Suicide and Mental Health of Young People: Tatton

Debate between Jim Shannon and Esther McVey

Tuesday 26th November 2024 Westminster Hall

[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it was deeply disturbing, as it revealed that Olivia’s experience of declining mental health as medication was withdrawn was far from unique and was a known risk, which made me determined to pursue this debate on behalf of her family and thus bring Olivia’s story and her family’s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?