Local Suicide Prevention Plans

Norman Lamb Excerpts

Wednesday 4th March 2015 Westminster Hall

[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.

--- Later in debate ---

[Norman Lamb]

I agree. Every person lost to suicide is a tragedy, for loved ones, the community and society as a whole. I was deeply concerned to read the latest figures from the Office for National Statistics, which showed a rise in the suicide rate. Back in 2012, when I launched the suicide prevention strategy for England, we knew that we could not afford to be complacent about suicide, and much remains to be done. The new challenges are now clear, and in the second annual report for the strategy, I called on services, communities and national agencies to be more ambitious than ever before with regard to suicide prevention.

Collectively, I want us to tackle the widespread assumption that suicides are inevitable for a certain proportion of people. That is absolutely not the case. I have had discussions with Professor Louis Appleby, who is the foremost thinker and academic on suicide, and he said that in his 25 years of experience he had never looked at the details of a suicide without seeing ways in which the death might have been prevented. That encapsulates the challenge for public services and, beyond, for society as a whole. Suicide is not inevitable for any individual. We need to get that point across.

In 2014, important steps were taken. In January of that year, we published the consensus statement on information sharing and suicide prevention, signed by the Royal College of Psychiatrists, the Royal College of General Practitioners, the Royal College of Nursing, the British Psychological Society, the British Association of Social Workers, the College of Social Work, the Mental Health Network of the NHS Confederation and the Association of Directors of Adult Social Services. The statement aims to improve information and support for families—that is critical—who are concerned about a relative who may be at risk of suicide, and to support better those who have been bereaved as a result of suicide.

In January 2014, we also published “Closing the Gap: priorities for essential change in mental health”, which sets out 25 changes that we believe it is absolutely necessary for the NHS and the care system to make in the next few years to improve the lives of people suffering from mental ill health, and to reduce health inequalities. It highlights how we will change the way front-line health services respond to self-harm, an issue that the hon. Lady has pursued vigorously, and how we improve crisis care in mental health.

At the start of 2014, the National Suicide Prevention Alliance was launched, facilitated by Samaritans and supported by Department of Health grant funding of £120,000 over 2013-14 and 2014-15. In July, the Department awarded a grant of £556,000 over three years to a partnership between Samaritans and Cruse, the bereavement counselling organisation, to increase support for those bereaved by suicide. Samaritans and Cruse will offer that support, working with organisations locally.

I know, however, that we can still save far more lives. It is a moral imperative that we take this issue seriously. As the hon. Lady will be aware from our previous discussions, I share her concerns about better suicide prevention. There have been a number of recent worrying trends in suicide rates, such as the rise of new suicide methods, such as using helium. The Government are committed to improving mental health services as a whole and reducing the suicide rate.

As the hon. Lady will be aware, the Deputy Prime Minister also shares my concerns, which is why in January he announced our ambition for zero suicides. That ambition has already been adopted in some areas. I pay tribute to the brilliant leaders, including Adrian James, a psychiatrist in Devon, and Joe Rafferty, the chief executive of Mersey Care, who have got organisations in their areas to adopt the ambition and start developing plans to achieve a dramatic reduction in suicide, aiming for zero suicide. That is of course what we should aim for, but it cannot be dictated from Whitehall. It requires real leaders to grasp the opportunity and to be ambitious.

Together we need to create a culture in our country in which everyone can talk about their mental health problems without fear or embarrassment. For that ambition to be fulfilled, it is essential that every part of the NHS commits to it. As I have mentioned, pioneering work in Merseyside, the south-west and the east of England means that health workers are starting to rethink how they care for people with mental health conditions. The Deputy Prime Minister called on the health service to look at the work being done by those three pioneering areas. Adopting those kinds of approaches across the country, with serious commitment, could save thousands of lives. We need to raise our aspirations for mental health, although we need to be clear that zero suicide is not a target but an ambition for organisations to aspire to. Nor is it about blame—that would be unhelpful for staff, for people using services and for communities and families. It is about constant learning—Louis Appleby has described so many examples from over the course of his career—and, critically, applying that learning to improve the system.

We know that many who take their own lives are not in touch with mental health services, a point that the hon. Lady frequently makes. That is why we need to apply the same ambition to primary care services and the wider community. The zero suicide initiative had its origins in Detroit, where a programme has successfully reduced the rate of suicides in in-patient care, with not a single suicide for a period of over two years. Although the study on the claim has not been peer-reviewed, the programme also claims to have reduced the suicide rate across the wider general population—that is the really exciting thing. That is why we need to be willing to learn constantly. We need to work together to challenge the stigma attached to mental ill health and change the way society as a whole thinks about it, starting in local communities.

I read with interest January’s report by the all-party group on suicide and self-harm. I know that the inquiry into local suicide plans concluded that there are significant gaps in the local implementation of the national suicide prevention strategy. I agree that that is a concern. As I have said in writing to the hon. Lady, I am confident that the APPG report will be of great value at local, regional and national levels. We know that it is at the local level that the most effective suicide prevention activity will take place. I am happy to write to those local authorities that have nothing in place, and to copy her into that correspondence.

Both the Department of Health and Public Health England agree that even the areas with comparatively low levels of suicide should aspire to do better. That is why we have challenged services, communities and national agencies to adopt the zero suicide ambition. I also agree with the APPG report that timely and reliable data are a valuable suicide prevention tool. Public Health England is working with police forces and local support agencies to pilot real-time surveillance of local suicides. The primary aim of the pilots is to provide prompt information to front-line local authority and NHS staff to enable them to respond to potential and real local clusters of suicides, and to provide timely support to people bereaved by suicide. Public Health England’s evaluation of the surveillance pilots will identify challenges to data collection at a local level and identify best practice to overcome them. The evaluation of the pilots will be available by the summer.

The national mental health intelligence network is developing a new profiling tool on suicide for release shortly, which will make available suicide rates and trends for the main age and gender groups at both local authority and clinical commissioning group level, so that there can be much more accountability. The tool will provide data on high-risk groups that can be used to inform priorities for local interventions.

I was pleased to see that the APPG welcomed Public Health England’s guidance for developing local suicide prevention action plans. The guidance will be updated later in the year and will incorporate best practice on data collection from the surveillance pilots. The hon. Lady will be aware that the guidance was published after the all-party group’s audit took place; Public Health England will contact all its centres over the coming months to discuss activity in their areas and track progress. Public Health England will publish further support for local authorities on identifying and responding to clusters and frequently used locations for suicides, and will also support local systems in developing and undertaking effective local suicide audits, a point that she raised.

We are also working with the National Suicide Prevention Alliance to help ensure that information is pulled together on its new website, which has been supported by grant funding from my Department. We know that sharing local case studies is important, which is why we included a number in the second annual report in the suicide prevention strategy.

The annual report was written for people working in local services, to pull together the key information that they need to implement the strategy locally. The second report on the strategy highlights the excellent work being done across sectors to prevent suicides, and sets out where efforts need to be concentrated for the next year. Local action, supported by national co-ordination, is essential to suicide prevention. The messages in the report are designed to help local areas focus on the most effective things that can be done to reduce suicides. The report also highlights the APPG’s findings and encourages local areas to use the detailed information from the inquiry in drafting their local suicide plans.

All our work on suicide prevention is part of our wider commitment to give mental health services parity of esteem and equality with physical health services. Investment and achievements in bettering mental health services inevitably have a positive impact on suicide prevention. If we make crisis response in mental health much better, so that people know how to get help at the moment when they need it, that will do so much to help those people get through a moment of crisis. I thank the hon. Lady for pursing this issue so vigorously.