Suicide
(11 years ago)
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Baroness Buscombe
To ask Her Majesty’s Government what support they are providing to community groups, voluntary organisations, charities and faith groups that support people at risk of suicide.
Baroness Buscombe
My Lords, I thank all noble Lords who are contributing to this short debate. It is a tough subject and deserves our attention and support. I begin by paying tribute to the work of the Samaritans which is, this year, celebrating 60 years of amazing support for people from all walks of life who are trying to cope through a critical period in their lives.
I am privileged to be chairman of the Samaritans Advisory Board and have learnt at first hand so much of the extraordinary achievements all began with one man, Chad Varah, and one phone in one room in a church in the City of London. Chad Varah recognised that suicide is not inevitable, and the ability for someone to be able to share their thoughts with another, on a confidential basis, through the power of communication, could prevent unnecessary deaths.
Since that time 60 years ago, when this was a totally taboo subject, more than 127,000 volunteers have answered over 115 million calls for help—that is, twice the population of the United Kingdom—all without one penny of taxpayer subsidy but through charitable giving.
Samaritans volunteers are ordinary people providing callers with a safe place to talk, without judgment. Today 20,665 volunteers answer 5 million calls across the UK 24 hours a day, seven days a week. That means a contact every six seconds by phone, text, e-mail and letter and face to face.
Confidentiality and anonymity are hallmarks of the charity. I now realise that I have some wonderful friends whom I have known for years without knowing that they are Samaritans. I pay tribute to them all.
Even with the support of Samaritans, more than 6,500 lives are lost each year across the UK to suicide, and it is on the increase—by over 8% in the past year alone. Totally indiscriminate, suicide can affect anyone, no matter what their age, gender or background. Last year Samaritans answered more than 650,000 calls for help from people experiencing suicidal feelings. For every suicide, approximately 20 attempts are made. In 2011, more than 130,000 suicide attempts were made. One little-known fact is that men are three times more likely to die by suicide than women. Men in their 30s to 50s in lower socioeconomic groups are at the highest risk, and we do not know enough about why this group is so vulnerable to suicide.
What, in addition to the wonderful support of Samaritans and other related charities, such as Combat Stress, can be done?
The Deputy Chairman of Committees (Lord Bates)
A Division having been called, the Committee stands adjourned for 10 minutes.
Baroness Buscombe
So, my Lords, what can be done in addition to the wonderful support of the Samaritans and other related charities, such as Combat Stress? Technology is key to recognising that young people, in particular, no longer use a phone in the conventional way. They text and use social media to communicate and share their thoughts. Partnerships between organisations affected by incidents of suicide are critical. An example of this is a five-year partnership between the Samaritans and Network Rail, who are working together to confront suicide with some considerable success. In addition, there is a strong role for government. The new suicide prevention strategy, Preventing Suicide in England, published by the Department of Health in September 2012, is very welcome. This important development in government thinking recognises that any strategy to tackle suicide must be cross-government and needs the support of the voluntary and statutory sectors, academic institutions and schools, businesses, industry, faith groups, journalists and other media.
The link to other social problems, such as family breakdown, unemployment, debt, alcohol and drug misuse and the criminal justice system is so important. In short, we live in a complex society where, too often, people are lonely and feel unable to cope, even when they may have a loving family around them. The strategy makes some critically important statements in its six defined areas of action, which aim to reduce the risk of suicide in key high-risk groups; to tailor approaches to improve mental health in specific groups; to reduce access to the means of suicide; to provide better information and support to those bereaved or affected by suicide; to support the media in delivering sensitive approaches to suicide and suicidal behaviour; and, finally, to support research, data collection and monitoring.
The strategy includes a new area for action, highlighting the importance of providing better support to people who have been bereaved by suicide. Some bereaved families say that hitherto there has been little support available for them to turn to. The strategy is also very clear that, for suicide prevention to be effective, mental and physical health have to be seen as equally important, and we need better mental health for all. That in itself presents an enormous challenge, albeit one that is entirely laudable and should be pursued with rigour.
The immediate challenge is to ensure that the six areas of action are applied in practice and filter through to all parts of the country, both urban and rural, and reach those in need of support. All upper-tier local authorities in England should, I suggest, commit to the development of a local suicide prevention action plan, involving a wide range of statutory agencies and voluntary organisations.
Improvements could also be made in relation to signposting. How do people know where to turn to when they are in shock following the suicide of a family member or friend? Coroners’ officers, GP surgeries and other gatekeepers need to ensure that they are referring people bereaved by suicide to sources of support—for example, making available the Help is at Hand support booklet. In addition, rollout of a new free-to-caller number, allocated by the European Commission and transferred by Ofcom to the Samaritans, is key, albeit additional funding to support this development is needed.
Given that implementation of the strategy is crucial, the All-Party Parliamentary Group on Suicide and Self-Harm Prevention has recently sought to investigate the effectiveness of local suicide prevention plans in England—a relevant question, given both the strategy and the fact that both recent public health and NHS reforms have, as of this month, become fully operational. The all-party group wrote to local authorities and PCTs to establish the extent of suicide prevention activity in each of the 152 county and unitary local authority areas in England, and the response is concerning: 27% of local authority areas do not have a local suicide prevention plan and 46% of local authority areas do not have a multi-agency suicide prevention group.
The all-party group made a number of important, practical recommendations. At national level, these are aimed primarily at the Department of Health, the main thrust being that a stronger set of requirements needs to be imposed by the Government to ensure that the aims and objectives of the strategy are implemented at local level. The necessary steps for implementation at local level include requiring local authorities each to develop a suicide prevention plan led by the director of public health, and those plans should reflect the six areas for action to which I have already referred. Progress needs to be monitored so that there is a clear understanding at national level of where there are gaps in local implementation. Also, a sharing of best practice and other information about suicide prevention work across the country and between the four nations of the UK should be put in place. Therefore, there is a very important role for government and I hope to hear from my noble friend this evening that there is a strong focus upon practical implementation of the strategy.
In addition, awareness among all citizens of this terrible curse upon society must be continually raised and discussed so that more can be done to support those at risk of suicide through all the agencies, coupled with the wonderful support of individuals that exists because of the thousands of volunteers who work tirelessly and with extraordinary compassion so that fewer people die by suicide.
Lord Giddens
My Lords, I congratulate the noble Baroness, Lady Buscombe, on having introduced this debate in such an effective fashion. Suicide is an extremely complex form of action to study and, hence, to develop preventive strategies against. There are two reasons for that. The first is that, by definition, you cannot interview people who have committed suicide—there are very few other examples in social life where this is true. Secondly, in order to be said to commit suicide, you have to have the intention to die. If you step off a kerb accidentally and a car knocks you down, it is not suicide. As most people do not leave notes, intention has to be inferred retrospectively by coroners.
When I studied suicide in the early part of my academic career, we looked at lots of judgments made by coroners. They led me to be deeply suspicious of suicide statistics and therefore of preventive strategies based on those statistics. It is not that suicide statistics are just inaccurate around the edges; in my opinion, they are often probably totally wrong and non-comparable. One thing about the government document on preventing suicide in England is that it is based almost wholly on statistics, and risk is calculated in that way. For example, the noble Baroness cited figures suggesting that three times as many young men commit suicide as other groups. However, I think that that is highly unlikely to be true. I do not have the time to say why, but I think that it is highly unlikely. One must depend upon intensive studies of suicide and not just statistical ones.
One way of studying who has committed suicide is to look at those who attempt suicide in various serious situations. We had an interesting study of people who jumped off the Golden Gate Bridge in San Francisco. If someone jumps off that bridge he is almost certain to die—only about 3% survive. The study interviewed the survivors. It was interesting that on the way down, people were thinking, “I didn’t need to do this”, or, “I could have solved my problems”. What they said was very interesting. It was admittedly a small sample, because most people die, but they all said that it was the Golden Gate or nothing. In other words, the method that you use to commit suicide is very important, especially if you intend to do it seriously—there is a massive difference between most attempted and actual suicides.
Another study of the Golden Gate Bridge covered 515 people who were stopped from jumping. That was also interesting. One might imagine that people who really want to kill themselves will go on until they do it, but that is not so at all. In the study, of the 515 people, 95% were either still alive 25 years later or had died of natural causes. In other words, at least for certain types of suicide, if prevented at source, it does not recur. That has important implications.
In this country, some 20 people on average jump off Beachy Head each year—124 people died there between 1965 and 1979. A medical researcher who studied the details very intensively—this is why I am recommending intensive studies—concluded that 115 of this group were almost certainly suicides. To show the point that I was making earlier, only 58 were recorded as suicides by the coroner. That is a huge difference; it is double the rate. A lot of people who jump off Beachy Head are women, not men. Having read Preventing Suicide in England, a bit more lateral thinking would be in order, in recognising all the great work that the Samaritans do.
In my minute I must ask quickly, first, what is the Government’s policy on popular suicide spots? Are they all left to volunteer groups, such as at Beachy Head, where it is mainly a chaplaincy group that tries to stop people? It is very important to know because probably about 500 people a year die in popular suicide spots, which is about 4% of the total number in the country. That is pretty significant. I do not know whether the Government have a policy on that, but as the Golden Gate study shows, if you stop them, the vast majority do not come back to try again. Secondly, is there an analogue to the Live Through This project in the United States, which is pretty intriguing to me. It is backed by the American Association of Suicidology. Oh dear, I will have to stop, I suppose. It is transformational because it is a website for people who have survived serious suicide attempts. They speak out openly in a variety of media sources and communities. The idea is to strip away stigma and shame, and it is the first time that that has ever been done. There is a major input from people on a large scale who have attempted suicide, and there is a public-private partnership to support it. The main thing is that people who have attempted suicide have been seen as objects not subjects. In this case, they appear as subjects. I had a good third point but have no time to make it.
Lord Roberts of Llandudno
My Lords, I, too, thank the noble Baroness, Lady Buscombe, for giving us this opportunity, and for bringing to our attention, as the noble Lord, Lord Giddens, said, the statistic that three times as many young men between the ages of 30 and 44 commit suicide than women in that age range, or perhaps a wider age range. Does that not somehow reflect the economic situation—jobs and so on? A University of Liverpool study suggested that 1,000 suicides in the general age range were because of the recession. How true that is I do not know, but that is the figure that the University of Liverpool gives us.
In Wales we had a different situation. In 2007, seven youngsters in Bridgend committed suicide, six of them by hanging. In that year, there was a terrible dilemma in Wales: why were these people doing it? They were saying, “It is such a boring place, what else can I do? What other job can I get? I want to get out of here”. The only way they could see to get out of there was by committing suicide.
The great contribution of the Samaritans has already been mentioned, as have Childline, the NSPCC, Chad Varah and Esther Rantzen. All these deserve our thanks for what they have done and the countless lives that they have saved.
The reasons for suicide vary tremendously. As a minister, I encountered it fairly often—not too often but often enough. Why did they try to do this? Sometimes you just shook your head and said, “No idea”. At other times you would say, “Ah yes”—there were problems that we were aware of. According to the statistics, 1 million people commit suicide every year worldwide. Of these, 100,000 are young people, 15 to 19 year-olds. I suggest that there are 100,000 different reasons why they would try to commit suicide—so many different countries, so many different situations.
A new scheme is being brought in in Indiana in July this year. Everyone seeking an initial teaching qualification will have to study education and training in the prevention of child suicide and recognising the danger signs. Somehow, because we are talking to machinery, computers or whatever, we are losing the personal touch—in communities and families.
I have discussed this with ministers of other denominations—the number of priests and ministers in communities and the number of lively, active, alert churches is far fewer than it used to be. When that happens, the community is weakened because there is not the person there to support the most vulnerable. The figures from my own church in Wales are startling: 100 years ago we had 137 Welsh-speaking ministers of our own home-grown variety; today we have two or three. It is a big difference. A Presbyterian minister told me, “In my church at the time of the great Welsh Revival 100 years ago we had 1,000 ministers. We now have 40”. So the people who would be in the community to support and listen are not there in the same way, and the families who would also get their support in the churches are not there.
However, it is not only churches. I have a list here: policemen, village-based teachers, local shop-owners, local football teams, bands and choirs, even well run pubs—and I might well be struck off for praising well run pubs. These are all part of the community and they are not there to the same extent any longer. The local community is the strongest and best friend of those who are most vulnerable. We must somehow give it new strength so that it can fulfil what it used to do in treating and responding to needs.
Baroness Wheatcroft
My Lords, every suicide is a glaring reflection of the fact that our society has failed to look after its most vulnerable. The noble Lord, Lord Roberts, has just explained how he sees failings in the community as partly responsible for that, and I can only agree. I welcome the Government’s decision to produce their new suicide prevention strategy, and congratulate my noble friend Lady Buscombe on securing this debate. At this point, I must declare an interest as a member of the Samaritans advisory board. We are well represented here this afternoon. I am in awe of the remarkable work that the Samaritans do.
The reasons why people decide to take their own lives are varied, although there are some factors that seem to be very regular occurrences, particularly financial ones. When World Suicide Prevention Day took place last year, there was a campaign under the heading “You Can Cope”, but those who kill themselves have generally decided that they cannot cope, or at least that they cannot cope alone. I agree with the noble Lord, Lord Roberts, that they feel alone. This does not necessarily mean that they are single. They may be in relationships, they may be in touch with their family, and they may apparently have a network of friends, but the person who is driven to suicide tends to feel very much alone. A problem shared is said to be a problem halved, but a problem left to grow like a malignant tutor—tumour, although there are a few malignant tutors around—inside the brain and heart of an individual is a problem multiplied. For whatever reasons, and pride may be one of them, too many people today have no one they can share their problems with.
The irony is that in an age when many people have hundreds, indeed, thousands, of what they would term friends on Facebook, there are more and more people who, when they hit the slough of despond, do not have a friend to turn to but welcome being able to turn to a stranger. A friend of mine who spent many years as a Samaritan told me that what was really wanted on the end of the phone was a friend. The main cause that really drove those people to ring was extreme loneliness. She told me that she kept one of her clients going for several days after he called to say that it was the end, there was nothing to eat in the house and he could not cope. She told him the ingredients for cauliflower cheese and sent him out to buy them, and when he came back, she talked him through the recipe. When he said, “But what about the bird? There’s nothing for the bird to eat”, she suggested that the bird should eat cauliflower cheese too. In the end, this guy went away, not happy, but feeling less alone, and over the years he called her again occasionally and they talked recipes.
For those at their wits’ end, the Samaritans enable them to phone a friend. People do that about 5 million times a year. Other charities do fantastic work in helping those who feel suicidal, and the national prevention strategy acknowledges the importance of getting all those organisations to work together and to work in tandem with social services and the National Health Service, but today I shall stress the one way in which these charities can be helped to be more effective; it is by making that life-saving phone call cheaper. The Samaritans’ national helpline number is an 0845 number, which means that landline calls are relatively inexpensive, but calls from mobiles are considerably more. Incredible although it may seem, the Samaritans’ research shows that the cost of that call will put people off making it. The aim is to have a free-to-caller national number. In 2009, Ofcom gave the Samaritans the number 116123, which is pretty easy and memorable. It has been successfully trialled, but to roll that out nationally requires about £1 million a year. It would be dreadful for somebody to pluck up the courage to phone a friend in extremis to ring that number and find it dead. Without the certainty that that £1 million will be there or that there will be some other means of achieving it, that potential lifeline is not being rolled out. Far be it from me to suggest in the current climate that the Government should dig deep, or even quite shallowly, into their pockets and find that extra money, but there has to be a way that together Ofcom, the telecoms operators and the Samaritans can get together and produce some way of doing this. Perhaps the lottery could help. It might cost a little money, but what it would save is immeasurable.
The Lord Bishop of Exeter
My Lords, I, too, am grateful for this debate. There are just two aspects on which I shall comment. The first is the issue of suicide prevention among people in contact with the criminal justice system—something that concerned me greatly in my early years as Bishop of Exeter. In the three prisons in the Exeter diocese, 20 men committed suicide between 2001 and 2011. Of these, 14 were at Exeter prison—a figure which reflects the higher incidence of suicide in local prisons, especially during the early days of imprisonment. Half of these deaths, though, were between 2001 and 2004, and I note that the number of suicides in prison nationally has also fallen steadily since 2004, apart from a spike in 2007. Hopefully this is a sign that measures taken under the NOMS suicide prevention strategy are having an effect. However, with 57 suicides in prison in 2011, there is still real cause for concern.
I am also aware that on 6 March this year, the Prisons and Probation Ombudsman published a “Learning lessons” bulletin, following investigation of the apparently self-inflicted deaths of three teenagers in young offender institutions. Each of these children was extremely vulnerable and the lessons learnt included better responses to bullying and a greater focus on the involvement of families and outside agencies. This is where I come to my second area of concern and the main subject of this debate. From this month, local authorities have new responsibilities for co-ordinating and implementing work on suicide prevention. It will be for local agencies, including working through health and well-being boards, to decide the best way to achieve the overall aim of reducing the suicide rate. However, while there are clearly opportunities here for local initiatives in co-ordinating and commissioning work, there is also a risk that, especially where there is no local suicide prevention plan, this priority may be overlooked in the allocation of funds.
The findings of the All-Party Group on Suicide and Self-Harm Prevention have already been referred to by the noble Baroness. Only half of local authorities have a local suicide prevention group, while a quarter said that there was no local suicide prevention plan, even where there is a local suicide prevention group. Often there is no formal mechanism for such groups to report directly to health and well-being boards. Only one-third of respondents mentioned specific suicide prevention programmes. Yet the report also mentioned the key role of third sector groups. Many suicide prevention actions contained in local plans involve the voluntary sector in delivering programmes such as support services for people bereaved by suicide. From the available evidence, the majority of groups had voluntary sector membership, underlining their importance to suicide prevention and the heavy reliance on them.
However, within the voluntary sector there are real concerns about the responsibilities placed upon them and the resources that enable them to respond. Take the example of just one not-for-profit, open-access counselling service in Devon. It sees around 160 clients a week. These are self-referring adults who pay according to means. Work is with individuals, couples and family groups. There are no paid employees and all are qualified volunteers. The work of such groups is really important, because the potentiality of suicide often does not appear as a presenting issue, but rather through other therapeutic work, revealing, for example, patterns of isolation, self-harm and despair. However, the sustainability of such a model of group work is increasingly a challenge in the current economic climate. Average client contributions have fallen and margins are tight. Yet the self-funding model still seems to be the only viable way of securing an effective service. Counselling services are notoriously difficult to fund. Counselling does not constitute a “charitable purpose”—something at which Her Majesty’s Government need to take a look—and thus many funders exclude counselling services as recipients.
Where funds are available, such as lottery funding, they can amount to the kiss of death for a service as they are often short-term. Culturally, funders tend to favour innovation and new services in preference to tried, tested and researched ways of working, and funding projects rather than vital revenue costs. In my own areas, the combination of these facts has led to the closure of numerous local services over the years, revolving door-style, including high-quality and relatively inexpensive services for young people at high risk. The fact is that this very important voluntary sector, of which much is expected, suffers from gross systemic underfunding, is too often neglected for its experience and understanding, and thus such funding as there is may often be misdirected and unwisely spent. I think, for example, of the privileging of short-term cognitive behavioural therapy over person-centred and psychodynamic approaches, which evidence shows have a greater longer-term effect.
If Her Majesty’s Government’s well intended suicide prevention strategy is to really work, more attention needs to be given to just how the voluntary sector is most effectively supported and engaged. This also means rectifying the fact that, while much of this work in the third sector is underpinned by a strong faith base, and a great deal of work is being done by faith groups in supporting those at risk of suicide and self-harm, I find it concerning that there is so little reference to faith groups in any of the official documents underpinning the structures and strategies that we are debating today.
Lord Grade of Yarmouth
My Lords, I declare an interest as another member of the Samaritans advisory group; I think we are quorate today, which is good news. I also declare another interest, as an independent lay commissioner of the Press Complaints Commission, since I want to talk a little bit about the media role in this subject.
About 28 years ago, my boss and mentor fell out of a window four or five stories high in a block of flats. The next morning, the Daily Mail’s front page had a photograph of a mansion block of flats, and a dotted line from the fifth floor to the pavement where he fell. His children had to look at that in the newspaper. The story of media coverage of suicide, and its imitative effects and so on, is actually a good story from that day because coverage is much more sensitive. It is much improved. Editors and journalists are much more aware of the damaging effect of the wrong kind of sensationalist and detailed coverage of the methods of suicide. This is particularly true in broadcasting, where the statutory guidelines for producers and coverage and so on deal in great detail with the coverage of suicide. The media have for once a good story to tell in the way they deal with this subject. There is a substantial body of evidence from around the world which indicates that certain types of media reporting of suicide can have a negative influence on the behaviour of people who are already vulnerable and put them at greater risk.
I am worried about the uncertainty, the lacuna that exists, as we move from the PCC to the Leveson-compliant new formula. There is considerable uncertainty about the nature of that, who is going to sign up to that regulation and so on, which has been well rehearsed in the Chamber. I am worried that the progress that the media has made—and it is a good story—should not get lost. The Government, and those charged with setting up the new body, will understand that the good work that has been undertaken should not be lost in the transition from the PCC to whatever the new body concerned is.
Others have spoken about the good work that the Samaritans and other organisations do, and that has to be true. The “116” phone line that my noble friend Lady Wheatcroft alluded to is a serious worry. We have to find the money to make this happen. I do not think it has to be government money—it is only £1 million. I know it is easy to say that but, somehow, through the lottery—I declare I was once chairman of Camelot—there has to be a way to find this money on a regular basis, because those calls may well, although I am sure not always, be life-saving.
One of the most worrying aspects concerns the causes of suicide. Sadly, throughout my professional and personal life, I have been very close to far too many suicides. In one or two cases you could look at them and say they had everything to live for. Lack of recognition of the symptoms is the most difficult aspect of this subject. I hope that the ease and availability of the Samaritans service and the “116” lines will permeate people’s consciousness, that they will make that last despairing call and that they will be able to afford to do so because the Samaritans can pay for it. That could, in time, save lives.
It is rare these days to pay tribute to the sensibilities and sensitivities of the media, but in this particular case I am very happy to put that on the record. I thank the noble Baroness, Lady Buscombe, for this debate, and all those who have taken part.
The Earl of Sandwich
My Lords, I thank noble Baroness for this opportunity. It seems that we are all supporters of the Samaritans, which is a wonderful organisation.
As the Minister knows, a member of my family has suffered for four years from acute withdrawal from benzodiazepines, especially sleeping pills given to him during periods of overwork and stress. He still suffers from burning sensations, tinnitus, agoraphobia and occasional suicidal tendencies that have confined him to his room—mostly unable to work or help his family.
This group of patients is still beyond the reach of the National Health Service. They are living in a policy “no-man’s land” because there are hardly any statutory services available or even people who are aware of their condition. Friends and family feel helpless and, in fact, are unable to help beyond informal counselling. There are dangerous moments when no one seems to be able to do anything. In this sense, the urban community has failed much more than the rural one.
Those who suffer first addiction and then withdrawal from prescribed iatrogenic drugs cannot look to their GPs or local clinics like other patients, because it was their doctors who prescribed the pills in the first place. The patients may have desperate thoughts of going to A&E as their last resort, until they remember that they will only be referred to a psychiatrist who will put them back where they started. The only slender threads of hope may be online, with the next e-mail from a fellow sufferer, or via a helpline to one of the saintly withdrawal charities such as CITAp in Liverpool, Recovery Road in Cardiff, the Bristol & District Tranquiliser Project or MIND in Camden, which is the only voluntary service available in London, but only to those who live in Camden. Some of these charities take thousands of calls a year, and I have no doubt that the Samaritans take many more similar calls from the same people.
I declare an interest as the vice-chair of the All-Party Parliamentary Group for Involuntary Tranquiliser Addiction. We are a small core group of about 12 active MPs and Peers. With occasional help from the media, we have been able to bring this issue to the attention of successive Ministers. The BMA held a useful seminar recently. I am glad to say that the present Health Ministers are now well aware of the risks, because it is known that 1 million people or more are taking benzodiazepines long term, not short term, and that their doctors are not stopping them. The Minister will remember all the arguments that we put forward during the Health Bill, and they remain valid today. These include the obvious need for greater awareness among doctors and junior doctors of the risks, good practice in the voluntary sector, better NICE and NTA guidelines, more understanding of the general protocol of withdrawal from prescribed drugs, and the need for a stronger national policy backing up the confusing new local health agenda. I went to see Public Health England only this afternoon and was encouraged that the new health and well-being boards and CCTs will have this subject in their list of priorities, but it will need a lot of encouragement.
Equally important is the need for the department to shift its spending priorities and its drugs agenda just a little way away from illegal drugs towards prescribed drugs. It is really the Samson and Goliath story. Almost all the knowledge in the National Treatment Agency is about methadone and alternatives to heroin, and about counselling. There is very little knowledge of the dangerous effects of prescribed benzodiazepines, SSRIs and Z-drugs, unless they coincide because people are using them with heroin. The US has much more experience. Changing the dosage of Prozac, for example, can trigger suicidal tendencies immediately. There is a black box warning of this in the United States.
We have now reached a critical point with all the new NHS changes. The voluntary agencies have high expectations that the Government will take these various points to heart, recognise the good practice that is out there and give it their fullest support. As the noble Baroness, Lady Buscombe, said, co-operation rather than competition is absolutely vital in this field.
Baroness Royall of Blaisdon
My Lords, I thank the noble Baroness, Lady Buscombe, for this important and timely debate. I am not a member of the Samaritans board. However, I fully support the calls for a free-to-caller number. I hope that Ofcom and the telephone companies are listening. I wonder whether we should all pen a joint letter to Ofcom and the telephone companies after this debate.
Like other noble Lords, I thank the organisations that have been mentioned, including faith groups, and especially the Samaritans in their important anniversary year. All these organisations, with their thousands of volunteers, work with, care for and support people who are troubled or have a mental illness. For too long, mental illness was shrouded by stigma and deprived of adequate resources. People with a mental illness, including those at risk of suicide, have always depended on what the Government might call the big society. The Samaritans have a shining record on this very tough subject. Thankfully, the stigma in society relating to mental health is increasingly being lifted, and all parties recognise the need for mental health to have parity with physical health. We would all agree on there being no mental health without physical health—and, I would add, without appropriate social care.
As Call to Action informs us, more lives in England are lost to suicide than to road traffic accidents, and every life lost to suicide is a tragedy. I welcome the cross-government strategy on preventing suicide. However, like Sarah Yiannoullou, the manager of the National Survivor User Network, I am concerned that self-help groups, survivor groups and small voluntary and community organisations that have helped with a preventive support have had increased burdens put on them and are having to close because of funding problems. There appears to be a conflict between what is said in the strategy and people believing that this can be delivered in the current climate. The right reverend Prelate made very important points about systemic and short-term funding.
Mental health services are clearly critical in providing the timely help and emotional support that can reduce the risk of people committing suicide. Having spoken to people working in mental health in my county of Gloucestershire, I know that they fear that recent changes in the NHS and the fracturing of services will have a negative impact on the delivery of mental health services in the community, especially in rural areas. There appears to be less co-ordination and less support for joint efforts between health services, charities, churches and other organisations that are working with people who have mental health problems. I would be grateful for the noble Earl’s views on whether there is appropriate integration where necessary. It feels as if the postcode lottery is being extended.
A briefing by the excellent organisation YoungMinds provides disturbing information about cuts by local authorities. Some have slashed 27% of their services, which has had an impact on people with mental health problems. Like the noble Baroness, Lady Buscombe, I am deeply concerned about the lack of local suicide prevention plans. The Government must not only provide requirements for such plans but must ensure that the funding is there in order for local authorities to implement the plans.
Society has changed profoundly in the past 50 years. We now live in a physically safer society, but emotionally people are far less secure. As many noble Lords said, many people live alone, and even when they do not live alone, they feel alone. We are all living longer, we have more stressful and isolated lives and we have to cope with huge and constant change. As the noble Lord, Lord Roberts, said, the increase in young people’s mental health problems is very disturbing. The factors that contribute to mental health problems, and indeed to suicide, such as drug and alcohol misuse, unemployment, social isolation, poverty and poor social conditions, appear at the moment to be increasing, and there are so many stresses and strains in society with little help available. There is a lack of hope, and it is incumbent on us all to give people more hope and vision for the future.
I look forward to the answers from the noble Earl about the support that the Government are providing to the voluntary and statutory sectors. Perhaps one of the greatest supports would be for the Government to change some of their current policies so that factors such as poverty, which increase the risk of suicide, are reduced. The risk of suicide in the whole population increases when we experience times of financial difficulty—this is not only my view but a widely held one—so I urge the Government to maintain their support for suicide prevention over the coming years.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, my noble friend Lady Buscombe is to be congratulated for bringing forward this emotive and important subject for a debate, which has generated some splendid speeches for which I, for one, am very grateful.
The loss of a loved one to suicide is a tragedy, and yet suicides are not inevitable. There are often opportunities to intervene, and those missed opportunities can highlight systemic failings. Timely access to high-quality mental health services is an essential foundation for suicide prevention. Although good progress has been made in reducing the suicide rate in England over the past 10 years, the recent rise in the number of people dying by suicide to around 4,500 in 2011 is worrying. Suicide continues to be a major public health issue, particularly at a time of economic and employment uncertainty. That is why we set out a new suicide prevention strategy for England in September 2012, which highlights the importance of targeting the groups most at risk by providing the right support at the right time.
My noble friend helpfully set out the key strands of that strategy and I was grateful for her endorsement of them. She is right that success in suicide prevention depends on communities, individuals and organisations working together to tackle the issue. Much of the planning and work to prevent suicides needs to be carried out locally. The right reverend Prelate rightly referred to the role of the new health and well-being boards in planning and co-ordinating local services based on local needs. That role will clearly be a pivotal one in the future. These health and well-being boards will become the forums for determining local needs and priorities, bringing together local authorities, clinical commissioning groups, directors of public health, adult social services and children’s services. I am sure he is right that third sector and voluntary groups will pay a key part in the delivery of local plans in many parts of the country. The concerns expressed by the noble Baroness, Lady Royall, about fragmentation of services are not ones I share. She may recall that in the Health and Social Care Act we laid great emphasis on integration as a key driver of commissioning. The very existence of health and well-being boards acting as the hub for so many key players in the public health and health arena will itself be a driver for that kind of integration.
As well as targeting high-risk groups, improving the mental health of the population is another way to prevent suicide, as has been mentioned. Our mental health outcomes strategy, No Health Without Mental Health, sets out an ambitious vision for improving people’s mental health. The implementation of the measures set out in the strategy will build individual and community resilience, promote mental health and well-being and challenge health inequalities where they exist. Again, the Health and Social Care Act passed last year was the first one to contain an objective in all parts of the health service to drive out health inequalities.
The noble Baroness, Lady Royall, referred to the need for parity of esteem between mental and physical health. Of course, I subscribe wholly to that aim. The Government’s mandate to NHS England explicitly recognises the importance of putting mental health on a par with physical health, and closing the health gap between people with mental health problems and the population as a whole. We expect the NHS to have made measurable progress towards this goal by March 2015. This will include ensuring timely access to the best available treatment through extending and developing open access to the IAPT programme, Improving Access to Psychological Therapies, particularly for those out of work. I think that is an important part of the targeting philosophy.
Alongside the development of the suicide prevention strategy, Samaritans—to whose work I pay special tribute in their anniversary year—have been facilitating a Call to Action for Suicide Prevention in England, supported by a grant from the Department of Health. Over 50 national organisations have signed the Call to Action, committing to work together so fewer lives are lost to suicide and to support those bereaved or affected by suicide. Organisations include public and private sector bodies and a wide range of charities, including those set up specifically to reduce suicide such as Papyrus, a charity dedicated to the prevention of young suicide in the UK. This is the first time that so many organisations have come together to deliver real action to reduce suicide across England.
Most people who take their own lives have not been in touch with mental health services. We know that some people, particularly men, find it difficult to speak to their doctor if they are having mental health problems, and this is partly because of stigma and shame. By tackling the stigma associated with mental health problems, we can remove a barrier to people seeking and receiving the help they need before they get to crisis point.
The department is therefore supporting the anti-stigma campaign, Time to Change, with up to £16 million of funding over four years. The campaign is run by the charities Mind and Rethink Mental Illness, and is an ambitious programme to end mental health stigma and discrimination. It has the potential to reach 29 million members of the public with its vital messages on mental health.
We know that the media have a significant influence on behaviour and attitudes towards suicide. My noble friend Lord Grade was absolutely right to highlight this. A number of organisations have developed guidance for the media on the reporting of suicide and its portrayal. One of these is Samaritans, which plays a key role in supporting sensitive reporting of suicide.
As my noble friend said, the media have a significant influence on behaviour and attitudes. There is already compelling evidence that media reporting and portrayals of suicide can lead to copycat behaviour, especially among young people and those already at risk. The media is aware of its responsibility in the representation of suicide. In 2006 the Press Complaints Commission added a clause to the editors’ code of practice explicitly recommending that the media avoid excessively detailed reporting of suicide methods. The 2009 edition of the PCC Editors’ Codebook highlights, for example, the distress that can be caused by insensitive and inappropriate graphic illustrations accompanying media reports of suicide.
We have made grants to charities directly involved in suicide prevention. In March 2010, Maytree Respite Centre was awarded a three-year grant totalling over £154,000 to support the continued implementation and development of its service. Maytree is a sanctuary for people in suicidal crisis, providing a non-medical alternative to hospitalisation or sectioning. The grant helped the organisation support over 4,000 people, with 300 being supported through a stay at the house. It also helped them to develop outcome-focused relationships with several NHS and private organisations. In March 2011 we awarded a £50,000 one-year grant to Survivors of Bereavement by Suicide, a charity that serves more than 8,000 clients each year. They provide a range of services from a national telephone line to local area support groups.
Early intervention is imperative to suicide prevention and various organisations, including charities, can help highlight and address problems such as bullying, poor body image and lack of self-esteem. The commitment to early intervention is borne out by the Department of Work and Pensions’ expectation that all Jobcentre Plus advisers are trained to enable them to identify and support people who are vulnerable and who may be at risk of suicide and self-harm. This is important, as we know that community locations, such as job centres and young people-friendly venues, are more successful in engaging with young men than more formal health settings such as GP surgeries.
The noble Lord, Lord Giddens, whose speech I listened to with great attention, spoke about statistics. I will certainly go away and reflect on his points on that score. He asked what the Government’s policy was on prevention at popular suicide spots. The suicide prevention strategy recognises that one of the most effective ways of preventing suicide is to reduce the means to access. Suicide risk can be reduced by limiting access to high-risk locations. Much of the planning and work to prevent suicides will, as I have said, be carried out locally; it will be for local agencies, working through health and well-being boards, to decide the best way to achieve the overall aim of reducing the suicide rate. I fully expect that the local agencies will work together to monitor those hotspots.
My noble friend Lord Roberts pointed to the effect of unemployment, a point made effectively by my noble friend Lady Wheatcroft. We know that previous periods of high unemployment or severe economic problems have had an adverse effect on the mental health and well-being of the population and have been associated with higher rates of suicide. Despite the good progress that has been made in reducing the suicide rate, we need to remain vigilant on that particular aspect of the risk.
Faith groups were mentioned by a number of noble Lords, including my noble friend Lord Roberts. I assure the Committee that the department recognises the comfort and support that people receive from their faith and would expect all medical practitioners to treat their patients holistically, taking into account their physical, cultural, social, mental and spiritual needs. The Government’s mental health strategy, No Health Without Mental Health, draws attention to the importance of ensuring that services meets the needs of diverse communities and faith groups. The right reverend Prelate will know that the former Archbishop of Canterbury, Rowan Williams, and Time to Change recently hosted an event for leaders from different faiths to look at ways of tackling the stigma and discrimination faced by people with mental health problems in their communities. That seminar was held at Lambeth Palace and was extremely well received.
The noble Earl, Lord Sandwich, spoke about the risk of prescribed anti-depressants. The suicide prevention strategy highlights the potential increase in suicide risk in the early stages of drug treatment and risks associated with withdrawal where people are dependent on prescribed drugs. The noble Earl has expressed his concerns forcefully in debate and privately to Ministers, and he knows that these messages have not gone unheeded—at least, I hope that he knows that. It is, as he said, for health and well-being boards to build into the joint strategic needs assessment suitable provision for this particular type of suicide risk.
Over the past 10 years, good progress has been made in reducing the suicide rate in England. Voluntary organisations, charities and community and faith groups have all played their part in this reduction. The messages are clear. We need individuals and organisations to support our continued efforts, to join us in our drive to sustain and reduce further the relatively low rates of suicide in England and to respond positively to the challenges that we face over the coming years.
Lord Grade of Yarmouth
Will my noble friend the Minister be kind enough to give us the benefit of his advice on how we might move forward an initiative to roll out the 116 line? I am much taken with the noble Baroness’s view that we might all write a letter, but I wonder if it is an initiative that the department might want to take up and try to co-ordinate to see if we can get a resolution.