Government Action on Suicide Prevention

Kerry McCarthy Excerpts

Wednesday 8th June 2022 Westminster Hall

[Kerry McCarthy (Bristol East) (Lab)]

I beg to move,

That this House has considered Government action on suicide prevention.

As always, it is a pleasure to see you in the Chair, Mr Bone.

Three weeks ago today, I hosted an event on mental health and suicide prevention in Speaker’s House. We heard from two members of the band Joy Division/New Order because the event took place on the 42nd anniversary of the death by suicide of the singer, Ian Curtis. I want to take this opportunity to thank Stephen and Bernard from the band for coming along, because if it had been just me speaking about this subject, not as many people would have listened, although I am sure a mass audience is hanging on to my every word today.

At the event, we also heard from Simon Gunning, chief executive officer of Campaign Against Living Miserably, or CALM, whom I thank for meeting me yesterday in advance of the debate. I also thank Mr Speaker, who spoke movingly about his daughter’s suicide and the recent loss of his brother-in-law. We also heard from the leader of the Labour party and the Minister. I thank the Minister for speaking at the event, but I hope she will forgive me for seizing the opportunity of securing today’s debate to press her further on some of the issues we discussed then. It is good to talk, but it is even better to see action.

I am sure the Minister will remind us that the Government are consulting on their 10-year mental health plan, which will also be used to inform a refreshed national suicide prevention plan—the previous one is 10 years old. I am a little concerned that the issue is being bundled up within the one consultation and that there are only passing references to suicide in the consultation overview, which is what most people will read. In fact, suicide is not mentioned at all in the chapter on crisis, which is where I would most expect to find it, and people have to go to the mental health and wellbeing plan discussion paper to find any detail. I hope that that does not mean that suicide is being treated as an afterthought.

We are told that the details of the suicide prevention plan will be set out in due course, but given that suicidality is recognised by the Government as needing its own separate strategy, I do not understand why it does not warrant its own consultation. The latest coroners’ statistics show that deaths by suicide are at a record high, and it is obvious that the Government have not met their target of reducing suicide by 10%. Clearly, a better strategy is needed.

I accept that setting any kind of target is complex. We saw a spike in suicides after the 2008 financial crash; we are now emerging from a pandemic that has taken a terrible toll on people’s mental health and the cost of living crisis is starting to bite. A lot of factors are not in the Minister’s control, but as is often said, what is measured is what gets done, so there has to be something to aim for. To help us to get there, several organisations have raised with me the need for real-time data. The Government are developing a national real-time suicide surveillance system, so perhaps the Minister will update us on progress with that.

As the British Psychological Society has explained, suicidal behaviour cannot be understood from any one perspective alone. Suicidality is best explained as a complex interplay between risk factors across domains. Not everyone who experiences bereavement or relationship breakdown, or who is under massive pressure at work or is struggling financially, will feel suicidal. There is often an accumulation of pressures and events, sometimes stretching back to adverse childhood experiences and exacerbated by adult trauma, although sometimes it is just that something bad has happened.

It is difficult to unpick all that, but Professor Louis Appleby has suggested some priority areas for the suicide prevention plan: where rates are high, such as among middle-aged men; where rates are rising, even if they are quite low, which relates to children and young people; where there is proximity to prevention, such as among current mental health patients; and where there is public concern, such as for university students. Professor Appleby also suggests, for political reasons, that the north should be a priority. That might also be because he is based at Manchester University and he is perhaps pushing his home turf, but as part of levelling up. Economic aspects such as poverty and unemployment can be big factors.

[Paul Blomfield (Sheffield Central) (Lab)]

In 2017, my constituent Jack Ritchie took his life at the age of 24 as a result of gambling addiction. I am pleased that his mother and father are in the Gallery with us today. It is estimated that there are more than 400 gambling-related suicides each year. The national suicide prevention strategy recognises high-risk groups, and my hon. Friend has highlighted the comments from Professor Appleby. Does she agree that as gambling-related suicides account for almost 8% of all suicides that group should be recognised in future strategies as high risk?

[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 ---

[Gillian Keegan]

The hon. Gentleman has my assurance that I will definitely work cross-Government, with the Under-Secretary of State for Digital, Culture, Media and Sport, my hon. Friend the Member for Mid Worcestershire (Nigel Huddleston) who actually sits in the office next door to me—he finds it very difficult to escape. I think that answers the questions from the hon. Member for Bristol East about whether there are ongoing conversations, which will also continue into the future.

I am happy to visit Paul’s Place. As the hon. Member for Liverpool, Walton (Dan Carden) knows, I am often back in Liverpool, visiting my parents and friends. The first visit I made in this role was actually to James’ Place, also in Liverpool, which was set up by a constituent of mine, Clare Milford Haven, who set up the charity after the tragic death of her son, James. We met in Liverpool, but she was a constituent of mine down in Chichester. Every time I go to one of these places, I learn—every time. There are so many families trying to help the next family avoid the tragedy of losing a loved one.

I also met Tim, Mike and Andy—the 3 Dads Walking. They have done a fantastic job, walking round the whole country. They came to tell me the stories of their three daughters, Sophie, Beth and Emily, who all tragically died by suicide. They told me about the number of people who came out to take part as they walked around the country. There is that saying, “Walk a mile in someone’s shoes.” They were walking a mile together, talking about their experiences. They said that many people had never spoken about their experiences before, because they still felt there was some stigma attached to it. One of the fantastic things about having these conversations is the de-stigmatisation of not only suicide, but mental health conditions in general.

One of the things I have learned as Minister for Mental Health is that anybody can have a mental health issue at any point in their lives. One, two or three things happen that they were not expecting, and anybody can be in that situation, but everybody can recover and manage their mental health. If I can achieve one thing in my role it would be for everybody to really understand that and for us to put the services in place to address it—that is what I hope to do.

I recognise that the last two years have been exceptionally difficult. They have impacted on the mental health and wellbeing of many people, and many will have experienced harmful or suicidal thoughts. The shadow Minister for Mental Health, the hon. Member for Tooting (Dr Allin-Khan), raised the concern that too many people are having to resort to A&E in a crisis. That is why mental health service providers worked across the country at pace during the pandemic to establish a 24/7 urgent mental health helplines for anybody of any age in crisis. Those services are now operational in every area of England, handling 230,000 to 250,000 calls each month. That service was not there before the pandemic; we have tried to respond and to respond quickly.

The long-term plan also committed to increasing the forms of provision for those in crisis, including safe havens and crisis cafés, providing a more suitable alternative to A&E. We know we need to do that. There are some excellent examples throughout the country, including the Evening Sanctuary at the Mosaic club in Lambeth.

[Kerry McCarthy]

In the case of my friend Ric, we learned at the inquest last week that he had phoned a mental health crisis helpline. In that conversation, he revealed that he was in the middle of a psychotic episode. When he later went to A&E at the suggestion of the helpline and spoke to a mental health nurse, he did not reveal that. In the prevention of future deaths report, the inquest recorded that there should have been real-time updating of his medical records, because the people at the hospital would not have let him leave A&E that night if they had realised that part of the problem was psychosis. I talked about taking note of what is said at inquests, and I hope that we can pick up the recommendation on real-time updating.

[Gillian Keegan]

Absolutely. I read all the prevention of future deaths reports, which come to me, and I take them very seriously. There is always so much to learn from them, and I agree with the hon. Lady. Sharing data between services sounds easy and trips off the tongue, but it is actually quite difficult to ensure that data is there in real time. That does not mean that we do not have the desire to achieve that; we absolutely do.

Talking therapies were mentioned by the hon. Member for Blaydon (Liz Twist), and we are improving access to those. I remind people that they can self-refer, rather than going through a GP. I am sure that many people are not aware of that. We are building up mental health support teams in schools. They will really help by providing our young people with first-level support in school, but we realise that we have to invest more in mental health. That is why we have £2.3 billion more to invest in mental health services in 2023-24. We need to build up the workforce, which is a challenge, because it takes a long time to train people for many of these roles. In fact, I had another meeting on this issue earlier this morning.

I want to address the use of risk assessment tools. I am running out of time, but I am happy to respond on the situation; it is important, and I definitely want to take the time to do so, particularly as Mr Pirie is in the Public Gallery. The guidelines published by the National Institute for Health and Care Excellence in 2011 make it clear that risk assessment tools should not be used to predict future suicide or repetition of self-harm, or to determine who should or should not be offered treatment, as the hon. Member for Bristol East said. We would expect health professionals to have regard to that, but it is clear that further work is needed, and discussions are under way right now to find out what further actions are necessary to achieve this.

I acknowledge the valuable role of the voluntary sector in complementing all the things we do. We have given more money—£5.4 million—to voluntary and community organisations. That money has supported 113 organisations, which do a fantastic job at helping people who are struggling. They are in lots of areas, and have often been set up by families who have lived experience. We have also provided funding to support the Hub of Hope, which was set up by a charity in Liverpool, and which is crucial in signposting people to services locally. For people who are at risk, we now have a fantastic opportunity with the call for evidence on mental health and the updated suicide prevention plan.

We have learned a lot more, and we know that there are a lot of things that we need to fix. We have mentioned debt, drugs and alcohol, and men’s sheds—I have visited those, and they are fantastic. Our LGBT expert advisory group is meeting tomorrow to discuss suicide prevention, and to see what more we need to do. I know that Members present are genuinely committed to working with me on situations that it is difficult to prevent, and we are absolutely convinced that we can do a lot better. We will work with colleagues across the Department for Education—we have mentioned the SEND review—and DCMS. It is vital that we work cross-sector, cross-Department and cross-party, because everybody has a role to play in suicide prevention. It is not just my job—if it was, it would be overwhelming. We all have a role to play.

There have been a lot of significant steps since the national suicide prevention strategy was published in 2012. Professor Louis Appleby is mentioned a lot in these circles and has put a lot of work and effort into this endeavour. Real-time surveillance is on the agenda, and the National Suicide Prevention Strategy Advisory Group will continue to work towards making things better. We have made a lot of progress, but everybody accepts that there is more to come. We have recently launched a call for evidence, and we have had about 2,500 people respond so far, but I would like a lot more to do so—particularly those from marginalised groups, or groups that find it harder to talk about these subjects. We need to hear their perspectives and get hon. Members’ help in making sure that everybody responds to the call for evidence, which is an opportunity. I am serious about this, as is the Secretary of State. I thank everybody for their contributions.

[Kerry McCarthy]

I think I have just about time to thank everybody for coming, and I hope that this debate continues. I am sure that it will.

Question put and agreed to.

Resolved,

That this House has considered Government action on suicide prevention.