Government Action on Suicide Prevention

Dan Carden Excerpts

Wednesday 8th June 2022 Westminster Hall

[Kerry McCarthy]

I thank my hon. Friend for his intervention. I know there was a very good debate in this Chamber yesterday morning, which unfortunately I could not attend, where such issues were raised. There are some discrete areas where a specific intervention suggests itself, such as gambling addiction, alcohol abuse, post-natal depression, or veterans’ mental health. I certainly feel that such risk factors ought to be reflected in the suicide prevention plan.

A quick win would be to obstruct people from accessing the means to die by suicide, with obstacles placed in their way. A lot of suicides are opportunistic. For example, the British Transport Police is very good in terms of how it polices stations and watches out for signs that somebody might be thinking of jumping in front of a train, and helplines can be flagged up at places such as the Humber bridge and the Clifton suspension bridge, but there are also physical measures that would make suicide more difficult. People might say, “Well, perhaps people will just go somewhere else,” but it does not always happen like that. If the moment is lost, there is a good chance a life will be saved.

Will the Minister tell us a little bit about the plans for the revised suicide prevention plan? Will it have clear priorities, with an evidence-based, tailored plan in each case for how we will bring rates down, and then targets set on that basis? One organisation described the current approach as very much a “throw everything at the wall and hope something sticks” approach. We need a far more tailored approach.

Will the Minister also tell us where the boundary falls between what is in the remit of the Department of Health and Social Care and work that requires action by other Departments? We have already talked about gambling, and the debate yesterday was answered by the Under-Secretary of State for Digital, Culture, Media and Sport, the hon. Member for Mid Worcestershire (Nigel Huddleston). The Online Safety Bill is another example of where another Department is taking the lead, and I am worried that the Government will not fully seize that opportunity to crack down on sites promoting suicide and self-harm. I gather there is a bit of a difference of opinion between the two Departments, which is particularly disappointing given that the current Secretary of State for Digital, Culture, Media and Sport, the right hon. Member for Mid Bedfordshire (Ms Dorries), was the first Minister for Suicide Prevention. Does the Minister agree that we need to strengthen the Bill’s provisions on this issue, or has she lost the battle with the Secretary of State for Health and Social Care? I hope not, and I hope that, if the Bill is not strengthened in Committee, we can improve it on Report.

The review of special educational needs and disability is another potential missed opportunity. It is meant to be a joint effort by the Department for Education and the Department of Health and Social Care—there is a joint foreword—but there is very little in it on child and adolescent mental health services. Given the overlap between children struggling at school who cannot get the right diagnosis and cannot get a timely education, health and care plan and children who end up in the mental health system, joint working is really important.

Obviously, it is not just children with SEND who struggle. One in six children are now said to have a probable mental health condition, up from one in nine in 2017. More than 400,000 under-18s were referred for specialist mental health care between April and October last year. These are children at the more severe end of the spectrum—those who presented with suicidal thoughts, self-harming or eating disorders. The number of attendances at A&E by young people with a diagnosed psychiatric condition has tripled since 2010.

We know that CAMHS is at breaking point. There are huge waiting lists, and severely mentally ill children are being cared for in inappropriate settings or being sent hundreds of miles away from home for treatment. It is said that half of all mental health problems are established by the age of 14, rising to 75% by the age of 24. If we do not want today’s children to be tomorrow’s suicide statistics, we need to do much more, much faster, to help them now, and I just do not see that sense of urgency from the Government. This consultation is all wrapped up in a 10-year plan, but we need a 10-day plan. We need action now.

One issue we discussed at the event in Speaker’s House was how schools could better nurture children’s creativity and give them an outlet for their emotions through music and art. We also talked about whether the current trajectory of education, with schools very focused on grades—someone described them as “exam factories”—places undue pressure on children. I agree with that to a large extent and worry about cuts to things like music education, which mean that creatively inclined children do not have that outlet. It is not plain sailing for the other 50%, the academic ones, either. Just because a child does well in education does not mean that they are set up for success in the wider world, whether that means higher education or the world of work.

I am sad to say, as a Bristol MP, that Bristol University has become known for the number of student suicides in recent years. It is obviously not the only university to have experienced this, but it has come to particular attention. There needs to be a constant process of reflection and review. We have just had the court ruling in the tragic case of Natasha Abrahart. She was a very able student at Bristol University, but she suffered terribly from social anxiety and just could not handle the oral side of her course and having to do presentations. Rather than trying to force all young people into one model of what success and achievement look like, institutions need to adapt to them. I hope that Natasha’s parents will be able to pursue their campaign to ensure that that happens in the future.

I have also spoken to various groups about data sharing, which I appreciate is a complicated area. When should parents of university students, who are adults, after all, be informed? What are the boundaries of patient confidentiality? Some students might be deterred from speaking to mental health services at uni if they think that their parents might be told, particularly if they are grappling with something like their sexuality or if they have become involved with drugs. There are all sorts of things that young people would not want their parents to know about. Some might come from abusive family backgrounds and their parents would not be helpful or supportive, but in many cases the parents would have desperately wanted to know that their child was struggling to the extent that they were.

Steve Mallen from the Zero Suicide Alliance thinks that more could be done within data protection laws to protect students, and I hope that that is under active consideration.

[Dan Carden (Liverpool, Walton) (Lab)]

I was at the Speaker’s House reception, and one of the most shocking things I heard was that two thirds of people who commit suicide have never sought any support for their mental health. What does my hon. Friend think are the consequences of that, and how should we be trying to deal with it? I think that we need to ensure that we have a holistic approach that offers support, because we all have mental health needs; we all need support. What does she think?

[Kerry McCarthy]

I thank my hon. Friend and agree with him, but I have some reservations about going down that path. A lot of the conversation about mental health in recent years has focused on the importance of getting people to open up and talk about their problems, and an obstacle in the way of doing that is that it can be very difficult for people to access GP appointments or to get the help that they need. I very much support Labour’s policy of publicly accessible mental health hubs in every community, as well as mental health support in every school. There needs to be swift and easy access to talking therapies or even to something less formal—just to someone who will sit there and be prepared to talk to the person. There is also campaigning to try to get people just to ask others how they are feeling, and that would help. I am a bit worried because there is a danger that we will focus totally on the softer end of things and talk a lot less about the more difficult areas, where people are well past the point where a nice cup of tea and a friendly chat would make a difference. At the moment, there certainly seems to be a huge problem where people are considered to be past the point where talking therapies would help. It might be that they are too high risk or too unwell to benefit from primary mental health services but not quite ill enough to access secondary services, such as the community mental health teams; they are not totally at crisis point. Often, they are left to fester somewhere in the middle, and when they reach crisis point, they finally get help, but that is too late in many cases to actually turn their mental health around. Too many people fall by the wayside because the right pathway is not available.

Currently, 40% of patients waiting for mental health treatment are forced to contact emergency or crisis services before they receive treatment. One in 10 of them ends up in A&E, and I have real concerns about whether A&E is appropriate, particularly if someone has experienced psychotic episodes. I cannot think of anything worse for them than being in an A&E department, with the sirens, flashing lights and people who have probably turned up there because they have drunk far too much or are off their heads on something or other and have got into fights on a Saturday night. Some hospital trusts are experimenting with trying to triage people very quickly away to mental health provision in A&E, which I think is a very good move.

We have waited a long time for the Government to bring forward the mental health reforms outlined in the Queen’s Speech. We are right to be concerned about the misuse of powers under the Mental Health Act 1983. We have heard terrible stories of people with autism being detained long term against their will, and the disproportionate use of those powers against people from ethnic minority backgrounds, particularly young black men. I hope that, as part of that debate, we can also talk about how the system fails people who do need to be in hospital, whether by voluntary admission or being sectioned, because a lot of people would benefit.

We see people on the streets talking to themselves, heads bowed, and everybody side-steps them. Sitting on public transport next to someone who is clearly unwell can be uncomfortable. If people have physical health problems, the expectation is that the health service is there to treat them. I know there is a question of capacity and whether people consent to treatment, but I feel we write people off when their mental health reaches a certain state, unless it gets so bad that they are a danger to themselves or others. The system needs to gear up to help people who are broken to that extent. It might not be possible to fix them, but their lives could be made better.

The number of beds in NHS mental health hospitals has fallen by a quarter since 2010, with almost 6,000 beds lost in England alone, despite big increases in the number of people needing mental health support, and cases where people are sectioned under the Mental Health Act. Figures obtained through freedom of information requests show that on a single day in February this year, all of England’s high and medium-security hospitals were operating above the Royal College of Psychiatrists’ maximum bed occupancy rate of 85%. The NHS pays £2 billion a year to private hospitals for mental health beds because it does not have enough of its own. Nine out of 10 mental health beds run by private operators are occupied by NHS patients.

It was also revealed last month, again through FOI requests, that over a five-year period from 2016 to 2021, more than half of the 5,403 prisoners in England assessed by prison-based psychiatrists as requiring hospitalisation were not transferred from prison to hospital. Those were not people with what might be called run-of-the-mill mental health concerns; they had major psychotic illnesses or chronic personality disorders. They needed to be in hospital, not in prison, but they did not get those transfers. We can only speculate on the problems that might store up for the future.

Where there are hospital beds, the pressures on the wards and staff are immense. There are way too many tragic stories of patients being discharged too soon, being wrongly assessed as low risk, and not getting the help they needed, with inevitable results. For example, 22-year-old Zoe Wilson died at Callington Road hospital in my constituency in 2019. She was put on a low-risk ward, despite ongoing psychosis. In January this year, the inquest jury returned a narrative conclusion, having found that multiple failings contributed to her death. The prevention of future deaths reports—the regulation 28 reports—published with the latest coroners’ statistics, make very grim reading. So many of the reports point to failings such as those noted in Zoe Wilson’s case.

I am not convinced that lessons will be learned from these reports, because what is required in many cases is not actions by individual hospital trusts. I should explain what happens. The coroner notes that an institution—a university, or any organisation that might have had contact with the person prior to their death—should learn a lesson and do something in future to try to save a life. Those comments are usually directed at a hospital trust or another organisation, but I would like to know what notice the Government take. Patterns showing where there are failings in the system emerge in these reports. I would be reassured if I felt that, rather than just informing the actions of an individual institution, the reports also informed future suicide-prevention strategy. I am sure the Minister will tell us how much more is being devoted to mental health spending, but we need to acknowledge the simple fact that, despite any figures she might produce today, our mental health services are drastically underfunded, under-resourced and under-staffed, which is why they are at crisis point.

I want to finish today by paying tribute to people who have spoken up about their own family experiences, as Mr Speaker did at the event in Parliament. He spoke so powerfully, because he was clearly very upset about what had happened. I, too, lost someone to suicide last year, as many other people will have, including people who are listening today. I started off by talking about how Bernard and Stephen from Joy Division/New Order came to speak about how, even 42 years later, they are still affected by the death of their singer Ian Curtis. Another musical genius and a musical hero of mine, David Berman, took his own life a few years ago. His last album, “Purple Mountains”, was basically a suicide note. He can be very funny at times—he has this real lyrical genius—but listening back to the album now, you can see where he is going. He suffered from depression for a long time, and he has this song, “Nights That Won’t Happen”, which says,

“The dead know what they’re doing when they leave this world behind…

When the dying’s finally done and the suffering subsides

All the suffering gets done by the ones we leave behind.”

I will finish on that note, because that is very true. He felt that he was escaping from something. He escaped from it, but I hope that support services for people who have recently been bereaved by suicide is at the top of the Minister’s agenda, because those are the people who really need it.

--- Later in debate ---

[Dan Carden (Liverpool, Walton) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Bone. I congratulate my hon. Friend the Member for Bristol East (Kerry McCarthy) on securing the debate, in which we have heard some really powerful contributions. I add my support to what has already been covered in the debate, including for a new suicide prevention plan. I will concentrate my remarks on suicide in the LGBT+ community, and on the important role of alcohol in this debate.

According to surveys, young LGBT+ people are three times more likely to self-harm, and twice as likely to contemplate suicide as their non-LGBT+ peers. Depending on the study we look at, gay people are between two and 10 times more likely as straight people to take their own life. We are twice as likely to have major depressive episodes. Surveys of gay men regularly find that three quarters of the community suffer from anxiety or depression, abuse drugs or alcohol, or are in abusive relationships. That is the case despite social progress and greater acceptance, and despite the fact that we have got rid of many discriminatory laws. Rates of depression, loneliness, substance abuse and suicide among gay men remain many, many times higher than for the general population.

A book that was very important to me was “The Velvet Rage: Overcoming the Pain of Growing Up Gay in a Straight Man’s World” by Alan Downs. The important message in that book is that when someone comes out about their sexuality or gender identity, the trauma is not overcome at that point. Growing up gay leaves trauma, so many people in the LGBT community require support to overcome trauma, shame and other issues of that nature. That is why counselling and therapy are important.

When we in this House talk about mental health, we rarely mention or acknowledge that addiction is a chronic mental health condition; addiction is an illness. Alcohol is a depressant that can exacerbate low mood and suicidal thoughts. It is probably the most normalised way of coping with mental health issues, trauma or suicidal thoughts; it is a fast-acting way to change how we feel. The relationship between alcohol and suicide is well established and a cause for great concern. Research by the Samaritans shows that people who are dependent on alcohol are two and a half times more likely to die by suicide. In England, nearly half of all patients who are in the care of mental health services and who die by suicide have a history of alcohol misuse. They account for almost 600 deaths a year on average.

Despite that harrowing evidence, there has been no national alcohol strategy since 2012. I welcome the Government’s recent efforts on tackling illicit drugs and gambling and tobacco harm. My question is: where is the effort on alcohol? To fully understand the current scale of alcohol harm, and to provide targeted recommendations to improve outcomes for people with co-occurring mental health and alcohol-use conditions, I would like to see the Government conduct a Dame Carol Black-style independent review of alcohol harm. I hope the Minister will respond to that point.

I will finish by mentioning a place in my constituency that I have visited over the years. Paul’s Place was set up by the parents of Paul Williams; Paul and I went to school together, and he took his own life in August 2015. Paul’s Place offers bereavement support to families who have lost members to suicide. I invite the Minister and the Opposition spokesperson to visit Paul’s Place to talk about the important work it does for communities across Walton, and how its funding can be sustained.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Bone. I start by thanking the hon. Member for Bristol East (Kerry McCarthy) and commending her work—she is an absolute champion for this matter. She spoke extremely powerfully on the need for data collection, which I think is the crux of taking good service delivery forward. She spoke very emotively about her own personal experience, and her words resonated with many people here when she advocated for services for those families who are left behind. I thank her for being a champion of this important issue. It is often neglected, and is something that for many years has been difficult for people to speak about. The more that it can be spoken about and raised in this place, the better for everybody right across the United Kingdom.

The hon. Member for Bradford West (Naz Shah) spoke about how difficult it is to access mental health services, particularly for children and young people. I think there are gaps—chasms, actually—in waiting times across the United Kingdom that need to be addressed. As chair of the all-party parliamentary health group, I hear about that constantly. No matter where someone lives, it is very difficult for them to access services. It takes far too long and people are falling through those gaps. The hon. Member for Blaydon (Liz Twist) spoke about the importance of levelling up regional and gender disparities. I am interested in the point she made about adult males being particularly at risk.

There has been good work going on across Scotland— I am sure these exist across the United Kingdom— through the Men’s Sheds developments. I have two in my own constituency that I have visited—one in Lesmahagow and Blackwood and one in the Stonehouse area. They are doing fantastic work to reduce loneliness and isolation, and to create environments where people can begin to speak about issues and receive important social support from like-minded people. We still have a society where there is more stigma for men who speak up about those issues, so such developments are crucial. The hon. Member for Blaydon is also an advocate for this issue in her role as chair of the all-party parliamentary group on suicide and self-harm prevention. She has made key recommendations for the Government to take forward.

The hon. Member for Liverpool, Walton (Dan Carden) spoke about the LGBT community and about alcohol-related harm. What is key—and I know this from my professional life prior to Parliament, working in psychology —is that often having an addiction diagnosis on someone’s medical records can make it more difficult for them to access mental health services. That just should not be the case because, exactly as he says, having alcohol or drug-related problems is, in itself, a risk factor for suicide. Therefore, it should be something that heightens people’s access to services, rather than diminishing it. I would therefore like to thank him once again for the work that he does on these matters.

The hon. Member for Strangford (Jim Shannon)—who is in his place in most of the debates that I happen to attend because he is such a strong advocate for his constituents—spoke about the devastating suicide rates in Northern Ireland, and something else that is very important, which was the impact of and bullying on social media. I think that that is something that really must be tackled. I know, from some work I have been doing with the Diana award in Parliament, that it has been supporting young people’s advocates across schools in the UK—anti-bullying ambassadors to give children and young people peer support—because often young people prefer to speak to peers than to parents. I know that myself, particularly from having adolescents at home who do not want to be seen with or speak to me at this stage in their life.

The hon. Member for Richmond Park (Sarah Olney) also raised an important constituency case—I am so pleased that the family is here today—that families are not listened to enough. Well, if we are not listening to families, who are we listening to? Families know people better than anybody else. I think that long gone is the time when we say, “Well, professionals know best.” It should be an assessment that involves everybody, wherever possible. Families who want to reach out to services are doing that because they have anxiety that something that is traumatic is going to happen in that case. They know that person better than anybody else, so they must be listened to.

When I worked in mental health, the training and risk assessment were very clear; it is not a static assessment; it is dynamic—it changes. That is the thing about it. The British Psychological Society issued guidance on risk assessment. A risk assessment is not a questionnaire; it is a clinical judgment with tools that help that. However, it also must highlight risk indicators. Importantly, it is not just that an assessment is completed; it is that there is a risk-management plan as well—people are aware of their risk indicators, they know when risk is heightened, they know who to seek help from, and that there is a risk-management plan that can protect them and prevent harm coming from risk. The point made by the hon. Member for Richmond Park is key, and I wish her all the support that I can give for her campaign for these matters to be taken forward and for key frontline staff to be given adequate training in risk assessment.

As chair of the all-party parliamentary health group, I hear constantly that the bar is set too high for access to services. Some of the things said are that because someone might have a personality disorder, they could not benefit from treatment. Well, we know that people with personality disorder diagnoses still suffer from mental distress, so of course they should be able to access treatment for that mental distress. That should not be a barrier to treatment. There are also psychological therapies that have been shown to be clinically valid for use in those cases, but people cannot access them.

People who have drug or alcohol problems may present at accident and emergency and be told, “Well, you’ll have to deal with your addiction and then come back and deal with your mental health problem.” However, that is not right either, because we know about the risk and the importance of services being integrated and created for dual diagnosis. Where people have more than one clinical condition, it is very important that both are treated together because, as has been said, mental health might be one of the triggers for alcohol and drug use, which, of course, exacerbates it.

[Dan Carden]

It is really important that we send a clear message that it is absolutely nonsense to send people away to recover from their addiction without the mental health support they need, as happens up and down the country. We should send a clear message that the guidance needs to be rewritten, and that support for mental health and addiction services must be delivered.

[Dr Cameron]

I thank the hon. Gentleman for making that important point. I wholeheartedly agree. If we are serious about preventing harm and suicide, and about helping people, their care must be looked at holistically. We cannot syphon off parts of people’s diagnosis and say, “Deal with this first, then that.” People’s lives are not like that. As we know, the formulation means that it is interwoven, so both conditions must be dealt with simultaneously.

Other things I have heard include, “It is attention-seeking,” “It is a behavioural issue,” “It is not a psychiatric illness,” “There’s no diagnosis,” but surely people who suffer acute psychological distress should have access to services without having to qualify in diagnostic terms as having a major mental illness. Many people need help at such time, and it should not need to be exacerbated to the point of mental illness if we can use prevention. Equally, many people who go on to harm themselves and even commit suicide never have a diagnosis of a mental illness such as depression or schizophrenia, but they still deserve help, so there must be services for them.

GP access is very important, as has been said. I know from my constituents and from chairing the all-party parliamentary health group that that is another issue that must be dealt with. People find it very difficult to see GPs face to face, and if they are in mental distress, speaking to receptionists on the telephone is really not adequate. They must be able to sit down and speak to a GP they know. It is hard enough to open up at that point, but without that access, I am afraid that so many people will fall through the net.

The Scottish Government have committed £120 million for a recovery fund following covid. They are committed to doubling the current £1.4 million of annual funding for suicide prevention, and they have a new strategy coming out.

I thank the services in my constituency, which have been on the frontline when people have been languishing on waiting lists, including the Trust Jack Foundation, set up because someone lost their life. The lady in charge of it is a wonderful individual who has taken her personal tragedy and turned it into support for other people across our constituency. Victorious People in East Kilbride is providing counselling for young people, and Talk Now in East Kilbride is providing services for trauma survivors. That is just to name a few of the fantastic services that have been developed.

I plead with the Minister to fill those gaps and make sure there are services for people suffering acute mental distress, crisis and suicidal ideation. They should not have to have a mental illness diagnosis to access treatment. That is why we are losing people, and families are being hurt in the process.