Suicide and Mental Health of Young People: Tatton

Tuesday 26th November 2024 Westminster Hall

15:59

[Peter Dowd (in the Chair)]

I will call Esther McVey to move the motion. I will then call the Minister to respond. There will not be an opportunity for the Member in charge to wind up, as is the convention for 30-minute debates.

[Esther McVey (Tatton) (Con)]

I beg to move,

That this House has considered the matter of suicide and mental health of young people in Tatton constituency.

It is a pleasure to speak under your chairmanship, Mr Dowd. I would like to convey my appreciation to the Minister for replying to this extremely important and sensitive debate on the management of withdrawal from antidepressant medication, specifically selective serotonin reuptake inhibitors, and the profound impact that that process can have on the mental health and suicide risk of young people.

I would like to begin by conveying my sincere thanks to my constituent, Gina Russell, who met me and bravely shared the experience of her daughter, Olivia, who tragically took her life in September 2021, following withdrawal from SSRI medication. Olivia’s mum is unable to be with us in Westminster Hall today. However, I know that she and her family are watching this debate at home, as they are determined to help prevent others having to suffer the same fate as Olivia.

I would also like to place on record my thanks to the charities Mind, Rethink Mental Illness, PAPYRUS Prevention of Young Suicide, as well as to The Children and Young People’s Mental Health Coalition and the House of Commons Library for the information provided to me before this debate. While the information was insightful, it was deeply disturbing, as it revealed that Olivia’s experience of declining mental health as medication was withdrawn was far from unique and was a known risk, which made me determined to pursue this debate on behalf of her family and thus bring Olivia’s story and her family’s suffering to a wider audience.

Let me start by painting a picture of Olivia, who was an intelligent, creative and hard-working 25-year-old who had just left Tatton to live in London. Her parents remember her as wonderful and vibrant—a loving daughter and a loving younger sister to her brother, Luke; a cherished and adored granddaughter; and a loyal, kind and supportive friend. She lit up a room and was admired by all who knew and loved her.

In November 2020, during the pandemic, Olivia became anxious. She began taking an SSRI—citalopram—to manage her anxiety. Initially, Olivia responded well to treatment. However, when the time came to discontinue the medication in June 2021, she experienced a rapid decline in her mental health, which was far worse than what she had previously faced. She then resumed SSRI treatment in August 2021, finally taking her life in September 2021. When she first came off her medication it was without consulting her GP, because she was feeling better. She should have been warned about stopping taking the antidepressant. The family was later to discover that citalopram is one of the most difficult antidepressants to come off.

Tragically, the Royal College of Psychiatrists suggests that between a third and half of people who take antidepressant medications experience withdrawal symptoms to some extent. The severity and duration of these symptoms, and whom they affect, is not certain. In Olivia’s case, the withdrawal symptoms were severe and the resulting deterioration in her mental state ultimately led to her taking her own life. Members should bear in mind that suicide remains the leading cause of death among young people under 35 in the UK, and the mental health of young people has declined alarmingly in recent years.

[Jim Shannon (Strangford) (DUP)]

I commend the right hon. Lady for the very sensitive way in which she is delivering her speech. In Northern Ireland, the worrying thing about suicides is that we have had an 8% increase in the last year. It worries me greatly that people are unable to cope with life. Does the right hon. Lady not agree that the inability of GPs—I think she mentioned this—to refer patients to early intervention on mental health is something that must be tackled? Early support for young people, and easy access to it, is the only way to give a lifeline to those who are struggling at a very young age.

[Esther McVey]

I thank my colleague and friend for that pertinent intervention.

The pandemic lockdown exacerbated the mental health crisis, as it brought isolation, uncertainty and disrupted routines at home, in education and in the workplace, taking an immense toll on young people’s wellbeing. During that period, the use of antidepressants, including SSRIs, rose significantly. Meanwhile, access to in-person medical support was often severely limited, which may have worsened the challenges faced by patients navigating their mental health and medication.

Last year, the closure of England’s only dedicated antidepressant withdrawal helpline, the Bristol and district tranquilliser project, left a further gap in support services for patients, at a time when mental health services are under immense strain. Analysis from the children and young people’s mental health coalition shows that 1.5 million children and young people could need new or increased mental health support as a result of the pandemic.

Those factors combined to create a perfect storm for young people struggling with mental health challenges, with many prescribed SSRI medication as a solution by their medical practitioners. It is important to note the life-changing and positive impact that such medication has had on many people across the country, and I do not seek to contest that or the ability of those medications vastly to improve the mental health of many patients. However, we must also acknowledge that the process of withdrawing from SSRIs can be fraught with challenges that leave patients vulnerable.

In Olivia’s case, her family believed that she was left in the dark. Her mother recalls that the information provided by her GP was limited and did not adequately warn of the risks of sudden or poorly managed withdrawal. As a result, following her death, the exceptional decision was taken by the coroner to produce a prevention of future deaths report. It found no evidence that Olivia was explicitly warned about the risks of relapse or the potential signs of withdrawal, or told that she might feel worse before feeling better. The report concluded that while advice may have been given, it was not conclusive and concern was expressed regarding the inconsistency of advice that each GP might give patients. The report could not say with confidence that every GP within Olivia’s practice was discussing the key risks associated with SSRI medication withdrawal.

That requires our immediate attention, as the principle of informed consent, which underpins our healthcare system, requires that patients are fully aware of the benefits and risks of any medical procedure or treatment. The General Medical Council’s professional standards for decision making and consent stipulate that doctors’ discussions should recognise the effect of the patient’s individual clinical circumstances on the probability of benefit or harm occurring.

Guidance from the GMC acknowledges that the amount of information doctors provide to patients can vary due to time constraints. Where such time constraints exist, doctors are encouraged to involve other medical professionals, such as clinicians, or to refer patients to the patient information leaflet accompanying their medication. Patients are legally entitled to a patient information leaflet with their prescriptions, but the responsibility for providing it lies with pharmacies. That places the onus on patients, potentially in a vulnerable position, to navigate complex decisions alone. The leaflets are often lengthy and rely on a patient reading and understanding information provided.

The issue is compounded by outdated guidance. Until recently, guidance from the National Institute for Health and Care Excellence—NICE—suggested that withdrawal symptoms typically last one to two weeks. That has now been updated to reflect the fact that symptoms can be more severe and prolonged, but the updates have not yet translated into comprehensive and systematic changes to ensure that patients are adequately supported. Inconsistent guidance on antidepressant withdrawal has resulted in many patients experiencing distressing and debilitating symptoms. Patients have been misdiagnosed as suffering from a relapse of their original mental health condition, and others have been left fearful about stopping using their antidepressants. That may have contributed to many individuals staying on their antidepressant medication for longer than is necessary, with a report in 2023 suggesting that 2 million people are taking antidepressants for five years or more.

What improvements can be made to ensure the better facilitation of SSRI withdrawal? Olivia’s family believe that there are measures that could be taken that would go far in protecting patients when withdrawing from the medication. A move as simple as placing a warning label on the packaging of SSRI prescriptions would be a straightforward way to convey the dangers of the medication. It would not replace the more comprehensive information provided in a patient information leaflet, or the guidance of a GP. However, it would act as a safeguard in circumstances should those fail. The safety of patients’ prescribed medications must be guaranteed, not left to change based on appointment time constraints or whether a patient has read in full the often lengthy patient information leaflet.

The story of Olivia and her family is a painful reminder of the urgent need to address the risks associated with SSRI withdrawal, and the broader mental health crisis facing young people today. While SSRIs have transformed countless lives, we cannot overlook the vulnerability of those navigating withdrawal. We owe it to families like Olivia’s to ensure that no one feels unsupported or uninformed when taking such important decisions. Simple measures, such as enhanced warnings on medication packages, improved guidance for medical practitioners and comprehensive advice can make the process of withdrawal palpably easier and safer, potentially offering better outcomes for individuals navigating the complex process of withdrawal from SSRIs.

I would be grateful for the Minister’s consideration of the issues I have discussed. Finally, in Olivia’s instance, the coroner produced a prevention of future deaths report, so I ask the Minister how such a report can become wholesale advice to the medical profession? Will he work with me to ensure that it does, in order to prevent lives like Olivia’s being cut tragically short?

16:12

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairmanship, Mr Dowd. I am grateful to the right hon. Member for Tatton (Esther McVey) for securing this debate and raising many important issues. I also thank her for sharing the tragic story of Olivia. My heart goes out to Olivia’s family and loved ones; it is a truly heartbreaking situation and process that they have gone through.

The right hon. Lady made a number of important points about withdrawal from SSRI antidepressants. A number of those points are quite specific, and I do not have in specific responses my notes. With her leave, I would like to write to her with responses on those points. She made a point about the coroner’s advice, which contained a lot of useful counsel on how we might address and tackle the issues raised. I will certainly look at that in detail, and will happily take those matters forward with her. We have a shared interest in addressing the issue. If the system is not working and people who are on that antidepressant are not being supported with withdrawal, we need to look at that in detail. We need to tackle it—I share her views on that.

I will turn to some more general points about the Government’s position on mental health. We have made suicide prevention and mental health a priority, especially for young people. Many of the issues raised today are symptomatic of an NHS that is broken. Looking at the figures, the challenges that face the NHS are truly sobering.

About 50% of lifetime mental health conditions are established by the time an individual is 14 and 75% by the time they are 24. Evidence suggests that the prevalence of mental health conditions is rising among children and young people. In 2023, 20.3% of eight to 16-year-olds had a probable disorder, compared with 12.5% in 2017. Of course, the covid-19 pandemic exacerbated needs, with analysis showing that 1.5 million children and young people under the age of 18 could need new or increased mental health support following the pandemic.

According to the Darzi review, 343,000 referrals for children and young people under the age of 18 are waiting for mental health services, including 109,000 referrals waiting for more than a year. Under the NHS Cheshire and Merseyside integrated care board, as of the end of September 2024, 10% of children and young people still waiting for first contact with NHS-funded mental health services were waiting for more than 951 days, equating to 1,301 people. Half of those still waiting had been waiting for more than 300 days. There are 13,010 children and young people still waiting for first contact with NHS-funded mental health services.

Until recently, there had been an upward trend in suicide rates for children and young people. For women between the ages of 10 and 24, the rate has nearly doubled since 2012, rising from 1.6 per 100,000 to 3.1 per 100,000 in 2023.

[Helen Grant (Maidstone and Malling) (Con)]

Over the past 10 years in England and Wales, one student has died every four days as a result of suicide. Despite that forlorn tragedy, the law remains unclear about the duties and responsibilities universities have towards their often very vulnerable young students. Will the Minister meet me and members of the LEARN Network and ForThe100 to discuss the introduction of a statutory duty of care for all higher education providers?

[Stephen Kinnock]

I thank the hon. Lady for that important intervention. I am happy to meet her and the LEARN Network. The Government cannot do all this alone; we need to work in partnership with all sorts of different stakeholders, including universities and the higher education sector. We would support any partnership working that we can do.

Until recently, there had been an upward trend in suicide rates for children and young people. For women between the ages of 10 and 24, the rate has almost doubled, but the trend for children and young people has flattened in the past year, despite overall increases in suicide. Although those rates are low compared with those for other age groups, children and young people are a priority group in our mission to tackle suicide. The Department is commissioning research via the National Institute for Health and Care Research to advance our understanding of why rates of suicide have been increasing in certain age groups.

We are committed to reforming the NHS to ensure that we give mental health the same attention and focus as physical health. It is unacceptable that too many children, young people and adults are not receiving the mental health care that they need. We know that waits for mental health services are far too long. We are determined to change that. That is why we will recruit 8,500 additional mental health workers across children’s and adult mental health services. We will also introduce a specialist mental health professional in every school and roll out young futures hubs to provide timely mental health support to our children and young people.

We are working with our colleagues at NHS England and the Department for Education as we plan delivery of those commitments. Furthermore, the Government are also committed to tackling suicide as one of the biggest killers in our country. The suicide prevention strategy proposes targeted support for priority groups such as children and young people. The Department for Education is reviewing the statutory guidance on relationships, sex and health education, and the Secretary of State for Education is clear that children’s wellbeing should be at the heart of it.

Some 79 voluntary, community or social enterprise organisations up and down the country have been allocated funding through the Department of Health and Social Care’s £10 million suicide prevention grant fund over the two years to March 2025. These organisations—from local and community-led through to national—deliver a broad and diverse range of activity that will prevent suicides and save lives.

Early intervention on mental health issues is vital if we want to stop young people reaching crisis point. Schools and colleges play an important role in that early support, which is why we have committed to providing a mental health professional at every school. Mental health support teams help to meet the needs of children and young people in education settings; such teams, which are made up of mental health practitioners and education mental health specialists, are available in schools in Tatton.

However, it is not enough to provide access to a mental health professional when young people are struggling. We want the education system to set young people up to thrive, and we know that schools and colleges can have a profound impact in promoting good mental health and wellbeing. Doing this well takes a holistic approach, drawing in many aspects of the school or college’s provision. Many schools are already doing that, and my Department is working alongside the Department for Education to understand how we can support such good practice across the sector, and across the length and breadth of our country.

The opportunity mission will break the link between people’s background and their success. The mission will build opportunity for all by giving every child the best start in life: high-quality early education, early child health, home learning environments and family support. The mission will also support children to achieve and thrive, ensuring high school standards with a broad curriculum, excellent teachers and targeted interventions, an inclusive approach to special educational needs and disabilities, mental health support, access to arts, culture and sport, and youth services and provision.

In our manifesto, the Government committed to rolling out young futures hubs. This national network is expected to bring together local services, deliver support for teenagers at risk of being drawn into crime or facing mental health challenges, and, where appropriate, deliver universal youth provision. The hubs will provide open-access mental health support for children and young people in every community.

We are concerned about the widespread availability of harmful material online, promoting content on eating disorders, suicide and self-harm, that can easily be accessed by people who may be young and/or vulnerable. We have been clear that the Government’s priority is the effective implementation of the Online Safety Act 2023, so that those who use social media—especially children—can benefit from its wide-ranging protections as soon in their lives as possible. Earlier this year, Ofcom concluded its consultations on the draft illegal content and child safety codes of practice. We expect the illegal content codes to be in effect by spring 2025, with the child safety codes following in the summer.

I will turn to other aspects of our plans to improve mental health services. The Mental Health Bill, which was announced in the King’s Speech, will deliver the Government’s manifesto commitment to modernise the Mental Health Act 1983 by giving patients greater choice and autonomy and enhanced rights and support, and aims to ensure that everyone is treated with dignity and respect throughout their treatment. It is important to get the balance right to ensure people get the support and treatment they need when necessary for their protection and for that of others.

I am pleased to say that the Bill has been introduced in the Lords and will be coming to the Commons in the new year. The Bill will make the Mental Health Act fit for the 21st century, redressing the balance of power from the system to the patient and ensuring that people with the most severe mental health conditions get better, more personalised care. It will limit the scope to detain people with a learning disability and autistic people under the Act unless they have a co-occurring mental health disorder that needs hospital treatment.

I conclude by once again commending the right hon. Member for Tatton for securing the debate and colleagues from across the House, including the hon. Members for Maidstone and Malling (Helen Grant) and for Strangford (Jim Shannon), for sharing their insight on the vital issue of suicide prevention and mental health care for children and young people. I am committed to working with the right hon. Member for Tatton and her hon. Friend, the hon. Member for Maidstone and Malling, to take forward these issues, and I hope that we can, together—across the House—address this vital issue.

Question put and agreed to.

16:24

Sitting suspended.