’t want to RECOMMENDATIONS be here. I was lucky. Before I knew it, this little old lady was Leeds Strategic Suicide Prevention Partnership Group to ensure that putting me on the bus and telling me to phone my doctor. That’s reducing suicide in 30–50 year old what I did and that’s why I’m still here.’ men remains a priority within the Leeds Suicide Prevention Plan. Derek was referred by his GP to mental health services and to the Space2 Men’s Leeds City Council to ensure Group, part of the Orion Partnership. Here, he began to build back his confidence delivery of targeted work with and start to meet other men who had been through similar experiences and men at high risk of suicide as part of the new Mentally Healthy were able to support each other. Leeds service.

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RISE HIGH In the introduction to this report I talked about The project approached this in three main ways: the need to combine the economic with the • economic investment in the physical fabric of the blocks, such as more social. Improving the health and wellbeing affordable biomass heating, a new lift and access to free Wi-Fi of people in deprived areas of Leeds is not • improved support to tenants while also doing more to challenge simply a matter of economic investment. We anti-social behaviour on the part of some tenants know that factors such as loneliness, money • integrated partnership working across the third sector, housing, worries, family problems and unemployment police and health services. have a negative impact on health and wellbeing and quality of life. We also know Leeds Adults and Health services and Housing Leeds worked in partnership with the that solving complex problems may involve a charity Barca–Leeds to provide support to improve people’s health and wellbeing. number of different agencies. This concluding The involvement of different agencies made it possible to treat people holistically and case study shows how a broader, multi- address the complexity of their needs, rather than approach each need individually agency perspective can improve the health from a single-service perspective. Many of the people who engaged with Rise High and wellbeing of people living in our more were not accessing the services they needed. The team worked with residents to deprived areas. identify their specific problems, develop goals to improve their health and wellbeing and put them ‘I feel happy again.’ New Wortley is one of the council’s priority neighbourhoods for change. It has lots in touch with the appropriate local services and agencies to support their needs. of community assets and positive things happening, despite being in the poorest The project aimed to build on people’s strengths rather than simply identifying shortcomings. ‘I wouldn’t have got 1% of neighbourhoods nationally based on deprivation figures. The local GP Anyone who asked for help got it – no thresholds – so that interventions could happen at an any of this (support) practices, primary school and new community centre are all fantastic assets for early stage before problems got worse. if it wasn’t for the community. And the recent Our Place initiative has brought together a number In total, over 65 of the 400 residents engaged with the service between November 2015 and of partners and local people keen to make a difference. the end of March 2017 when the project ended. Half of these clients didn’t speak English as your help’ Leeds City Council’s housing department has historically faced a number of their first language and many struggled to communicate in English. There was also a lack of 53% problems in the Clydes and Wortleys tower blocks, however. There are four understanding of UK systems. For example, one household was spending £10–15 per day on ‘I’ve received more of Rise High blocks: Clyde Court, Clyde Grange, Wortley Heights and Wortley Towers. These topping up their electricity card because they didn’t realise that they had to inform the supplier support from you in clients reported an increase in housing blocks house around 400 people altogether, mainly in one-bedroom properties. of their new tenancy. This meant that they were paying off the arrears left on the account the past two weeks satisfaction Resident turnover is high and there are high levels of crime, drug use, rough by the previous tenants. The team fed this information back to Housing Leeds so they could than I have from sleeping and prostitution. Under-reporting of crime has been a long-term problem. address this problem when developing pre-tenancy training. any other service.’ Over 70% of residents in each block are single males aged between 30 and 50. Eight of those assessed, six of whom were male, stated that they currently had suicidal thoughts, More than half of residents are receiving Housing Benefit and so are unlikely or had had such thoughts in the past. Three of the eight had actually attempted suicide. ‘You’re a superstar, to be working. The Leeds Suicide Audit for 2011–13 has identified that LS12 has The project delivered noticeable outcomes and improvements for tenants. The measure of one of the highest levels of recorded suicides in the city. The people in the flats overall self-rated health improved. Over half (53%) of clients reported an increase in housing thank you for have many of the risk factors for suicide: men with high levels of unemployment, satisfaction. They also reported reducing debt, finding employment and volunteering. Problems your help.’ single occupancy, social isolation, as well as alcohol and drug abuse. with self-care (washing and dressing) dropped by 11%, from 33% to 22%. The multi-agency Rise High project aimed to improve the perception and The learning from this project is now being used to inform the Engage Leeds city-wide drop in problems reputation of the Clydes and Wortleys blocks. supported housing contract as well as the Adopt a Block project described earlier in this report. with self-care CASE STUDY 46 49

CONCLUSIONS RECOMMENDATIONS 2017-18

My report this year has focused have undertaken what is so far the ...... Leeds City Council to undertake Leeds City Council, Leeds Leeds City Council and Forward on a worsening life expectancy for largest health needs assessment a comprehensive health needs Clinical Commissioning Groups Leeds to review routes of opiate women and a static life expectancy for men in this country. We now RECOMMENDATIONS assessment for women. (CCGs) and Leeds NHS Trusts drug treatment for males and for men in our city. The individual need to undertake similar work on to increase identification and ensure that interventions occur sections around alcohol mortality the needs of women, recognising Leeds City Council to undertake Leeds City Council Public Health brief advice (IBA) in primary and at times of greatest risk and that in women, self-harm in women, that this will uncover both need a comprehensive health needs Intelligence Team to continue to secondary care with a particular treatment services are appropriate drug misuse in men and suicide and information gaps. So I have two assessment for women. monitor life expectancy and report focus on areas of deprivation with to need. in men each carry important more recommendations and these Leeds City Council Public back to the Leeds City Council highest alcohol harm. recommendations. There are also are set out below. Health Intelligence Team Executive Board and Leeds Health Leeds City Council and Leeds recommendations around Best Start to continue to monitor life and Wellbeing Board. Leeds City Council and Forward Drug and Alcohol Board members and the Inclusive Growth Strategy. My report highlights a number of expectancy and report back to Leeds to review alcohol treatment to ensure that partners work However, taking a step back, there public health issues that are causing the Leeds City Council Executive Leeds City Council to identify a services for females and ensure collaboratively to address the are some broader conclusions to the health of men and women to Board and Leeds Health and broad range of indicators to assess services are appropriate to the physical and mental health be drawn – namely the importance get worse. Reversing these worrying Wellbeing Board. progress on Inclusive Growth needs of women. needs of heroin/opiate users, of local public health information trends needs to be a priority. Our through the new Inclusive Growth enhancing access and support with and intelligence. Yes, we need actions must be based on a greater ...... Strategy, reflecting different Leeds City Council Public Mental employment, housing and other Public Health England for a national understanding of underlying gender geographies and populations Health team to lead insight services that promote sustained picture and for a picture of Leeds issues than we have had in the past. within the city. work with local communities to recovery. as a whole. But we are also seeing I do realise that there is increasing explore and understand self-harm the benefits of a strong Leeds awareness about those who cross Leeds City Council to ensure that its behaviours. Leeds Strategic Suicide Prevention Public Health intelligence function traditional gender boundaries new Leeds Inclusive Growth Strategy Partnership Group to ensure that that can analyse public health (trans) whether permanently or improves the socio-economic Leeds City Council Public reducing suicide in 30–50 year old issues within the city. The recent otherwise. In the future, there will position of the most deprived 10% Health teams to review and men remains a priority within the decision to combine the Public be a need to better understand the of communities in the city. further develop targeted early Leeds Suicide Prevention Plan. Health intelligence function with health and wellbeing issues and interventions to promote positive the NHS Clinical Commissioning challenges that trans people face in The Leeds Best Start Strategy Group mental health and reduce self-harm Leeds City Council to ensure delivery Group intelligence function will only their lives. to help ensure that parents are risk in girls and young women. of targeted work with men at high help this ability further and is to be well prepared for pregnancy and risk of suicide as part of the new welcomed. I know these are challenging times, that families with complex lives are Leeds City Council to use the Mentally Healthy Leeds service. and it is perhaps inevitable that identified early and supported. drug misuse death audit findings The skill of our Public Health this will have a negative impact to better target interventions to Intelligence Team at getting beneath on the health of the people in our Leeds City Council, Leeds Clinical prevent drug deaths in Leeds. the headlines has been crucial to city. However, partnership working Commissioning Groups (CCGs) and a better understanding of the real on health and wellbeing has never Forward Leeds to use local insight to areas of concern for Leeds. We will been stronger. The city’s Health and develop a social marketing campaign continue to monitor the health Wellbeing Strategy and Inclusive targeting young women and aimed status of our population. However, Growth Strategy set out a clear at reducing alcohol consumption there are emerging health issues direction of travel. I have no doubt and promoting access to services. that are different for men and for we have the right priorities. I retain women. There is an urgent need to my optimism that, by working better understand the particular together for the city, we can return health needs of men and of women. to improving life expectancies and Professor Alan White and Amanda reducing health inequalities. Siems from Leeds Beckett University, in conjunction with Public Health,

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ACKNOWLEDGEMENTS

A warm thank you to everyone who Editor has contributed to this year’s annual ...... report, particularly the Public Health Barbara MacDonald Intelligence Team and Richard Dixon. Without them, our understanding of the changes in life expectancy would Graphic design not be possible...... Leeds City Council Communications Authors and Marketing team (with special ...... thanks to Lindy Dark) Sarah Erskine Anna Frearson Photography Vineeta Sehmbi ...... Julie Stafford Heather Magner Tim Taylor Northern Exposure Photography Catherine Ward Shutterstock.com

Case study contributors ...... Communications Forward Leeds – Drug and Alcohol support Prevention and Treatment Service ...... The Key – Womens Health Matters Phil Morcom Women’s Lives Leeds West Yorkshire Fire and Rescue Production support Service (WYFRS) Adopt a Block ...... Insight Project – Barca Leeds/Public Kathryn Jeffreys Health Leeds Suicide Bereavement Service Derek Green, Orion Partnership Rise High

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