Suicide

Debate between Earl Howe and Lord Grade of Yarmouth

Tuesday 23rd April 2013 Grand Committee

[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.