England faces a “ticking timebomb” of suicides because of a lack of funding and a failure to roll out a nationwide prevention strategy – a problem that the government is “choosing to ignore”, a leading parliamentarian has warned.
On the eve of the latest suicide data for the UK, Madeleine Moon, chair of the all-party parliamentary group for suicide and self-harm prevention (APPG), said a third of local authorities in England had no suicide action plan.
Despite a government suicide prevention strategy introduced in 2012,insufficient funds and lack of a statutory responsibility on local authorities had resulted in widespread failure to take action.
Moon, Labour MP for Bridgend, told the Guardian: “We know it’s ticking. We know it’s there. We know it’s a problem, and we are choosing to ignore it, or the government is choosing to ignore it.”
Approximately 6,000 people die by suicide in the UK each year, with more than 4,500 of those in England. The rate was in steady decline until 2008, since when there has been a small increase, which some researchers attribute to the economic downturn.
“Because the figures are not huge, it’s very easy to think we can ignore that group. Even though they are fit and healthy, often young men, we are almost callously saying that because the numbers are so small, it doesn’t matter if they die. And that is so wrong,” Moon said.
An APPG survey of local authorities in England has found that about 30% do not have a suicide prevention action plan, about 40% do not have a multiagency suicide prevention group and roughly 30% do not collect local suicide data.
Moon said lack of funding meant suicide was not a priority and the gaps in prevention provision around the country meant “we are going to have more deaths by suicide”. She is calling for Public Health England to “take a coordinating responsibility”.
“Most people who take their own lives are totally unknown to the mental health services,” she said. Without local strategies to identify those at risk earlier, “we are going to have more people harming themselves and we are not going to be aware, therefore, we are not going to be tackling it right at the start with the people who are at the early stages of risk.”
The government’s strategy was failing for lack of money, she said. “The numbers are small so when cash-strapped local authorities are looking at where their public health priorities are, suicide can often fall off the priority list, or it gets pushed over into mental health. And that is a big risk, because, quite often, if you are doing that, you might as well say they don’t have a strategy at all,” Moon said.
The APPG is calling on Public Health England to use its 15 local centres nationwide to support public health teams in areas where its survey shows the national strategy is not being fully implemented. The call is backed by Samaritans. “We know that areas of deprivation are likely to have higher suicide rates and so it is particularly worrying that many of these areas do not have suicide prevention plans in place,” Samaritans’ executive director of policy, Joe Ferns, said.
As part of his Blue Monday pre-election pledge, Nick Clegg has promised to sign up the NHS to a national “zero suicide” campaign, citing a programme to combat depression in Detroit, Michigan, that has reduced suicides sharply over the past decade.
His national initiative aims to build on existing local schemes that are adapting the Detroit programme – Mersey Care in Liverpool, Project Zero in south-west England and four pilot schemes in the east of England.
David Fearnley, medical director of Mersey Care and a consultant forensic psychiatrist, said the NHS trust hoped to see a year-on-year decline in deaths by suicide through several new initiatives. Adopting the absolute ambition of zero suicide, rather than just a reduction, had produced a shift in mindset, he said.
“It stands out. When you say ‘zero suicide’, people start to wonder if it is realistic. You open up a very different discussion,” he said. “People are suddenly standing back and thinking: ‘Well, maybe suicide isn’t inevitable.’ You start to challenge practice and you start to think about things differently.”
Fearnley believes it is achievable. “Most people who die by suicide have seen somebody, probably a GP, in the 12 months before they die – although not everybody has been seen by a mental health trust,” he said. So one key intervention is educating GPs about suicide, he added.
The aim is to ensure “the whole pathway” – from community to GP to specialist services – is thinking on the same lines, from A&E, acute hospitals, police, ambulance, prisons and coastguards.
Safety plans – talking to people about how they would take their life and discussing how they might stop themselves – and a “safe from suicide” emergency team to marshal resources for those thought at immediate risk are among initiatives.
But Prof Keith Hawton, at Oxford University’s suicide research centre, though “encouraged by the spirit behind the zero suicide movement”, admitted he was not keen on the terminology. “I think the use of this label implies an unreasonable aspiration and it has not been thought through clearly,” he said.
“I know that it is causing concern to clinical staff in psychiatric services responsible for the care of people at risk of suicide. It is likely to encourage unhelpful defensive approaches to care. It may also have untoward negative effects on people bereaved by suicide, with a risk of increasing feelings of guilt and stigmatisation.”
He said he hoped the APPG survey would “encourage all public health departments to ensure that very soon local suicide prevention policies and planning groups are in place in all areas”. “Unfortunately, we are still struggling with the impacts of a long period of austerity, which has undoubtedly contributed to a substantial number of suicides,” Hawton said.
“The recent large increase in suicides in prisons following large reductions in staffing is a clear example. Full implementation of effective suicide prevention will undoubtedly require major investments, both in clinical services and more general suicide prevention initiatives.”
Samaritans: 08457 90 90 90 (24-hour national helpline)
