Suicide Prevention

Bob Stewart Excerpts

Wednesday 6th February 2013 Commons Chamber

[Dr McCrea]

I thank my right hon. Friend for his intervention. I trust that the Minister will take those points very seriously.

Between January and September last year, 223 deaths by suicide were recorded in Northern Ireland, again with socially deprived areas in Belfast North and Belfast West worst affected. However, although we must concentrate particularly on Belfast North and Belfast West, where the rate is highest, suicide has, worryingly, been spreading not only in urban communities, but into rural Northern Ireland—into those areas where people feel isolated and vulnerable to thoughts of suicide.

[Bob Stewart (Beckenham) (Con)]

Does the hon. Gentleman have any idea whether there is a link between suicide and past membership of illegal organisations, and whether those who were inclined to carry out such violence have become so depressed that they take their own lives?

[Dr McCrea]

Once again, I hope to touch on that point. I believe that that link needs to be considered. Certainly, for many people who were involved in such activities—perhaps they were drawn into them and now, unfortunately, must live with the consequences for the rest of their lives—guilt can be a leading factor pushing them towards suicide.

The Bamford review on mental health promotion, published in Northern Ireland in May 2006, reinforced the need to prevent suicide. It found that in the 25 years from 1969 to 1994, more people died by suicide than as a result of the troubles in our Province.

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[Dr McCrea]

I thank my colleague for his intervention.

Although I have given a lot of statistics—I will come to some of the causes in a moment—they can be very cold things. I want to draw the House’s attention, very earnestly and gently, to the fact that behind every statistic is a personal tragedy—a personal tragedy that a person reached the point where they felt that there was no other way to go; a personal tragedy because no one can fully understand the loneliness or desperation that a person feels trapped by whenever they reach the point at which they think that the only way out is suicide.

There is no one reason why people take their own lives. It is often a result of problems building up to the point where that person can see no way out to cope with what they are experiencing. Factors that have been linked with suicide include unemployment; economic decline; personal debt; painful and disabling illness; heavy use of, or dependency on, alcohol or other drugs; children and adults dealing with the impact of family breakdown; the loss or break-up of a close relationship; depression; social isolation; bullying; and poor educational attainment. Those experiences have been shown to make people more susceptible to suicide. It may be that a seemingly minor event becomes the trigger for them attempting to take their own lives—on many occasions not to die, but simply to get relief from their unbearable pain. Low self-esteem, being close to tears and not being able to cope with small, everyday events are all signs that someone is struggling to cope with overwhelming feelings. Yet it is often difficult to tell whether someone is suicidal or depressed, as people in crises react in different ways. Uncharacteristic behaviour can often be a sign that something is very wrong.

One of the main problems that I want to address in this debate is: where do people turn to for support and help? Let me first acknowledge the work done by our front-line health and social care professionals, and the effort that has gone into the development and delivery of suicide prevention strategies, which aim to identify regional risk factors, establish key objectives via a cross-section of organisations, and seek ultimately to reduce rates of suicide and self-harm throughout the United Kingdom. For example, in Northern Ireland, I appreciate our ministerial co-ordination group in the Northern Ireland Assembly. It was established in 2006 to ensure that suicide prevention is a priority across relevant Departments and to enhance cross-departmental co-operation on the issue. I was delighted by the changes made by Minister Poots, so that instead of the group meeting on a needs basis, it meets regularly to provide the sustained effort and leadership needed to reduce the high rate of suicide in Northern Ireland. I commend him for taking a long-term, upstream intervention approach to the problem.

However, in addition to Government-led initiatives in England, Wales, Scotland and Northern Ireland, credit must be given to the agencies and voluntary organisations working at the heart of our communities to provide a vital lifeline when one is needed most. I acknowledge the excellent work done by many Church organisations, which give spiritual counselling to many who feel that life is so burdensome that it is not worth the struggle. These organisations—whether Government agencies, voluntary agencies or Church agencies—have a vital role to play in complementing local mental and public health services. This work at the coal face is truly inspirational. I pay tribute to the men and women who dedicate so much of their lives to helping others.

I said earlier that people needed to know about the availability of those who are willing to help. I say that because about three weeks ago a conference was held in my constituency in Antrim after two suicides had taken place—it was not called by politicians, but by the community, because of a desire in the community to do something. I was delighted and honoured to be part of that occasion, but what I found out that day was that although a multitude of organisations deal with the problem, many in the community do not know about them. Many do not know where help can be got at the moment it is needed.

Over the past year I have had the pleasure of working closely with my right hon. Friend the Member for Belfast North (Mr Dodds) with PIPS—the Public Initiative for Prevention of Suicide and Self-Harm—a not-for-profit organisation in Belfast North that has been delivering suicide prevention and awareness training since 2008. Through my association with PIPS, I have come to understand how it believes that, through training local people to be more aware of the risk of suicide and of the sources of help available, our communities will be safer and more people will be saved from taking their own lives. Surely this must be all about prevention, because, unfortunately, there is no cure when suicide takes place.

[Bob Stewart]

I am listening intently to the hon. Gentleman. Does he think that there is anything the Northern Ireland Assembly or the Government could do to provide publicly funded advertisements on this matter on television in Northern Ireland, for example? Does he also believe that priests could raise the matter when they are preaching, to alert their congregations to the problem? Perhaps he will come to those points in his speech.

[Dr McCrea]

Again, I thank the hon. Gentleman for his intervention; I will come to those points. I certainly have endeavoured, when speaking in congregations, to remind them of the loneliness that people experience when they are in that vulnerable situation. No one knows the depths of that valley; no one knows how dark is the night that they are walking through. There must be greater understanding, and we can gain that understanding if people talk to each other and express their own experiences, as is happening in Antrim. That is helpful not only for them but for our understanding and for that of the community.

Members will also be aware that I have spoken recently in the House about child and adolescent internet safety, following horrific reports in the media of young people taking their own lives as a result of cyber-bullying.

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[Norman Lamb]

I cannot give the hon. Lady precise figures here and now, but I will write to her and make sure she gets a full response to that legitimate point.

This debate serves as a timely reminder that suicide continues to be a major public health issue, particularly at a time of economic and employment uncertainty. The suicide rate in England is relatively low on international comparisons, and good progress has been made in reducing the rate in England over the past 10 years. That is something to be proud of, but it must not be the end of the struggle. We must be vigilant. About 4,500 people took their own lives in England alone in 2011, an increase on the previous year of about 6%. Although the three-year average suicide rate has remained steady since 2005-07, the rise in the number of people dying by suicide in 2011 is deeply worrying.

We know that suicide rates vary across the UK, and the hon. Member for South Antrim made the point that the suicide rate in Northern Ireland is higher than in England. In fact, it is the highest in the United Kingdom, and Scotland and Wales also have their own very real challenges. The coalition Government are working with the devolved Administrations to share evidence on suicide prevention and effective interventions. Suicide is still a major taboo. The hon. Gentleman highlighted the importance of our collectively speaking up about the subject. The way to reduce the number of suicides is not to comply with that taboo and keep it under wraps; on the contrary, we must tackle the problem and the surrounding issues head on.

We published a new suicide prevention strategy for England in September last year. It was written to help to reduce the suicide rate and it prioritises the importance of supporting families, so that those who are worried about a loved one know where to go for help, and supporting those who are bereaved as a result of suicide. They must receive help. There are excellent organisations such as Cruse Bereavement Care—I should declare an interest as my wife works for it—that provide support for people who are bereaved.

The strategy is backed up by up to £1.5 million for research, and it highlights the importance of helping the groups at highest risk of suicide by targeting interventions in the right way and at the right time. In-patient services are getting better at that. The most recent national confidential inquiry into suicide and homicide shows that the long-term downward trend in patient suicides continues.

Giving greater priority to mental health services is also critical. We are championing parity of esteem for physical and mental health, and through our improving access to psychological therapies—IAPT—schemes we are treating more people than ever before for mental health problems. Through the Government’s NHS mandate, we have gone much further than ever before in emphasising the priority the NHS must give to mental health. The mandate also makes specific reference to the need for mental health services to seek to reduce the suicide rate among users of their services, although I take on board the point made by the hon. Member for Bridgend (Mrs Moon): we must also be acutely aware that many people—I think she gave the figure of 75%—who take their own lives are not known to the statutory services. It is very important that the statutory services do everything they can, but that is not the whole problem; there is a very significant issue beyond that.

We also need to make sure there is enough information about treatment and support, and that it is freely available to those who need it, including those who are suffering bereavement following a suicide. A lot of that planning and work will happen locally, with local agencies deciding on how best to reduce the suicide rate and support families. Our recent strategy is not an instruction manual; it is more a tool to support local agencies in working out what is needed.

Suicide prevention will also be a priority for the new public health system. The public health outcomes framework has the suicide rate as an indicator. That is a horrible piece of jargon, but this project addresses what outcomes and results the whole system is trying to achieve, and one of them is the need to reduce the suicide rate. A shared indicator with the NHS outcomes framework also focuses on reducing the number of premature deaths of people with serious mental illness—such deaths also, of course, include suicides.

We are tackling stigma in relation to mental health, which the hon. Member for South Antrim rightly mentioned, with the brilliant Time to Change programme led by the charities Mind and Rethink Mental Illness, which is designed to reduce stigma and break isolation. A few months ago, we had a brilliant debate in this House when Members talked about their own experiences of mental health. That, in itself, was very important in bringing the issue out into the open and recognising that successful people, as well as many others, suffer from mental health problems and it is nothing to be ashamed of.

Children and young people have an important place in the new suicide prevention strategy. The suicide rate among teenagers is below that in the overall population, but that does not mean it is not a problem. For example, suicide is still the most common cause of death in young men, as I mentioned earlier. In addition, about half of mental health problems begin to emerge by the age of 14.

[Bob Stewart]

I apologise for intervening, as the Minister was perhaps going on to deal with this matter. We have now heard four or five times that the level of suicide among young men is much higher than that among young women, but nobody has said why that might be. Is there an answer to that question?

[Norman Lamb]

I thank my hon. Friend for that intervention. I would not want to indulge in cheap speculation about that. The statistics are clear on the prevalence of suicide among young men and clear that it is significantly higher than among young women. It is important that we carry out the research, which is why the Government have also committed to that as well; it is so that we gain a better understanding.

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[Mrs Moon]

I thank the hon. Gentleman for his intervention. We have not yet looked at that issue, but I pay close attention to it because I have Parc prison in my constituency. I hope at some point to secure an Adjournment debate on work that people are doing there on the Invisible Walls project, which builds and re-establishes links between prisoners and their families—their partners and children—because the best sense of rehabilitation that can be given to someone serving a sentence is the feeling that there is hope for a family life once they leave prison. That extremely important work is one of the ways we could focus on improving outcomes for people once they leave prison.

[Bob Stewart]

I suspect that the most vulnerable people are those who leave prison without a place to go to, in much the same way as, in my experience, soldiers who leave the armed forces go back to nothing if they have no family. Does the hon. Lady agree that we must take a great deal of interest in the people who have nothing, when they have a break from routine, such as leaving prison or the armed forces?

[Mrs Moon]

The Ministry of Defence commissioned a study by Dr Nav Kapur of Manchester university on suicide in the armed forces. He found that the largest number of suicides were by young people leaving the armed forces, usually without having completed their basic training or shortly after they had passed it. Further research is needed to confirm this, but the indications were that there was a feeling of hopelessness with regard to attempts to build a family in the armed forces, that a sense of success and of identity had been lost, and that that was perhaps one of the motivations towards suicide. Additional funding is needed for that research to be completed, but that was the outcome of the best study that I have seen so far of suicide in the armed forces.

The all-party group has discussed how coroners record suicide and the importance of accurate suicide reporting. I cannot stress that enough. One of the problems is narrative verdicts, which were introduced as an addition to a statutory verdict. If someone died in the custody of the Crown, for example, they allowed for a narrative of that death to teach lessons about how it had happened. Instead, however, they have replaced the verdict and become a verdict in their own right. Often, the death of someone who takes their own life by tying a ligature around their neck is not recorded as a suicide, because the appropriate word has not been used. The Ministry of Justice needs to work on this area. I know that it is doing so and I hope to meet the chief coroner soon to see how we can make progress.

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[Mr Dodds]

The hon. Gentleman is absolutely right. When I speak to people working in those organisations, I am told that this issue comes up time and time again. It is very difficult to give answers to families who are struggling to cope with the nature of the passing of their loved one. Often it is hard to find any answer that can satisfy—it is just not possible to do that—but in the long run, the work these organisations do provides enormous consolation, help and support. The work of the Samaritans has been mentioned. The right hon. Member for Bermondsey and Old Southwark (Simon Hughes) mentioned Papyrus, and there are many, many others. It is right to put on record our tremendous debt to such organisations and the people who do such tremendous work.

The new suicide prevention strategy, which was launched in September 2012 here in England and Wales, is excellent. The chair of the advisory group, Professor Appleby, who has been mentioned, has said:

“Suicide does not have one cause—many factors combine to produce an individual tragedy.”

Therefore,

“Prevention too must be broad—communities, families and front-line services all have a vital role.”

That is absolutely right, and that is why our motion today talks about government, community and society—all of us—working together to try to prevent suicide. The Samaritans chief executive, Catherine Johnstone, has made an important point—I suppose this sums up what we are trying to get at today—which is that

“suicide can be prevented by making sure people get support when they need it, how they need it and where they need it.”

We know that that is very difficult and complicated to put into practice, because as has been said—the hon. Member for Bridgend (Mrs Moon) mentioned this and the Minister reiterated it—75% of those who die by suicide were not known by, or in contact with, social services. This is not just a simple matter of saying that it is about people who are having mental health problems and who are known to the various agencies; that is often not the case at all.

As I have said, we have a particular problem in Northern Ireland, where death by suicide has gone up by 100% in less than 15 years. Some 300 people each year are dying by suicide in the Province, with men three times more likely to die in that way than females. I shall discuss some of the reasons for men being more prone to taking their lives and for their reticence in coming forward.

The hon. Member for North Down (Lady Hermon) asked the Minister a question about the amount of money that was being spent. I am glad to say that the Department of Health, Social Services and Public Safety in Northern Ireland has spent £32 million over the past six years on suicide prevention under the Protect Life strategy. That money has been extremely helpful, and it has been well spent on helping some of the groups that I have mentioned.

Of course, money can do only so much, because of the broad range of reasons that lie behind suicide. I will not go over all the issues that have been mentioned, but I will deal with one or two of them. As well as social isolation, there is the problem of drug misuse, which my hon. Friend the Member for East Antrim (Sammy Wilson) mentioned. In Rathcool and elsewhere in my constituency, good work is being done to try to reach young people with drug problems and to counter those problems. We are finding that a lot of young men—again, it is particularly young men—who get themselves into that situation end up attempting to commit suicide or actually dying by suicide. Problems with alcohol abuse are also a factor.

I also want to draw attention to a piece of research recently carried out by Mike Tomlinson of the school of sociology at Queen’s university. The key finding of his study entitled “War, peace and suicide: the case of Northern Ireland” was that

“the cohort of children and young people who grew up in the worst years of violence…have the highest and most rapidly increasing suicide rates”.

Those generations were the most acculturated to division and conflict, and to externalised expressions of aggression. The report continues:

“The transition to peace means that externalized aggression is no longer socially approved. It becomes internalized instead.”

My constituency of Belfast North probably suffered more than any other constituency in Northern Ireland—that could be true of Belfast West as well, but I can speak only for my constituency—during the period euphemistically known as the troubles. That was a heinous, horrible period of our history, with its violence, blood-letting, murder and mayhem. Today in Belfast North, and in Belfast West, we are still paying the price for that period of violence and bloodshed. Young men and women are still dying, as are middle-aged men and women, as a result of the troubles in Northern Ireland. Nowadays, they are dying not as a result of murders committed by paramilitaries, but as a direct result of the troubles because, having been brought up in a culture of violence, they cannot cope in this period of relative peace.

[Bob Stewart]

Is the despair of some of those people accelerated by the fact that they are lonely? Does the fact that they are away from their families and from society, for example, act as a catalyst? Does their loneliness gear up the despair that makes them take their own lives?

[Mr Dodds]

It is difficult to be too specific, as every individual’s case is different. Undoubtedly, however, one of the biggest factors, particularly in my constituency, is loneliness and isolation, along with drugs and alcohol. That combination, together with the context in which people have grown up, can often become a too powerful and overwhelming set of circumstances with which to cope.

Particular issues, then, arise in Northern Ireland and my constituency, and they might be different from many cases in England, Wales and Scotland. We have this added problem and pressure of coming out of the period of awful violence that we suffered. Only today, as we look back at the research and work done, do people realise that that period was so awful that we are still living with the consequences. Indeed, people are still dying, even today, as a result of what happened in that period. The hon. Member for Beckenham (Bob Stewart) talked about the experience of soldiers—he was right to highlight that—and it applies to people who served in the security forces, too.

On the issue of how this affects family members, I am thinking particularly of a dear lady who had lost a number of her family members, including two children, to suicide. She told me that she feared for other members of her family because of the increasing prevalence of family members copying what other family members or their close friends had done. The problem is exacerbated not only by sites on the web that encourage suicide but even by Facebook, when an insidious form of peer pressure can be applied.