Suicide and Self-harm in a Recession

Paul Burstow Excerpts

Wednesday 27th October 2010 Commons Chamber

[The Minister of State, Department of Health (Paul Burstow)]

I congratulate the hon. Member for Bridgend (Mrs Moon) on securing the debate. I want to pay tribute to her, and to thank her for the work that she does in leading the all-party group on suicide and self-harm prevention. Her name sticks in my mind because, when I first became a Minister, I answered many questions that she had tabled on these issues. When I saw that she had secured this debate, I was conscious that she had been pursuing this matter vigorously and diligently for many a year. She brings that important issue to the House’s attention tonight. The fact that she has constituency experience of the matter, given the tragedies that have taken place there in recent years, lends added weight to her argument.

The hon. Lady was right to bring us back to the personal stories behind the statistics, and to recognise that, while strategies are important, they offer little consolation to those who are affected personally and directly by suicide and self-harm. She rightly paid tribute to the work of the Samaritans and other organisations. She was also right to highlight the need to share best practice and research; I entirely subscribe to that view.

There is plenty of evidence across the world that in times of recession and high unemployment, rates of mental illness and suicide tend to rise. In this country, Office for National Statistics figures tell us that suicides rose 6% between 2007 and 2008 when the recession began to bite. Tomorrow, as the hon. Lady said, the Department of Health publishes its “Mortality Monitoring Bulletin”, updated to include the data for 2009. I am unable to share it with the House now, but it will be in the public domain then. This will include new information on suicide rates, giving us the full picture of how the course of the recession affected the nation’s public health. The figures illustrate in the most dramatic way the human tragedies that took place in the economic downturn.

We now need to ensure that economic recovery is matched by psychological recovery from a long and painful recession. The 2010 Legatum Institute’s report, published earlier this week, showed that there is plenty of work to do. It gave a salutary warning that in terms of happiness and the general well-being of our fellow citizens, the UK is sorely lacking compared with other countries. In our services, too, across society, we have to ensure that we start valuing GWB, or general well-being, as highly as we do GDP. Specifically, as the hon. Lady argues, we must do everything we can to return to the pattern of declining suicide rates that we saw for most of the last decade.

To help us do so, I can first confirm for the hon. Lady that we will publish a new suicide prevention strategy in the new year. As the old strategy comes to an end, we need to update it and make sure that it is fit for purpose. We will certainly take into account the points she has made. I will want to look at the studies to which she referred and ensure that suicide prevention is referenced in the forthcoming mental health strategy, too.

The new prevention strategy for suicide will include new measures, particularly those to support high-risk groups. I will ask officials to discuss the hon. Lady’s suggestion of how best to collaborate with the devolved Administrations to ensure that we share learning and best practice across the countries. The strategy will also look at how we can restrict access to some of the methods people use to self-harm or commit suicide. The hon. Member for Pendle (Andrew Stephenson), who talked about a particular constituency example, illustrates why we need to erect barriers, quite literally, to deal with suicide hotspots. I am shocked and appalled by the attitude that the business in his constituency adopted to that necessary investment in prevention. The strategy will also involve working with all forms of media to ensure that we get responsible reporting to prevent copycat suicides.

Let me say something about the issues raised about the internet and how it can be used to promote suicide and provide information about methods. There is now greater clarity in the law. Section 59 of the Coroners and Justice Act 2009 simplified and modernised the law on encouraging or assisting suicide by online means. The Government continue to work with internet service providers through the UK Council for Child Internet Safety to remove harmful or illegal content. We continue to work with search engine providers, encouraging them to link only to appropriate, supportive websites when somebody uses “suicide” as a search term.

There is clearly a difficulty in how to strike the balance correctly, which does not really lend itself to arbitrary Government action. Banning all discussions and content on suicides from sites popular with young people risks driving them to parts of the internet that are far less safe and certainly not moderated, so more harm could be done. There is a need to update existing guidance, and we plan to publish updated guidance for technology providers to keep children safe online. We expect internet providers to follow that advice and remove harmful content as quickly as possible. I will certainly look at the hon. Lady’s points about the provision of helpful advice on the Department of Health and associated websites.

[Andrew Percy (Brigg and Goole) (Con)]

If the organisations that we are trying to get to remove content refuse to do so, will the Minister name and shame them?

[Paul Burstow]

I will certainly consider that, and we will discuss with colleagues across Government the approach and tone we should adopt with ISPs.

In reducing suicides, we have a specific focus on the health service, but we need a much broader programme of work across Government to improve general well-being while ensuring that the right services are in place for people who experience mental illness.

Everything that we know about the pattern of suicide rates demands a twin-track approach covering both clinical and societal issues. On the clinical side, we will do more to ensure that the NHS gives people the support that they need, and a new outcomes framework should make clear that the NHS must give mental health services the same priority as physical health services. There should be no difference in the esteem that we attach to those services. That approach will help us to shift cultures and priorities, ensuring that accident and emergency and hospital staff are trained to deal with self-harm or other indications of poor mental health, and are able to refer patients to the appropriate services rather than creating the revolving door to which the hon. Lady referred. GPs also need to be properly trained to help them to identify those at risk of suicide, and to provide appropriate drug treatment and psychological support in line with National Institute for Health and Clinical Excellence guidelines.

The hon. Lady was right to say that talking therapies are a critical part of the onward journey for those at risk. In 2009, the last Government initiated the Improving Access to Psychological Therapies programme. Where they exist, IAPT services work extremely well, but coverage around the country is still patchy. Earlier this year, I was able to announce additional investment of £70 million in the current financial year to ensure that we could continue the roll-out of IAPT, in order to deliver a commitment in the coalition programme. I am pleased that the Chancellor confirmed last week that we are now committed to investing more additional resources to allow the continuing expansion of IAPT up to 2014, including its extension to cover people of all ages rather than just those of working age.

However, we must not over-medicalise what is also a social and cultural issue. The Foresight report from the Office of Science shows that mental health problems are closely linked to a range of social problems. Debt and unemployment are key triggers for suicide, as are social isolation, family breakdown and substance misuse. Those are best addressed and best prevented in the community, not in the clinic. In developing our new mental health strategy, we will also consider how we can change cultures and develop resilience and relationships in communities to prevent mental illness and suicides.

We will, for instance, target those with alcohol or drug problems, and create better links between treatment services and mental health services. We will support vulnerable families by providing more health visitors and family nurse partnerships to give children the stable upbringings that provide a basis for good mental health in later life. We will also address the stigma associated with mental illness. It is that stigma—that reluctance to express emotions and accept help, advice and support, especially among men—that can be such a serious cause of the problems in our mental health services and, ultimately, even a cause of suicides. We also need to harness the expertise and experience of the third sector and voluntary groups to create local grass-roots plans and action to support better public mental health.

One of the biggest priorities will be returning more people with mental health problems to employment. We know that long-term unemployment has a hugely corrosive effect on a person’s mental health. Those who are unemployed for an extended period are 35 times more likely to commit suicide than those in stable employment. The sad legacy of the last decade has been the huge rise in the number of people trapped on benefits, along with all the damage that that does to a person’s self-esteem and self-worth.

We will build on the good links that have been established in some areas between IAPT and employment services. Many primary care trusts are already making connections with their local Jobcentre Plus, and I want to ensure that such relationships are formed in all IAPT centres as the roll-out continues. However, we also need businesses and organisations to invest in the good mental health of their staff, particularly during times of anxiety and change. Research shows that employers who invest in staff well-being receive a ninefold return on their investment in terms of increased productivity and reduced sickness absence. We want to drive that message home in the context of the employers’ occupational health responsibilities.

The human effect of dealing with the deficit crisis is not something that the Government can take lightly. I know that many in the public sector will be feeling anxious and concerned as a result of the spending review, and that demands the utmost vigilance from us in our support for people’s mental health in the months and years ahead. We are committed to mending the psychological as well as the economic scars of the past recession, improving mental health services, promoting greater community resilience to mental illness, and doing much more to help unemployed people regain their confidence and return to work.

I am grateful to the hon. Lady for securing the debate, and for the leadership that she provides in this regard. I hope that we shall be able to deliver the changes that we all want to see, and ensure that we have good-quality mental health in this country.

Question put and agreed to.