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Local Suicide Prevention Plans

Volume 593: debated on Wednesday 4 March 2015

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.

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?

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—

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.

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.

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.

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.

Sitting suspended.