Local Suicide Prevention Plans

Madeleine Moon Excerpts

Wednesday 4th March 2015 Westminster Hall

[Mrs Madeleine Moon (Bridgend) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Gray.

This debate comes after a report by the all-party group on suicide and self-harm prevention, as well as the publication of the most recent suicide statistics two weeks ago. I want to start with a quote from someone who gave evidence to the all-party group. It was the most powerful statement that we received. Speaking on behalf of one of the London authorities, the person said:

“People don’t want to talk about sad subjects…I could get dozens of people in a room for mental health but not suicide…I had maybe four or five people in the room for a suicide meeting, out of an invitation list of dozens who had attended similar events on the subject of mental health.”

There is the problem. People do not want to talk about sad subjects. They do not want to look at suicide. It is too painful and too difficult. They avoid tackling a problem that blights the lives of far too many people in this country.

The all-party group requested information from all 152 local authorities in England. Eventually, after some poking with a sharp stick and freedom of information requests, all but two replied. The data revealed a shocking lack of understanding of the basic difference between suicide and mental health. Some people think that if someone is suicidal, surely they have a mental health problem, but it depends on the definition of mental health. They almost certainly will not have a classified mental illness. It is generally acknowledged that three quarters of people who take their own life have never been near mental health services. It would be wrong to assume a close working correlation—that if someone is working to prevent mental health problems, they are helping to prevent suicide.

The most worrying finding of all was that a third of local authorities in England had no suicide prevention action plan whatever. A third did not undertake suicide audit work, and 40% had no multi-agency suicide prevention group. That is totally unacceptable. Mr Gray, you and I have spent some time over the past couple of months looking at the importance of having a strategic plan and knowing what one is trying to achieve and the required outcomes. Across England, a third of local authorities have no strategy—nothing at all. They are doing nothing to prevent preventable deaths, and 40% have no multi-agency suicide prevention group.

This does not require big money. It is not about expensive drugs. It is about putting time and effort into looking at what the problem is locally and how it can be tackled, and then pulling together the agencies that can work together to deliver a plan. That does not seem too big an ask to prevent an avoidable death, yet for a third of local authorities in England it is too big an ask. That is shocking. I hope that the Minister will approach those local authorities and say, “Things need to be better”. All Members whose local authorities do not have such a plan and action group ought to be proactively telling them that they are wrong.

[Jessica Morden (Newport East) (Lab)]

I commend my hon. Friend and the all-party group for their work on this issue. She speaks with great authority about the data for England, but what is her understanding of the situation in Wales?

--- Later in debate ---

[Mrs Moon]

I thank my hon. Friend for her question. We are both Welsh MPs, and we know how dire the situation is in Wales. The suicide rate in Wales is 15.6 deaths per 100,000—the highest in the UK. That is perhaps part of what drives me. I know that we have our own problems in Wales, but the matter is devolved to the Welsh Assembly. The all-party group’s work helps to highlight the problems here in England. After Wales, Scotland has the next highest rate, followed by Northern Ireland and the north-east of England. There is a serious problem in Wales that we must tackle as well.

People cannot be complacent if their area has a low level of suicide, because facts change, deaths change, and the figures change. At one point, the Isle of Wight had a very low suicide rate, but now it is higher, and it is considered to have an average rate. It has gone from low to average—that is a rise. We cannot assume that because the suicide rate is currently low it will remain that way.

The report highlighted particular concerns about London. It shows poor levels of suicide prevention planning, but also low levels of deaths. That does not make sense: not only the lack of action planning, but everything about the demographic profile of London and some of its regions would suggest that normally there would be a higher level of deaths in certain local authorities. Something must be done to examine what is happening, because either the data are wrong, and what is really happening is being hidden, or something very special is happening in London that provides some sort of insulation against suicide. We need to understand that. The age-standardised rate of death in London is 7.9 per 100,000, compared with Wales’s rate of 15.6. The gap is huge and must be addressed.

The most active local authorities and those with the highest rates of death from suicide in England are in the north-east, the south-west and the north-west, areas of social deprivation and high unemployment, and where the so-called economic recovery is not being felt. In those areas, the all-persons rates of death are 13.8, 12.5 and 12.3 respectively. On the whole, local authorities in those parts of the country are active, and the report commended their work. However, that raises new questions. We must look at what those active local authorities are actually doing and how they are spending their time and effort. The importance of local initiatives, local focus and local understanding in suicide prevention is recognised—we need to know the terrain, the population and where the pressure points are—but we must also examine the variation in what is being done across England without apparent consistent reasons for the strategic choices that are made.

For example, in some areas, funding is put into helplines, such as the Samaritans and the Campaign Against Living Miserably—CALM. In others, it is put into training, such as applied suicide intervention skills training—ASIST—and in some into better data collection, such as on self-harm, which the Minister and I have discussed often. Other activities will have gone unreported. With wide variability and without clear indication of the evidence on which the various initiatives are based, however, there are questions about which of those initiatives are more effective and why. We need to be able to understand how our suicide prevention work is working and the best way for local authorities to focus their attentions.

The all-party group concluded that both Public Health England and the national suicide prevention strategy advisory group should examine ways in which local authorities can share information about suicide prevention initiatives that have worked, in order to develop best practice. In addition, central funding of research and evaluation studies into the methodologies used is necessary, so that we can drill down to what is effective and why. In that way we can realistically make a difference with any necessary changes even at a time of economic austerity.

The Minister and I have talked about the importance of suicide audits and of timely information, so that people are not waiting for retrospective information to see if a problem is developing locally. Some authorities have a complete lack of clarity about audit work and that needs to be tackled. Much can be dealt with through better co-ordination with coroners and the provision of timely information by them, but I appreciate that the Minister might have difficulties with that, because coroners fall within the purview of the Ministry of Justice, which is perhaps less focused on the timeliness of information from coroners to help suicide prevention work. That is something that I hope the all-party group will come back to in the next Parliament, because the situation cannot be allowed to continue.

The rate of suicide in this country has generally been on the rise since 2008. Last year the number of people taking their own life increased by 4%. Suicide remains the leading cause of death for men aged between 20 and 34. Last year, 6,233 people in England and Wales died by suicide, which you could describe as a small number—

[Mr James Gray (in the Chair)]

indicated dissent.

[Mrs Moon]

You would not—I am glad to hear that, Mr Gray, thank you.

Each death by suicide is estimated to have an economic impact of around £l million. The reverberations across communities, families and workplaces are devastating. The suicide rate is a key indicator for the health and well-being of our country, our communities and our way of life. Suicide is not some niche issue that can be ignored by a local authority in its public health role because the numbers are too small. The issue is critical and indicates how healthy and how vibrant our communities and our society are.

The debate is probably the last about suicide in this Parliament, so I want to take the opportunity to make a few final remarks. The Minister and his predecessor, the right hon. Member for Sutton and Cheam (Paul Burstow), have been active in support of the all-party group and in suicide prevention work. I thank them for their support and acknowledge their work. Despite the failure of local authorities, active third-sector groups such as the Samaritans and individuals touched by suicide have offered support to those struggling to cope with life and to bereaved families. Sports figures and other celebrities have stepped forward to talk about their personal struggles and things that have changed their lives.

The police and other front-line workers are trying to save lives and responding to desperate people on a daily basis. During this Parliament, the role of the police in particular in tackling mental health problems, suicide, missing children and a whole range of other social problems outside their normal crime reduction role has shown their leadership and initiative. The work that the police are now undertaking to draw up a national process for responding to suicide is particularly welcome.

Suicide has not been illegal in this country since 1961, but it continues to carry a stigma, which we need to tackle. We also need to give support to bereaved families; to provide access to services that offer hope and a future for the suicidal; research in order to identify risks, best practice and awareness training that can prevent needless deaths; and local authorities to accept their responsibilities to support the dedicated individuals who already work across the four nations to prevent suicide. Without such individuals, the figures from two weeks ago would have been so much worse. It is time for us to take suicide seriously.

[The Minister of State, Department of Health (Norman Lamb)]

It is a pleasure to serve under your chairmanship, Mr Gray, I think for the first time. I congratulate the hon. Member for Bridgend (Mrs Moon) on securing the debate and, more importantly, on her leadership on the subject of suicide prevention. Nothing could be more important, and any conversation with those going through bereavement following the death of a loved one through suicide makes us realise just how important it is for us to do better. The impact on those people’s lives is massive—the reverberations that she talked about are enormous. We can talk about the cold economic facts and the cost of £1 million per suicide, but the reverberations and economic impact on the whole family and beyond are incalculable.

The hon. Lady also made a point about the suicide rate varying so much around the country, and said that in some areas it appears to be remarkably low. One of the issues that she and I have talked about is whether suicides are being accurately recorded in inquests. We have a completely shared view on the need, once and for all, to confront the issue of the burden of proof, which is an example of the continuing stigma on suicide. To secure a suicide verdict, it remains necessary to prove the suicide “beyond reasonable doubt”; the only other type of death in which that level of proof applies is unlawful killing. That harks back to when suicide was a criminal offence. It is high time that was changed. I have argued the case in government and will continue to do so—whether in or out of government—in the next Parliament, because the change has to happen.

I congratulate the all-party group on suicide and self-harm prevention on its work, and from the start I want to pick up on the role of the police. In my work on mental health, I have been impressed by some inspiring leadership in police forces across the country. In London, the Metropolitan police have worked brilliantly with mental health trusts. In many areas, police are taking the lead in ending the scandal of people being put into police cells in the middle of a mental health crisis. I applaud them.

[Mrs Moon]

The British Transport police have undertaken some particularly successful work in conjunction with the Samaritans on preventing deaths on the railway. That, too, should be recognised.