Male Suicide and International Men’s Day

Luciana Berger Excerpts

Thursday 19th November 2015 Westminster Hall

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

As the shadow Mental Health Minister, I am grateful for the opportunity to take part in this debate on International Men’s Day. I will respond specifically to the motion, which tackles male suicide.

I thank Members from throughout the House for their contributions to the debate, which have revealed just how significant a challenge male suicide is in all our communities. I also add my thanks to CALM for the work it has done to raise the profile of the issue and push for a debate on it. Its #BiggerIssues Thunderclap campaign today has reached millions of people on Twitter and across social media. That is an important indication of the strength of feeling on this issue. On Monday, the Mind media awards featured countless nominations for programmes and coverage that had raised the profile of this significant issue. The campaign award was won by the #FindMike campaign, which was run by Jonny Benjamin and Neil Laybourn, recognising the contribution that they have made to the debate.

I pay tribute to the chair of the all-party group on suicide and self-harm prevention, my hon. Friend the Member for Bridgend (Mrs Moon), for the vital contribution that she and the group have made and continue to make to the ongoing debate on suicide. As a society, we should be doing everything that we possibly can to prevent it. I also thank the Samaritans and the Royal College of Psychiatrists for their helpful briefings ahead of this debate.

The rate of male suicide in this country is a national scandal. It is shocking that in today’s society the number of people taking their own life is increasing. The fact that such a disproportionate number of those suicides are by men demands our urgent attention. I shall share again some statistics that we have already heard, because they are so significant: of the total number of suicides in the UK in 2013, 78% were male and 22% were female, and suicide is the single biggest killer of men aged under 45 in the UK. Every time a person is lost to suicide, it is a tragedy—for their loved ones, their friends, their community, and society as a whole.

Members from across the House have mentioned cases of suicide in their constituencies, and sometimes within their own families; each one is tragic and devastating in its own right. The impact of suicide can be wide-reaching and incredibly long-lasting. Apart from the obvious human cost, which often affects whole communities in schools, colleges or workplaces, we must consider the huge economic cost. I was particularly struck by the Department of Health impact assessment, which put the economic cost of just one suicide at a staggering £1.7 million.

This debate has given us an important opportunity to examine the factors that might lie behind the shocking statistics. A report by the charity Mind outlined some of the possible reasons why men are more likely to take their own life. It suggests that men compare themselves to a gold standard of masculinity, power and control, and are more likely to feel shame and guilt when they fall from that standard. There is a link between unemployment and suicide—unemployed people are two to three times more likely to take their own life. Just this week, the University of Liverpool published research into the number of suicides that, tragically, have happened in areas with a higher number of work capability assessments.

[Philip Davies]

The hon. Lady and the hon. Member for Caithness, Sutherland and Easter Ross (Dr Monaghan) try to draw attention to work capability assessments and blame suicides on them. Will she accept that it was the Labour Government who introduced work capability assessments, under which more than 60% of people were found fit for work? In work capability assessments now, only 27% of people are found fit for work, so her Government were finding more people fit for work than this Government ever have. Will she at least acknowledge that fact, rather than trying to make a rather cheap political point?

[Luciana Berger]

I pointed out just one reference to the work capability assessment that is particularly relevant because that research has been prominent in the press today. There are many other factors—that is just one—and I will come on to address them, but that research has been conducted academically and is particularly relevant this week. That is not a political point; it is something that is significant in many communities and that has been raised by Members of all parties, not just by the Opposition.

Some groups of young men are particularly at risk. Research conducted by the charity METRO found that more than a third of LGBT young people have attempted suicide at least once. Shockingly, it has recently come to light that suicides in our prisons have increased by more than 50% in recent years. Every four days a prisoner takes their own life, and the majority are men. Analysis by the Samaritans and a number of academic studies show that there is also a very strong link between socioeconomic class and suicide, with those living in deprived areas on the lowest incomes being most at risk.

Men are more likely to take risks with drugs and alcohol. They are also much less likely to open up to their friends and family and seek emotional support, as many Members have said. We have also heard concerns about the impact of economic crises on suicide rates, which I echo. My hon. Friend the Member for York Central (Rachael Maskell) referred to debt, and we also heard about the challenges in Greece, which has seen an increase in suicides.

All those individual factors are important and demand our consideration and attention, and I hope that the Minister will respond to each of them in turn. Whatever factors contribute to a person wanting to take their own life, there is one thing of which we must never lose sight: suicide is not inevitable. If people are in crisis, good care can make a vital difference, and it can and does save lives.

We have heard about the challenges in ensuring that people with mental health problems get the support that they need, and there are particular challenges due to fragmentation in the system. Service users, professionals and experts are warning of a mental health system under unsustainable pressure. The number of people becoming so ill with mental illness that they need hospital care has increased. At the same time, the number of mental health nurses has decreased, and we are hearing of too many instances of people having to travel hundreds of miles for a bed or, in some cases, not getting any help at all.

The Royal College of Psychiatrists has advised that men tend to use more lethal forms of suicide than women. It is therefore vital that the very first time someone says they have had suicidal thoughts, they get the best support possible. It is vital that that support is provided in the first 24 hours after a crisis begins. Mental health charities have long been campaigning for better crisis care. Research from the charity Mind has found that people in mental health crisis might not be able to get help immediately.

I echo the comments of my hon. Friends the Members for Bridgend and for York Central about the role of the police. Some important pilots of street triage teams are going on throughout the country. I had the opportunity to join one in Liverpool and saw at first hand the fantastic work being done by the police and mental health professionals to contend with issues of suicide and suicide prevention. They often identify people and take them to a safe place, but we know that only one third of people who use NHS crisis care services are assessed within four hours, which should concern all hon. Members. Research has found that when people present to services, perhaps after having been brought there by a member of the police or a street triage team, there are often not enough staff to provide the care that they need.

When someone has a mental health crisis and is most at risk of suicide, one of the places they are most likely to be taken is the local hospital’s accident and emergency department. I echo the point made by the hon. Member for Faversham and Mid Kent (Helen Whately): there is a serious shortage of liaison psychiatrists in acute hospitals. I have had the opportunity to join a number of such teams in A & E. They do an incredible job in very difficult circumstances and under a lot of pressure. I have heard the staff say that they are not able to deal with all the cases they would like to in an adequate time, which should concern all of us. Having experts on hand is key to ensuring that people get the support they need. I would welcome an update from the Minister on the work he is doing to increase the number and coverage of liaison psychiatrists in our hospitals.

Labour Members welcome the mental health crisis care concordat—the national agreement between local agencies to work together more closely when responding to people in mental health crisis. I note that great strides have been made in supporting the police to improve their response to people with mental health problems. However, it is not clear what tangible progress is being made on the ground in relation to suicide as a consequence of the crisis care concordat. A King’s Fund report published last week found that just 14% of people felt that they received appropriate care in a crisis. I hope the Minister will share with us his plans to evaluate what the crisis care concordat has achieved and what it might go on to achieve.

My hon. Friend the Member for Bridgend rightly raised the complex and under-researched issue of suicide contagion. I echo the concerns raised by Members from both sides of the House about the challenges caused by the lack of research into suicide. There are some great research facilities, but they are few and far between. Although their work leads the way, funding for all types of mental health research is significantly lower than funding for research into physical health conditions. Public Health England published guidance in September on how to identify and respond to suicide clusters. I hope the Minister will tell us about the work his Department is doing to understand more about and prevent suicide contagion.

Ensuring that people in mental health crisis get the support they need is an urgent priority. However, to stem the tide of male suicide, we must do much more to prevent men from reaching the crisis point in the first place. A number of hon. Members have talked about the important fact that three quarters of people who take their own life are not in contact with mental health services. Men who suffer from depression are much less likely than women to look for formal help from mental health professionals. They are also less likely than women even to talk to their family and friends about how they are feeling. We need a cultural shift so that men feel able to discuss their mental health, seek help and get the support they need.

Just as important as ensuring that men feel able to talk openly about their mental health is ensuring that when they come forward, there are services available that they feel comfortable accessing. We need to do more to ensure that men can access information about mental health problems. We must make support available in what might be considered traditionally male settings, such as where men meet, eat and watch sport. That point has already been made this afternoon. I have seen at first hand the work done by Everton in the Community, an organisation connected to Everton football club that looks at mental health in particular. It has mental health champions and does work on the football playing field and just after matches, and it has a significant impact. It is a great project and there are others, but they are not the norm, so we need to do more work.

There is a real need for joined-up working between different sectors, including health, social care, education, employment, social welfare and the Ministry of Justice, to reach out to men who are depressed and at risk of suicide. Underpinning all of that is the need for a concerted and co-ordinated approach from the Government to prevent suicide. The Government’s suicide prevention strategy was published in 2012, yet there is still a high rate of suicide in our country. The strategy has not been as successful as any of us would like. My hon. Friend the Member for Bridgend said that she is concerned that the strategy lacks teeth and that there are no timeframes or tangible reporting mechanisms by which to measure its success. Does the Minister agree that it is time for an urgent review of the suicide prevention strategy? We also need timely access to data about suicide. It is not right that there is a two-year delay in receiving such figures. What plans does the Minister have to improve the availability and transparency of information about suicide across the country?

In the light of the rising suicide rates, it is clear that we need a revolution in suicide prevention to address the fact that many more men than women take their own lives. For too long, mental illness has been the subject of stigma and prejudice, which means that people—particularly men—often feel that they cannot talk openly about their mental health problems. A few brave public figures, such as Stephen Fry, Graham Norton and my hon. Friend the Member for North Durham (Mr Jones), have spoken up about their own mental illness, but for too many people mental health remains hard to speak about openly. Only last week, in my constituency surgery a man in his 50s told me that he is not able to relate to either his siblings or his parents about the mental health condition he has been affected by throughout his adult life.

It is incumbent on all of us to make the rhetoric about parity of esteem a reality. Challenging stigma is key to making equality for mental health a reality. We need a cultural shift in our schools, colleges, universities and workplaces to enable men to discuss their mental health and feel able to seek help. We need to overcome the stereotypes of masculinity placed on men’s shoulders and give them the support they need. Each suicide is a terrible tragedy and a waste of precious life. Members from both sides of the House have talked about the important work that must be done to tackle the challenge and about the many practical steps that must be taken. It is clear from their contributions that together we can prevent suicide and save the lives of many men. I look forward to the Minister’s response.

--- Later in debate ---

[Alistair Burt]

My hon. Friend is absolutely right. Those connected with housing increasingly recognise the relationship between housing, mental health issues and suicide. When I was with my hon. Friend the Member for Derby North, I met the lady responsible for the YMCA there and its housing outreach, and she made some pertinent comments. Housing and homelessness are closely connected with the problem we are discussing, and I commend the constituent that my hon. Friend the Member for Worcester mentioned.

We know that men are often reluctant to talk about mental health problems. Many colleagues have referred to men’s attitudes, so I do not think that I need to labour that point. They are reluctant to seek help when they need it. In part, we know that is because some men feel that it may be a form of weakness. We need to assure men that that is not the case, as many colleagues have said. We, along with the charities Mind and Rethink Mental Illness, are seeking to reduce the stigma around mental illness through the Time to Change campaign.

Time to Change aims to empower people to challenge stigma and speak openly about their own mental health experiences—particularly men—and to change public attitudes towards those with mental health problems. The campaign has improved the attitudes of more than 2 million people. However, we know that men can be a particularly hard-to-reach group, and we are looking at further ways to improve reach in that area.

We know, tragically, what the outcome of unacknowledged mental ill health can be for a person. When someone bottles it up—that phrase was used in this Chamber today—their condition can worsen and may, in the worst cases, increase the risk of suicide. As I mentioned earlier, suicide rates in England remain low compared with in other European countries and other UK administrations, but I am concerned, as we all are, to see that rates have been rising in recent years. We anticipated that after the global financial crisis in 2008, and it has been seen in other countries around the world, as the hon. Member for York Central said. We know about that, but it is important that the inevitability of that does not go unchallenged. We can appreciate that such times bring extra pressures, but we need to ask what we can do when we know they are coming.

We know that the recent rise in suicide rates has been driven by an increase in male suicides, which is what led my hon. Friend the Member for Shipley to call for the debate in the first place. The threefold difference between male and female suicide rates has increased further, and we know that is a common experience in other countries around the world. It is right, therefore, that preventing suicide is dominated by efforts to prevent male suicide, but we recognise that this issue affects everyone. Whether men or women, boys or girls, when it happens it is an immense tragedy.

The greater risk of suicide among men is a complex issue. Many of the clinical and social risk factors for suicide are more common in men. Cultural expectations that men will be decisive and strong can make them more vulnerable to psychological factors associated with suicide, such as impulsiveness and humiliation. It is critical that, in addressing those issues, we provide information and support in a way that suits men’s needs and behaviours, and that we provide services that are appropriate for men, which may include moving away from traditional health settings.

What are we doing about it, and what will we do about it? We published the cross-Government suicide prevention strategy for England in 2012, and I am committed to implementing it by working across Government and with our partner organisations in the NHS and other sectors such as transport and the community, voluntary and charitable sectors. I will also be speaking to our partner organisations soon to discuss how we can review and strengthen the national suicide strategy. I want to make it clear that I see that as a dynamic and flexible instrument, not as something that we will do and then I will see how it works and make some decisions in years to come. We are looking at it now. It needs to be reviewed and refreshed now. It is an ongoing process, and I am committed to it.

The objectives of the strategy are to reduce suicide and to support the people bereaved or affected by it. It is right that men are identified in the strategy as a high-risk group for whom our suicide prevention activities should be and are prioritised. The strategy also recognises that schools, social care and the youth justice system have an important contribution to make in suicide prevention by promoting mental wellbeing and identifying underlying issues such as bullying, poor self-image and lack of self-esteem.

As well as having the strategy, we continue to provide financial support for the National Suicide Prevention Alliance, which brings together our key partners across Government and the community, voluntary and charitable sectors with expertise in suicide prevention. I am particularly pleased to say that many of the organisations that campaigned for the debate are members of the NSPA. It has been working with all those organisations to develop its strategy for delivering improvements in suicide prevention, which I welcome. My Department of Health officials are helping with that work. Those organisations make tremendous individual contributions to suicide prevention. The Campaign Against Living Miserably, which was prominent in calling for this debate, works tirelessly to target men specifically, and to support them, so that they feel able to talk about mental health issues. The Department of Health provided financial support to CALM in its early days, and I am proud to see how it has grown in size and profile.

I have had a variety of meetings on the issue since I took office; I have mentioned some already. I went to see the Samaritans bereavement centre in Peckham for World Suicide Prevention Day, and to mark the launch of a new initiative between Cruse Bereavement Care and the Samaritans. I met the British Transport police and saw the extraordinary work they do with Network Rail. I saw some of the triage work going on in Birmingham, including placing a mental health professional in the police control room 24 hours a day to help provide necessary information. I held a meeting on suicide prevention on 29 June, with researchers, the Samaritans, and representatives from areas such as Merseyside, the east of England and the south-west.

We have started to look at something called zero suicide. I have an interest in the concept and ambition of zero suicide. It was pioneered in Detroit by a college acquaintance of mine from many years ago, Ed Coffey, and I am very interested in his work. We can follow part of it, although some things are different in the States and will not be pertinent here. The whole concept of zero suicide—recognising that as an ambition, and challenging the inevitability of suicide—is really important and has very much grabbed my attention. Public Health England also recently published the refreshed “Help is at Hand” document, which provides compassionate support and information to people bereaved by suicide.

I will conclude by saying a little about research and data, as it will cover a number of issues raised by colleagues. One of the key drivers for improving our approach to suicide prevention is investing in research and data. I want us to lead the world in suicide prevention research, and to be at the forefront of service delivery, using the best knowledge and information to provide the best care. We have invested over £1.5 million in suicide and self-harm prevention research since bringing in the national suicide prevention strategy, to inform and target our strategy for reducing suicide rates. I will have a look at whether that is enough, and at what more needs to be done.

The hon. Member for Bridgend mentioned longitudinal studies. We are committed to carrying on the work on that. We have provided the Multicentre Study of Self-harm in England with £300,000 this year. I will very much bear in mind the opportunities that there might be for us to do more.

The zero suicide ambition I mentioned is being piloted in three areas: Merseyside, the south-west and the east of England. Early learning from the pilots has identified some innovative practice, which I am sure will help other areas to develop innovative plans for reducing suicide in their communities. There will be more research that we can work through to find whether it could have applications elsewhere.

[Luciana Berger]

Will that work extend to our prisons, which are a particular area of concern?

[Alistair Burt]

I know the Ministry of Justice is looking closely at the increase in prison and detention suicides. Again, it is not huge, statistically, but any increase is a matter for concern.

The work capability assessment has been mentioned. It started in 2008, which is about the time that the rise in suicides began. The authors of the recent study that has been mentioned have said that they were cautious about making a link or claiming cause and effect, but I have already asked the Department of Health to have a look at that study, because I feel it is important that my Department looks at the matters involved.

This has been a really good and important debate. First, it has put the issues connected to International Men’s Day on the agenda and allowed us to talk about male issues, in a way that is not a zero-sum game. We have been able to make reference to some difficult issues that are not discussed enough, and I am grateful to my hon. Friend the Member for Shipley for that. We have spent the bulk of our time discussing suicide, and Members on both sides of the House have been able to work together and demonstrate a common interest in things that affect us all. The sense I get from everyone is that none of us is prepared to accept the status quo and simply see the statistics accepted—my hon. Friend the Member for Bury North made that point.

These will not be easy issues to tackle. More men commit suicide than women, not because someone is making them do so—it is not anyone’s fault—but that is a fact. What more can we do? What can we learn from overseas and from the work being done in different areas of this country? I am absolutely confident that this House will talk about this issue again. I hope that when we do, we will have learned still more. People and organisations outside the House do such excellent work on this; with the benefit of that work, perhaps our ambition to make this the country with the best suicide prevention strategy in the world can, in time, become a reality.