Suicide Prevention

Lord McCrea of Magherafelt and Cookstown Excerpts

Wednesday 6th February 2013 Commons Chamber

[Dr William McCrea (South Antrim) (DUP)]

I beg to move,

That this House recognises that the number of suicides in the UK, particularly amongst young people, represents a major challenge for government and society; acknowledges the work that is taking place to address the issue; calls for even more urgency to be shown in seeking to reduce the rate of suicides; notes the danger posed in particular by websites which promote or give information about harmful behaviours such as suicide; and calls upon the Government to adequately resource and promote child and adolescent digital safety.

For years this subject has been swept under the carpet. I believe it deserves a mature and thoughtful debate. Suicide is a significant problem in our society. Its impact is often sudden and shocking. While we can to some degree prepare ourselves for the death, through ageing, of elderly parents or the loss of loved ones through chronic illness, suicide catches us by surprise. Often there is no warning and we are left with a feeling of utter bewilderment. We ask: was it preventable? Were there warning signs that we failed to recognise? Was it simply a cry for help that went wrong? All of those are questions to which we will, regrettably, never receive an answer.

It can be seen that suicide touches the lives of many people and is, in every case, a tragedy both for the life that has ended and for the family, friends and community left behind. We must always remember that each person who has been lost to suicide has been someone’s child, someone’s parent, brother, sister or friend. Their passing leaves a wound that does not easily heal, even with the passing of time. In addition, those bereaved by suicide have special needs and require special support, for bereavement by suicide is itself a risk factor for suicide.

We cannot afford to ignore or be complacent about the prevalence of suicide and self-harm in the United Kingdom. Preventing suicide presents a serious socio-economic issue, as well as a political challenge. It is a problem that we all have a duty to address. There is a great need to change public attitudes and to increase awareness and understanding about suicide as a major public health problem that is largely preventable. Globally, almost 1 million people die from suicide every year. In the past 45 years, suicide rates have increased by 60% worldwide. Suicide is one of the three leading causes of death among those aged 15 to 44 years in many countries. Although suicide rates have traditionally been highest among the male elderly, rates among young people have been increasing to such an extent that they are now the group at highest risk in a third of countries worldwide.

In 2011, 289 deaths by suicide were recorded in Northern Ireland, with the male suicide rate approximately three times greater than that of females.

[Tracey Crouch (Chatham and Aylesford) (Con)]

I congratulate the hon. Gentleman and his party on securing this important debate on the Floor of the House. He references male suicide. Does he not agree that one of the more worrying statistics is that people who have just come out of prison are at a very high risk of committing suicide in the first two weeks of their release? Does he not agree that we should make better use of community and health care pathways to ensure that we can prevent and protect people who are very vulnerable, such as those coming out of prison?

[Dr McCrea]

I agree wholeheartedly about the importance of those pathways. It is vital that every effort be made to ensure that persons at a vulnerable moment in their lives—this is what the hon. Lady was talking about—receive the best possible support. I will develop that point later.

[Sammy Wilson (East Antrim) (DUP)]

Does my hon. Friend agree that, as well as prison leavers being vulnerable to suicidal tendencies, one of the groups at most risk are young males involved in the drug culture, and is it not odd, therefore, that some people are still campaigning to legalise drug use?

[Dr McCrea]

That is very true, and I agree wholeheartedly with my hon. Friend’s comments. Again, I will seek to develop that point later.

The figures I gave a moment ago represent a welcome reduction on the highest-ever recorded figure of 313 suicides in Northern Ireland in 2010. Nevertheless, Northern Ireland continues to experience higher rates of suicide among adolescents and young adults, particularly young men, than any other part of the UK.

Deliberate self-harm is also a significant problem, with a growing number of cases being seen in hospital accident and emergency departments. Statistics from the Department of Health, Social Services and Public Safety suggest that almost 500 patients presented at the hospital emergency department in Belfast with deliberate self-harm between April and June 2012. Many more incidents never come to the attention of health services at all. In 2011, the highest rate of registered suicides was recorded in the parliamentary constituencies of Belfast West and Belfast North. In my constituency, 18 lives were lost to suicide, 16 of them males.

[Mr Jeffrey M. Donaldson (Lagan Valley) (DUP)]

Is my hon. Friend aware of an international study highlighting the fact that Northern Ireland has the highest incidence of post-conflict trauma of any post-conflict region across the globe, and that this contributes to the high level of suicide? That is evidenced by the fact that much of it is concentrated in the parts of Northern Ireland where the conflict was fiercest, and it is added to by the fact that many of the people suffering trauma served in the armed forces. What we need in Northern Ireland, under the military covenant, is a specialist centre for the treatment of trauma for those who have served our country.

[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.

[Rehman Chishti (Gillingham and Rainham) (Con)]

I congratulate the hon. Gentleman and his party on bringing this important debate to the Floor of the House. He talks about the factors linked to suicide. Will he accept that mental health issues are another key factor linked to suicide and that MPs and others need to remove the stigma attached to mental illness so that people feel able to ask for the help they badly need?

[Dr McCrea]

I agree wholeheartedly with those remarks. The Bamford report highlighted the link with mental health. I agree that we must remove the stigma attached to mental health, as well as the stigma attached to suicide, because many families are deeply hurt by it.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Is the hon. Gentleman aware of research carried out by Louis Appleby, the suicide tsar, showing that 75% of those who commit suicide have had no connection with mental health services, and that it is dangerous to focus suicide help and support only on mental health teams? If we do that, we risk failing to protect many of those who need our help.

[Dr McCrea]

I thank the hon. Lady for her interest in this matter and for commendably seeking to highlight it in one of the Committee Rooms. There is no one reason for a person coming to that place where they feel that suicide is the only way out.

[Simon Hughes (Bermondsey and Old Southwark) (LD)]

I hope the hon. Gentleman realises how much appreciated his colleagues’ choice of subject is today. I declare two interests: I am joint president of a Samaritan branch, through past family links, and I am involved with the organisational charity, Papyrus, which campaigns to prevent suicide among young people in the UK. May I accentuate what he has said? People can feel as depressed in rural areas as they do in urban areas, and there can be no presumption about the reason. Teenagers can be very depressed because of medication—I have had family experience of that—and university students because of the pressure of their studies and relationships. It can be for anybody at any time, and organisations such as the Samaritans and Papyrus ought to be known abroad, so that anybody can reach them on the phone.

[Dr McCrea]

I agree wholeheartedly with the right hon. Gentleman’s comments. I have found a lack of knowledge in the community about the help available through such agencies.

We community leaders must be willing to say, “This is not a taboo subject. We can talk about this.” The country must be willing to open up. We tell young people to open up when they have a problem or feel isolated, but we legislators must be willing to do the same, and not run away from the issue, treating it as something to be hidden or pushed aside.

I am delighted that my right hon. and hon. Friends have brought this debate before the House today—I know that I have support on this issue from across the political spectrum in Northern Ireland—but I really feel that this is a problem right across the United Kingdom. As I pointed out at the beginning, in one year, 1 million people across the world reached the point where they took their own lives. That is very serious and we are not immune to it—not one part or region of the United Kingdom is immune and I can assure hon. Members that not one family is immune either. This issue can touch every family, no matter how rich or how poor. Every family can experience the very same pain and hurt that has been expressed to me. That is why we have secured this debate.

The report also found that, on average, deaths due to suicide since 2000 have exceeded deaths on the roads and concluded that suicidal behaviour places a heavy human and financial burden on society in Northern Ireland, with an annual cost to the economy of £170 million owing to work days lost and hospital admissions for attempted suicides and suicidal behaviour. Research undertaken by Mike Tomlinson of Queen’s university in 2007 found that the Northern Ireland suicide rate had grown since the mid-1990s, which was attributed to younger people, particularly men, taking their own lives.

[Rehman Chishti]

The hon. Gentleman talks about young people. Does he know whether there have been any discussions between the devolved nations about preventing young people from accessing suicide websites? Such prevention work is crucial.

[Dr McCrea]

Once again, I am deeply appreciative of the hon. Gentleman’s intervention and I wholeheartedly agree with him. We will endeavour to take up that point as the debate continues.

Tomlinson found that about 150 suicides were recorded annually between 2000 and 2004, but by 2006 that figure rose to 291. He argued that the end of the conflict in Northern Ireland might have brought its own problems. Figures released by the Office for National Statistics show that in 2011 there were 6,045 suicides among people aged 15 and over in the United Kingdom—an increase of 437 compared with 2010. The UK suicide rate increased significantly between 2010 and 2011, from 11.1 to 11.8 deaths per 100,000 of the population. That trend was further reflected in Wales, which recorded 341 suicides—its highest rate since 2004. Scotland also saw an increase, from 781 deaths by suicide in 2010 to 889 in 2011.

[Jim Shannon (Strangford) (DUP)]

I thank my hon. Friend for setting the scene so clearly for everyone in the Chamber. The suicide rates over the last few years, which he has outlined, cover the period of the economic downturn. Does he feel that, at this time especially and for that very reason—the economy and the downturn in jobs—there should be a greater focus on suicide across the whole of the United Kingdom?

[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.

[Mr Donaldson]

My hon. Friend referred to support groups. I have recently met members of Horizons, a local support group in Lisburn. It is doing excellent work on a voluntary basis, but it is struggling to get the funding that it needs. Many of its members have had family experience of losing a loved one in these circumstances, and they are well placed to provide the support that our communities need, because they have walked through that dark valley. Greater priority for the funding of such groups is essential.

[Dr McCrea]

I thank my right hon. Friend for that intervention. In fact, the motion

“calls upon the Government to adequately resource and promote child and adolescent digital safety.”

The motion goes wider than that, but resources are certainly a problem that such organisations need help with.

The internet and new media are prominent features in youth culture nowadays. Young people see the use of technology as a vital part of their social lives, and the online environment has created unique opportunities for learning, connection and communication. Almost 99% of children aged between eight and 17 access the internet, and 90% of children aged five to 16 have a computer at home. Although the risks created by the internet and new media have yet to be properly assessed, there is growing concern over the use of the internet for cyber-bullying and for normalising and encouraging suicide and suicidal behaviour.

The Byron review, conducted in 2008, entitled “Safer Children in a Digital World”, found that

“there is a range of material on the Internet that may present particular issues for specific groups of children and young people. This includes content or sites that promote or give information about harmful behaviour such as suicide and self harm”.

The report found that, although some children might be deterred from harmful behaviours by witnessing such content, or might find emotional and social support from others experiencing the same feelings, it was clear that for some children there were major risks. Sites providing information about suicide techniques, for example, could increase the chance of a suicide attempt being successful and decrease the chances of a young person receiving help.

[Mrs Moon]

The hon. Gentleman will be aware that the hosting of such sites is illegal in the United Kingdom, thanks to the Coroners and Justice Act 2009. The problem is that many of those sites are hosted outside the UK, where they are not illegal. Internet providers need to block access to the sites. They move them down the access chain when people google them, but they do not block access to them altogether. How can we ensure that access to those sites is blocked?

[Dr McCrea]

I thank the hon. Lady for that intervention. I intend to touch on that point in a moment.

[Simon Hughes]

The hon. Gentleman is covering lots of bases. One of the issues that we face as a society is that young people can become isolated from contact with other young people, other than through the internet or texting. That is a real danger zone. They retire to their bedrooms and they are not seen from one night to the next. Their communication with others is limited. The exercise of parental and family responsibility, to ensure that youngsters are out and being monitored so that people can pick up signs that they might be led to suicide sites, is as important as dealing with the sites themselves.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. May I point out to Members, in relation to those last two interventions, that such interventions should come through the Chair? Instead, they have been focused on the hon. Member for South Antrim (Dr McCrea), whom we all wish to hear.

[Dr McCrea]

I agree with the point that the right hon. Member for Bermondsey and Old Southwark (Simon Hughes) makes. I was talking to folks at the weekend about how young people isolate and withdraw themselves. If we set our minds back to just a few years ago, we remember that we used to see children playing football on the streets, and little girls out with their prams. If we look at our streets today, we see very few children out there. So where are they? They are in their rooms. They are not with their families. In many cases, the internet has taken over their lives, and that leads to the isolation that the right hon. Gentleman mentioned.

When online discussions or communities emerge around harmful behaviours, there is a risk of what the Samaritans describe as an “echo chamber”, in which users reinforce each others’ behaviour and negative feelings about themselves. In a communication to me, the Samaritans stated that

“there are some aspects of the ways that individuals interact with one another online, through social networking sites or online chat rooms, that can place vulnerable people at risk by exposing them to detail about suicide methods or conversations that encourage suicide ideation. Indeed in recent years there have been several widely reported cases of individuals taking their own lives having used websites that have provided explicit information on suicide methods or have been used to facilitate suicide pacts. Restriction of access to information about suicide methods is an established component of suicide prevention. However, this is particularly difficult to achieve online not least because suicide related websites hosted abroad are legal in most other countries”.

The Samaritans have worked in partnership with major companies to develop practical initiatives to support people at risk from suicide online. In November 2010, an initiative was launched in partnership with Google to display the Samaritans helpline number and a highly visited telephone icon above the normal Google search results when people in the UK use a number of search terms related to suicide. The Samaritans also worked closely with Facebook to allow users to get help for a friend they believe is struggling to cope or feeling suicidal. We must express our appreciation to the Samaritans for doing this excellent work.

These pioneering initiatives are to be commended, but more must be done. The Department of Health suicide prevention strategy in England recognises the need to continue to support the internet industry to remove content that encourages suicide and to provide ready access to suicide prevention services. In Northern Ireland, the refreshed “Protect Life” strategy includes a new objective to develop and implement internet guidelines that seek both to restrict the promotion of suicide and self-harm and to encourage the circulation of positive mental health messages.

Online risks must be managed more effectively, and advertisements with hyperlinks to support services must be displayed whenever users discuss or search for information about harmful behaviour if we are to ensure that people in distress can access useful resources quickly.

I acknowledge that the Byron review calls for a shared culture of resilience with families, industry, Government and others in the public and third sector all playing their part to reduce the availability of potential harmful material, to restrict access to it by children and to increase children’s resilience. There needs to be a greater understanding of how young people use modern technologies and communications if they are to be engaged in respect of suicide awareness and prevention, and mental health and well-being.

In conclusion, the causes of suicide are multiple and complex, and they cannot be addressed by any one Government Department working in isolation. Recent years have seen a commitment by Government to deliver suicide prevention strategies throughout the UK, but these must be adequately resourced on a sustainable basis if the progress already made is to be maintained. While we must acknowledge the good work already taking place, there is, of course, always room for improvement, and I believe that efforts must be concentrated on making the internet a safer place for our young people.

I recognise that this is a particularly complex matter and that the challenges it presents are indeed multiple. None the less, they are challenges that must be overcome, for children have the right to be protected from all forms of abuse, violence and harm. Enhanced internet safety is only part of the solution to the growing problem of suicide and self-harm. Through a co-ordinated approach, we must effectively address the issues impacting on emotional health so that we reach a point where so-called “suicide” sites will no longer be attractive to vulnerable individuals and will be made naturally obsolete or unattractive to view. We need to think innovatively about what more can be done across government and the community to reduce the rate of suicide in the UK.

I trust that my right hon. and hon. Friends will deal not only with the issues I have touched on, but with the families of those who have experienced suicide, because they also need help.

[Paul Goggins (Wythenshawe and Sale East) (Lab)]

I congratulate the hon. Gentleman on the speech he is making in leading this debate and on the tremendous work he is doing to highlight the issue in this place. He has mentioned the refreshed “Protect Life” strategy, and it is good to know that that strategy is developing under devolution. He may just about remember that I was the Minister with responsibility for health at the time when that was launched in 2006. On the hon. Gentleman’s point, I emphasise and ask him to emphasise how important it is for the families of those with direct experience to be at the core of that strategy because they better understand the issues at stake and can inform us all about the best way forward.

[Dr McCrea]

rose—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. I wish to be helpful to the Chamber, and point out that Members are meant to speak through the Chair rather than to the individual Members concerned. I know that some Members have not been on the Back Benches for a while, but I hope that they are back into the swing of being in opposition and will remember to speak through the Chair.

[Dr McCrea]

I concur with the remarks of the right hon. Member for Wythenshawe and Sale East (Paul Goggins). I can honestly say that there was no better person than himself to introduce and bring in this sort of measure from the beginning. He certainly did sterling work on it, and we in Northern Ireland appreciate what he did, and want to carry it forward to the next step. Thus families in their grief, bewilderment and loss need help and should be at the very heart of whatever next step is taken. The emphasis on suicide prevention must remain, for as the Stamp Out Suicide! website plainly notes:

“once a suicide is completed, very sadly, there is no cure.”