Suicide and Self-harm in a Recession
(14 years ago)
Commons ChamberRead Hansard Text Read Debate Ministerial Extracts
Mrs Madeleine Moon (Bridgend) (Lab)
I am grateful for the opportunity to raise this important issue. In the past few months, the House has debated public spending cuts, job losses and the scaling back of services, but the human and personal costs are often forgotten among the facts, figures and policies, with a profound and tragic impact on individual lives and families.
When people take their own lives and self-harm, their reasons are complex and often individual, but running through too many incidents are worries about money and debt, the loss of status and esteem often associated with unemployment, and fears about a house or job loss. The increases in personal debt, bankruptcy, homelessness and unemployment that can follow can substantially increase the incidence of suicide and self-harm. A survey for Mind this year showed that one in 10 workers had approached their GP as a direct result of the recession, mostly for depression.
The points that I wish to make this evening are drawn from papers written by academics working in a range of institutions, including the universities of Bristol, Oxford and Manchester, which have departments focusing on suicide and its prevention. I am also indebted to the tremendous work of the Samaritans and the Royal College of Psychiatrists. The academic community draws on research on the effect of recession on cultures across Europe, as well as those in east and south-east Asia, Australia, America and elsewhere. The data go back to the great depression of the 1930s and are right up to date.
The steps that I will urge the Government to take are recommended by leading experts in the causes and prevention of suicide and self-harm. I thank those experts not only for their support and access to their research, which has helped me to prepare for the debate, but for their dedication and commitment to preventing self-harm and saving lives.
Self-harm includes intentional acts of self-poisoning or self-injury, irrespective of the motivation or the degree of suicidal intent. It includes suicide attempts as well as acts in which little or no suicidal intent is involved, such as when people harm themselves as a form of interpersonal communication of distress, to reduce internal tension or to punish themselves.
The Royal College of Psychiatrists points out in its report “Self-harm, suicide and risk: helping people who self-harm” that the incidence of self-harm has continued to rise in the UK over the past 20 years. For young people, the rate here in the UK is said to be the highest in Europe. The RCP points out that
“the needs, care, well-being and individual human dilemma of the person who harms themselves should be at the heart of what we as clinicians do. Public health policy has a vital role to play and psychiatrists must be involved and not leave these crucial political and managerial decisions to those who are not professionally equipped to appreciate the complexities of self-harm and suicide.”
It goes on to point out that
“we must never forget that we are not just dealing with social phenomena but with people who are often at, and beyond the limit of what they can emotionally endure.”
Research has shown clearly that economic cycles give a clear indication of suicidal trends, and recession has been shown to be accompanied by an increase in suicide rates across the world. Falling stock prices, increased bankruptcies, and housing insecurities including evictions, the anticipated loss of a home and higher interest rates are all associated with increased suicide risk. Study has shown that being in debt is associated with mental health problems and suicide ideation, which contribute to someone taking their life.
We know that the unemployed are two to three times more likely to die by suicide than people in employment. Unemployed men are particularly at risk. Unemployment can result in poorer mental health and contribute to anxiety, depression, low self-esteem and feelings of hopelessness, all of which increase the likelihood that someone will think that their life is no longer worth living.
For those who have no history of mental health problems, there is a 70% increase in suicide risk if they are unemployed. The great depression of the ’20s and ’30s resulted in a steep increase in male suicides. The people most at risk of suicide are those who are experiencing financial problems, those in poverty, those struggling with the rising cost of living, those who have recently lost their jobs or who are affected by a downturn in business, those who are in low-status occupations, and those with existing mental health problems. People who are self-employed or who live in single-person households, those experiencing relationship breakdowns, and those who are isolated and without strong social networks are also particularly at risk.
Initially, people often turn to drugs and alcohol to mitigate the emotional pain and confusion that they feel. Some argue that improving access to psychological therapies is the best way of helping those who suffer from mental health problems as a result of the recession. Treatments such as cognitive behavioural therapies can benefit people, but as Professor Drinkwater of the university of Bristol has made clear,
“unless you do something about the environment in which they live they are…likely to relapse. Without real jobs, decent housing, and adequate incomes people are going to be at risk of becoming ill again”.
Andrew Stephenson (Pendle) (Con)
I congratulate the hon. Lady on securing this important debate. In addition to what she says, I suggest that businesses have a role to play. In Nelson in my constituency, six deaths in the past six years resulted from people falling from a multi-storey car park by the Pendle Rise shopping centre. Despite that, when Pendle borough council proposed new safety measures in July last years, the car park owners refused to support such measures, saying that town hall chiefs were “wasting their money” because people with a desire to commit suicide would always “find a way”. Does she agree that such an attitude from certain businessmen is completely unacceptable?
Mrs Moon
Anyone who can take any step to turn someone away for that brief moment in which they might think again should do so. I agree with the hon. Gentleman that whatever barriers are needed in that car park should be in place, and I thank him for his intervention.
I would direct the Minister to research carried out by Professor David Gunnell et al on the effect of the economic crisis in east and south-east Asia in the 1990s, to recent work by Professor Keith Hawton, David Platt and Camilla Haw, and to the work of Professor Purkis and the steps taken in Australia to deal with, and indeed to reduce, suicide in a recession.
There is broad agreement in academia, psychiatry and mental health charities on what steps need to be taken to reduce suicide and the effect of a recession on suicide and self-harm rates. Suicide prevention must remain a priority of public health policy in all countries in the UK. There should be structures at national, regional and local level and mechanisms for the flow of information, evaluation and best practice in reducing suicide and self-harm. That best practice must be known, shared and implemented. It is essential that research into what works and why people are taking their own lives be funded.
The current national suicide prevention strategy for England is coming to an end. I urge the Government to ensure that this work continues to be funded and taken forward. Overseeing and administering the strategy, including issuing annual reports, costs very little, but the potential cost-effectiveness of continuing it is enormous. It is important that the strategy should help to ensure a continued focus on all those working in the field. The Samaritans and the Royal College of Psychiatrists stress the need for all people attending accident and emergency departments, as well as those admitted to hospital following incidents of self-harm or attempted suicide, to be referred to trained mental health professionals and sources of help. It is sad to say that many people—especially those who self-harm—are seen as attention-seeking, and do not get the help and support that they need. They do not get onward referrals, and instead return again and again. The risk of their self-harming becoming suicide ideation and suicide is very high. It is critical to ensure that people receive the help and support that they need, once they take that first step of approaching A and E.
Mental health needs in general, and a specific strategy to prevent suicide and self-harm in particular, should form a central part of the upcoming White Paper on public health. I would be grateful if the Minister confirmed that that will be the case. In addition to those facing unemployment and debt, or relationship problems, the needs of those at particular risk—they include asylum seekers, those in minority ethnic groups, those in institutional care, sexual minorities, veterans and those bereaved by suicide—should be actively addressed as part of the strategy.
I call on the Government to establish a UK-wide forum to bring together agencies from the four nations that are involved in suicide prevention policy, research and practice, to help us formulate a way forward through the difficult years ahead. The Departments responsible for public health in each of the four Administrations must lead a cross-departmental strategy to raise awareness of self-harm and ensure that front-line staff in education, social work, prisons, Jobcentre Plus, the police and other relevant agencies receive appropriate training in dealing with self-harm and those at risk of suicide.
Included in such a strategy should be the monitoring of harmful internet sites that encourage or incite suicide and self-harm. I would like to pay my personal thanks to my hon. Friend the Member for Garston and Halewood (Maria Eagle) for her help in taking that issue forward in the Coroners and Justice Act 2009. However, we now urgently need to address the legal status of those sites on a European level, so that we can increase our control over them and prevent them from reaching out and damaging the lives of people across the UK. It is important that Government websites, including the NHS Direct and Department of Health sites, should include authoritative, accessible and user-friendly information on the help and support available both to those who self-harm or who are contemplating taking their own lives, and to their friends and their family.
The NHS has a guide, entitled “Help is at Hand: A resource for people bereaved by suicide and other sudden, traumatic death”. That excellent guide, which could possibly be updated and reviewed, gives advice for those who are suddenly bereaved. It is an excellent example of the kind of information that should be available. Unfortunately, not enough front-line staff know about it, so the information is not getting to those who need it. Services coming into contact with those who have been bereaved by suicide should know about the document and be able to distribute it. It is vital to ensure that GPs’ surgeries, the police, social workers and coroners have access to it, and that families receive it.
Professors Gunnell, Platt and Hawton, in an article recently published in the British Medical Journal, stress the importance of social policy measures to create new jobs, of adequate welfare benefits for unemployed people, and of the provision of alternatives to early entry into the labour market, especially for young people, such as increasing the number of university places. It is important to give people a sense of hope. They also argue that employers and trade unions must be mindful of the potential risk to mental health of redundancy, and that workers should be given the help and support that they need.
I was pleased by the help and support that I received from the former Member for South Dorset to ensure that front-line Jobcentre Plus staff had access to support and training to give them an understanding of mental health needs, and of the risk to the mental health and emotional stability of those who had newly been made redundant or become unemployed. I should like to know whether that help, support and training will continue to be available to Jobcentre Plus staff.
In concluding my remarks, I want to stress that most people who lose their jobs, their homes or their businesses in a recession do not commit suicide or self-harm, but we must be aware of the increased risk in the current economic climate. This must be addressed by the Government. I am aware that new figures are coming out tomorrow, and I look forward to seeing whether the tremendous reduction in suicides in this country is continuing. I fear that perhaps it is not.
I also encourage the Government to enter discussions with the media on the reporting of suicides, to prevent the potential for social contagion. In the past few years, many of the national newspapers have become much more aware of what they are doing when they report such cases. I do not wish to criticise, but it is important, in a recession, that we do not exaggerate or even raise the link between the loss of a job and a death. I believe that the Government could take a lead in that area.
I would also ask all Ministers, when looking at policy, to bear in mind the emotional devastation and exhaustion that drives a person to suicide, and the enormous loss for friends and family, and to avoid trivialising that pain and despair as the Secretary of State for Transport, the right hon. Member for Runnymede and Weybridge (Mr Hammond) did in a recent article on train delays. I do not want to see that repeated.
It has been my aim in this debate to raise awareness, and to concentrate focus across government on the potential consequences of policy decisions if they are not mitigated by the help and support recommended by the Royal College of Psychiatrists, leading academic researchers and voluntary agencies working in this field. Finally, I invite the Minister to attend a meeting of the all-party parliamentary group on suicide and self-harm prevention, to discuss what the Government are going to do to reduce suicide and self-harm, so that we can engage and work together to reduce the incidence of such terrible loss and damage.
The Minister of State, Department of Health (Paul Burstow)
I congratulate the hon. Member for Bridgend (Mrs Moon) on securing the debate. I want to pay tribute to her, and to thank her for the work that she does in leading the all-party group on suicide and self-harm prevention. Her name sticks in my mind because, when I first became a Minister, I answered many questions that she had tabled on these issues. When I saw that she had secured this debate, I was conscious that she had been pursuing this matter vigorously and diligently for many a year. She brings that important issue to the House’s attention tonight. The fact that she has constituency experience of the matter, given the tragedies that have taken place there in recent years, lends added weight to her argument.
The hon. Lady was right to bring us back to the personal stories behind the statistics, and to recognise that, while strategies are important, they offer little consolation to those who are affected personally and directly by suicide and self-harm. She rightly paid tribute to the work of the Samaritans and other organisations. She was also right to highlight the need to share best practice and research; I entirely subscribe to that view.
There is plenty of evidence across the world that in times of recession and high unemployment, rates of mental illness and suicide tend to rise. In this country, Office for National Statistics figures tell us that suicides rose 6% between 2007 and 2008 when the recession began to bite. Tomorrow, as the hon. Lady said, the Department of Health publishes its “Mortality Monitoring Bulletin”, updated to include the data for 2009. I am unable to share it with the House now, but it will be in the public domain then. This will include new information on suicide rates, giving us the full picture of how the course of the recession affected the nation’s public health. The figures illustrate in the most dramatic way the human tragedies that took place in the economic downturn.
We now need to ensure that economic recovery is matched by psychological recovery from a long and painful recession. The 2010 Legatum Institute’s report, published earlier this week, showed that there is plenty of work to do. It gave a salutary warning that in terms of happiness and the general well-being of our fellow citizens, the UK is sorely lacking compared with other countries. In our services, too, across society, we have to ensure that we start valuing GWB, or general well-being, as highly as we do GDP. Specifically, as the hon. Lady argues, we must do everything we can to return to the pattern of declining suicide rates that we saw for most of the last decade.
To help us do so, I can first confirm for the hon. Lady that we will publish a new suicide prevention strategy in the new year. As the old strategy comes to an end, we need to update it and make sure that it is fit for purpose. We will certainly take into account the points she has made. I will want to look at the studies to which she referred and ensure that suicide prevention is referenced in the forthcoming mental health strategy, too.
The new prevention strategy for suicide will include new measures, particularly those to support high-risk groups. I will ask officials to discuss the hon. Lady’s suggestion of how best to collaborate with the devolved Administrations to ensure that we share learning and best practice across the countries. The strategy will also look at how we can restrict access to some of the methods people use to self-harm or commit suicide. The hon. Member for Pendle (Andrew Stephenson), who talked about a particular constituency example, illustrates why we need to erect barriers, quite literally, to deal with suicide hotspots. I am shocked and appalled by the attitude that the business in his constituency adopted to that necessary investment in prevention. The strategy will also involve working with all forms of media to ensure that we get responsible reporting to prevent copycat suicides.
Let me say something about the issues raised about the internet and how it can be used to promote suicide and provide information about methods. There is now greater clarity in the law. Section 59 of the Coroners and Justice Act 2009 simplified and modernised the law on encouraging or assisting suicide by online means. The Government continue to work with internet service providers through the UK Council for Child Internet Safety to remove harmful or illegal content. We continue to work with search engine providers, encouraging them to link only to appropriate, supportive websites when somebody uses “suicide” as a search term.
There is clearly a difficulty in how to strike the balance correctly, which does not really lend itself to arbitrary Government action. Banning all discussions and content on suicides from sites popular with young people risks driving them to parts of the internet that are far less safe and certainly not moderated, so more harm could be done. There is a need to update existing guidance, and we plan to publish updated guidance for technology providers to keep children safe online. We expect internet providers to follow that advice and remove harmful content as quickly as possible. I will certainly look at the hon. Lady’s points about the provision of helpful advice on the Department of Health and associated websites.
Andrew Percy (Brigg and Goole) (Con)
If the organisations that we are trying to get to remove content refuse to do so, will the Minister name and shame them?
Paul Burstow
I will certainly consider that, and we will discuss with colleagues across Government the approach and tone we should adopt with ISPs.
In reducing suicides, we have a specific focus on the health service, but we need a much broader programme of work across Government to improve general well-being while ensuring that the right services are in place for people who experience mental illness.
Everything that we know about the pattern of suicide rates demands a twin-track approach covering both clinical and societal issues. On the clinical side, we will do more to ensure that the NHS gives people the support that they need, and a new outcomes framework should make clear that the NHS must give mental health services the same priority as physical health services. There should be no difference in the esteem that we attach to those services. That approach will help us to shift cultures and priorities, ensuring that accident and emergency and hospital staff are trained to deal with self-harm or other indications of poor mental health, and are able to refer patients to the appropriate services rather than creating the revolving door to which the hon. Lady referred. GPs also need to be properly trained to help them to identify those at risk of suicide, and to provide appropriate drug treatment and psychological support in line with National Institute for Health and Clinical Excellence guidelines.
The hon. Lady was right to say that talking therapies are a critical part of the onward journey for those at risk. In 2009, the last Government initiated the Improving Access to Psychological Therapies programme. Where they exist, IAPT services work extremely well, but coverage around the country is still patchy. Earlier this year, I was able to announce additional investment of £70 million in the current financial year to ensure that we could continue the roll-out of IAPT, in order to deliver a commitment in the coalition programme. I am pleased that the Chancellor confirmed last week that we are now committed to investing more additional resources to allow the continuing expansion of IAPT up to 2014, including its extension to cover people of all ages rather than just those of working age.
However, we must not over-medicalise what is also a social and cultural issue. The Foresight report from the Office of Science shows that mental health problems are closely linked to a range of social problems. Debt and unemployment are key triggers for suicide, as are social isolation, family breakdown and substance misuse. Those are best addressed and best prevented in the community, not in the clinic. In developing our new mental health strategy, we will also consider how we can change cultures and develop resilience and relationships in communities to prevent mental illness and suicides.
We will, for instance, target those with alcohol or drug problems, and create better links between treatment services and mental health services. We will support vulnerable families by providing more health visitors and family nurse partnerships to give children the stable upbringings that provide a basis for good mental health in later life. We will also address the stigma associated with mental illness. It is that stigma—that reluctance to express emotions and accept help, advice and support, especially among men—that can be such a serious cause of the problems in our mental health services and, ultimately, even a cause of suicides. We also need to harness the expertise and experience of the third sector and voluntary groups to create local grass-roots plans and action to support better public mental health.
One of the biggest priorities will be returning more people with mental health problems to employment. We know that long-term unemployment has a hugely corrosive effect on a person’s mental health. Those who are unemployed for an extended period are 35 times more likely to commit suicide than those in stable employment. The sad legacy of the last decade has been the huge rise in the number of people trapped on benefits, along with all the damage that that does to a person’s self-esteem and self-worth.
We will build on the good links that have been established in some areas between IAPT and employment services. Many primary care trusts are already making connections with their local Jobcentre Plus, and I want to ensure that such relationships are formed in all IAPT centres as the roll-out continues. However, we also need businesses and organisations to invest in the good mental health of their staff, particularly during times of anxiety and change. Research shows that employers who invest in staff well-being receive a ninefold return on their investment in terms of increased productivity and reduced sickness absence. We want to drive that message home in the context of the employers’ occupational health responsibilities.
The human effect of dealing with the deficit crisis is not something that the Government can take lightly. I know that many in the public sector will be feeling anxious and concerned as a result of the spending review, and that demands the utmost vigilance from us in our support for people’s mental health in the months and years ahead. We are committed to mending the psychological as well as the economic scars of the past recession, improving mental health services, promoting greater community resilience to mental illness, and doing much more to help unemployed people regain their confidence and return to work.
I am grateful to the hon. Lady for securing the debate, and for the leadership that she provides in this regard. I hope that we shall be able to deliver the changes that we all want to see, and ensure that we have good-quality mental health in this country.
Question put and agreed to.