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Health Committee

Volume 623: debated on Thursday 16 March 2017

(Select Committee Statement): The scale of the avoidable loss of life from suicide is unacceptable. In 2015, 4,820 people in England took their own lives, and across the UK 6,122 people did so in 2014. But those official figures underestimate the true scale of the devastating loss from suicide, which remains the leading cause of death in young people between the ages of 15 and 24, and it is the leading cause of death in men under 50. It is strongly linked to deprivation and is a major contributor to health inequality. However, the key message our Committee heard throughout its inquiry is that suicide is preventable, and we can and should be doing far more to make sure we reduce it. That was the key focus of our suicide prevention inquiry.

First, let me thank all those who contributed to the inquiry, particularly families bereaved by suicide, and those who had experienced suicidal ideation and been users of mental health services. Their evidence was courageous and compelling. I also thank all the voluntary groups and volunteers who are working to provide support for people in crisis, and all our front-line staff. Finally, I thank my fellow Committee members and our Committee staff, particularly Laura Daniels, Katya Cassidy and Huw Yardley.

I shall now move on to what we found in our inquiry. First, let me say to the Government that we welcome their suicide prevention strategy, but as with any strategy the key is implementation. We therefore call on them to go far further in implementing and resourcing it, and to give greater attention to the workforce in order to make the important improvements come forward. We also make further recommendations and we are disappointed that the Government have not gone further in a number of areas. We know that we can take actions to reduce suicide and we highlight a number of these in our report. For example, we know that half of those who take their own lives have previously self-harmed, and we feel it is really disappointing that the experience of so many of those who have self-harmed when they go to casualty departments is that they are made to feel that they are wasting people’s time. We know that liaison psychiatry makes an enormous difference, but there are resourcing issues on that.

We also know that those who have been in-patients in mental health settings should receive a visit within three days of leaving in-patient services, but there simply are not the resources available for that to be put in place. We call on the Government to go further in looking at the workforce and resourcing needed for that to happen. We know of other serious issues, for example, the fact that about a third of people who take their own lives are not in contact with either primary care or specialist health services in the year before their death. We feel that suicide is everyone’s business and we all have a responsibility to reduce the stigma attached to mental health so that it is easier for people to seek help. Again, I pay tribute to all those who are working in this field, reaching out to people in non-health settings and making a real difference. However, many of those voluntary groups are coming under great financial pressure. It is welcome that the Government have announced that there will be £5 million for suicide prevention, although that does not come in until next year, with £10 million in each of the subsequent two years. However, we feel that that is too little, too late, particularly given the cuts to public health grants and across local authorities to those services that can reach out to people who are vulnerable to suicide.

We would like the Government to put a greater focus on adequately resourcing the measures they set out in their suicide prevention strategy. We would particularly like them to look at how those plans are being implemented. It is very welcome that 95% of local authorities have a suicide prevention plan either in place or in development, but there does not seem to be sufficient quality assurance for those plans. We would therefore like a national implementation board to look at how we can move those plans forward, because any strategy, however good, cannot be effective if it is sitting on the shelf and not being implemented. That was one of the key messages we heard from our witnesses, and I know that the Minister will have heard it from the National Suicide Prevention Strategy Advisory Group loud and clear.

We also know that there are things that need to happen when people are in contact with services. It is disappointing that greater focus has not been put on the consensus statement for information sharing. On too many occasions, when someone hears that a loved one has taken their life it is the first time they have heard that their loved one had been in contact with services—nobody had let them know. Understandably, health professionals are concerned about issues of confidentiality and consent, but what the consensus statement makes clear is that if we ask people in the right way, they are much more likely to give that consent to information sharing. We would like to have seen the Government put a greater focus on how we can increase awareness of how health professionals go about sharing information with people’s loved ones, because we believe that will save lives.

We think that measures can be taken across the board both out in the community and within health care settings and specialist settings, but the Minister will know that our inquiry also examines the role of the media. Irresponsible reporting of suicide increases suicide rates, as we know, and far more can be done within the broadcast media, the mainstream media, on social media and on the internet to make sure that we save lives. I was very pleased that during today’s Culture, Media and Sport questions the Culture Secretary agreed to a meeting with me, but I hope that the Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood), will assure me that she will be liaising with colleagues in the Government to make sure we can save lives in that way.

Finally, I wish to touch on the issue of data. We know that there is an issue relating to the increasing use of narrative verdicts which are hard to code. That results in the official data we have on suicide under-representing the true scale of the avoidable loss of life, and with the huge variation we have around the country this makes it much more difficult to understand what works best in preventing suicide. We would like the Minister to revisit the recommendations in our report on how to provide better training to coroners and how we review the evidential standard and move from using “beyond reasonable doubt” to the “balance of probability” in recording suicide. Only in that way can we ensure that we are doing absolutely everything possible to protect families and individuals in future. I commend the report on suicide prevention to the House and call on the Government to go further in implementation.

Labour welcomes the recommendations in the report, and I join the hon. Lady in thanking Select Committee members and staff for their work.

The Committee visited the award-winning Salford mental health liaison team, which offers 24/7 mental health support at Salford Royal hospital and has been able to halve the admission rates for people with mental health problems. The Royal College of Psychiatrists reminds us that only 7% of emergency departments provide 24/7 liaison psychiatry services, and said it would be difficult to recruit enough psychiatrists and other staff to provide such a service in every hospital—the hon. Lady touched on that in her statement. What does she think the Government must do to ensure that there are enough trained staff to establish and sustain liaison psychiatry services in every acute hospital to help to deliver the suicide prevention strategy?

We need to start right back at medical school recruitment and what happens in medical schools and beyond, to encourage more health professionals—not just doctors, but nurses as well—to consider psychiatry and mental health services as a career. One of the key issues is the lack of a workforce. I know the Government are working with Health Education England to improve the situation, but we would like to see them go further. Also, we need to ensure that resources get to the frontline.

I congratulate my hon. Friend on her chairmanship of the Select Committee and its recent report. She will know that recent studies, particularly one done in Sweden, have indicated that people with high-functioning autism spectrum disorder have a ninefold increased suicide risk. What more could be done to help those individuals and their families? How can we raise awareness among the agencies that intervene with them and their families, and particularly among health professionals, so that they are aware of the heightened risk?

I commend the work my right hon. Friend has done over her whole career on autism and to highlight what more can be done to help those individuals and their families. She will know that one of the key barriers is having an assessment in the first place for people who suffer from autism. Too often, they fall between the gaps in mental health services. My key message would be that we must ensure that they receive the services and support that they need and that that is delivered in the right way.

I congratulate the hon. Lady on bringing this critical issue to the House and I fully support the report. I declare an interest as the patron of Chris’s House, a centre for help, response and, critically, intervention on suicide, and the first 24-hour interventionist suicide support service in Scotland. We set up the centre to offer a safe environment in which people in crisis may have respite from their current unwellness. They can find refuge in Chris’s House and receive an individually tailored programme to offer support and respite throughout their journey to wellbeing. I urge others throughout the UK to look at this more interventionist model and replicate it to the benefit of all UK citizens. I further urge as many people as possible to join us in our Walk of Hope on 6 May 2017 in Glasgow, as we walk from darkness to light to raise awareness about suicide prevention.

I thank the hon. Gentleman for his contribution and join him in paying tribute to voluntary groups throughout the country that are doing extraordinary work to reach out to people in crisis. As he will know, the level of variation in support is a key issue, along with the financial challenge faced by people around the UK who are trying to provide proper support.

I thank my hon. Friend very much indeed for the work that she and her Committee have done on this issue. The suicide rate among men is three times that among women, and the gap has increased since 1981. As she mentioned, suicide is the leading cause of death for men under 50. A particular problem is contagion, whereby one suicide can often lead to a spate of others in the same area. During the inquiry, did the Committee identify how this aspect could be dealt with?

I thank my hon. Friend for his important question. We absolutely looked at that issue and specifically mentioned it in our report. He will know that part of the problem is that irresponsible reporting can sometimes lead to contagion. We know that when local areas work together closely to identify suicides, particularly early clusters, measures can be taken—people can go into workplaces, schools and colleges—to provide support and stop it. It does, though, require that we notice it early, so the Committee urges coroners to work with local authorities and public health teams to ensure that they are aware of the high risk of suicides spreading.

I thank the Select Committee and the hon. Lady for the report. The Scottish National party welcomes the recommendations and urges that they are fully taken into account. We particularly urge the Government to commit to rolling out crisis intervention teams and support to prevent suicide, so that people in such circumstances can be followed up directly. Suicidal individuals are not always mentally ill, and lengthy waiting lists for psychological treatment or attendance at A&E are sometimes not the most appropriate options. Liaison psychiatry is under-resourced, and urgent follow-up through crisis support is needed. How will we ensure liaison between services? Only when that occurs seamlessly between health, social care, community services and criminal justice will we prevent suicidal individuals from falling between the gaps.

I thank the hon. Lady for highlighting a really important point about the need for communication, not only with families but within services. One problem is that there is what happens in local authorities and what happens in the health service, and too often there is not sufficient communication between the two.

I congratulate the hon. Lady and her Select Committee on their work. She might be aware that in the mid-2000s there was a series of tragic suicides across the Bridgend County Borough Council area, of which my constituency forms part. I obviously was not a Member of this House when those suicides took place, but they are a major part of people’s memories of what happened across those communities.

On media attention, the hon. Lady may be aware that a film was made about those suicides that was not welcomed by the various communities; I am glad she is pursuing the part of the report on tackling the media impact regarding the glorification of suicide, if I can put it like that. Suicide prevention and health policy more widely are devolved to the Welsh Government, but will she consider sharing the Select Committee’s report with the Welsh Assembly’s Health, Social Care and Sport Committee? I passionately believe that if we can learn best practice on tackling suicides from Select Committees in the Scottish Parliament, the Northern Ireland Assembly or, indeed, the Welsh Assembly, we should share that throughout the UK.

I would be delighted to meet the hon. Gentleman and share the report, as he suggests, because I agree that we should be sharing best practice throughout the devolved nations and England. On the specific point about the role of the media, the Samaritans has produced really clear guidelines, which I hope all media organisations will look at closely. We should also go beyond broadcast and print media and look at the role of social media and the internet.

I welcome the Health Committee’s report on suicide prevention and congratulate my hon. Friend and her Committee on their work on this very important issue. I join her in thanking those with lived experience who bravely contributed to the Committee’s work; the impact of their contribution cannot be overestimated.

Every death by suicide is a tragedy that has a devastating effect on families and communities, which is why the Government are committed to reducing the national suicide rate by 10% by 2020. We want all areas to learn lessons from organisations such as Mersey Care, with its zero suicide ambition. We were particularly grateful that the Committee published an interim report in December, as it allowed us to address many of its recommendations in our update of the national strategy. These included how we are driving local delivery, addressing stigma, improving suicide bereavement services and increasing awareness of the consensus statement for information sharing for people at risk of suicide. However, we do accept that we need to go further on implementing the cross-Government national suicide prevention strategy, which is why we published the updated strategy to strengthen delivery in key areas, including in implementation. It is also why we will continue to provide further updates.

The refreshed strategy now includes better targeting of high-risk groups and, for the first time, addresses self-harm as an issue in its own right, which is one of the most significant issues of suicide risk. We are working with the National Suicide Prevention Strategy Advisory Group, delivery partners across Government, and other agencies and stakeholders to develop an improved implementation framework.

We are already making good progress in ensuring that all local areas have a suicide prevention plan in place by the end of the year. To date, 95% of local areas have a suicide prevention plan in place or in development. We will also work with local areas to assess the quality of those plans, building on guidance on good practice. We have run a series of suicide-prevention planning masterclasses carried out by Public Health England to improve that quality. We have also published guidance to local authorities in January on developing and providing suicide bereavement services as an important plank of the plan.

Furthermore, we have announced that we will publish a Green Paper this year on children and young people’s mental health and develop a national internet strategy, which will explore the impact of the internet and social media on suicide prevention and mental health. That will address some of the issues that my hon. Friend has raised about the media and suicide. Hon. Members will also know that we are committed to all A&Es having core liaison services by 2020. They have rightly raised the fact that the workforce will be essential in delivering that ambition, and we will imminently be publishing our mental health workforce strategy, the performance of which I am sure that the Select Committee will closely scrutinise. We will carefully consider all the recommendations made by the Committee in this report and respond to them in due course.

My hon. Friend has rightly raised the connection between mental health services and suicide prevention. Does she agree that we cannot think about suicide without considering the broader matter of mental health? Will she and the Committee join me in welcoming the wide range of measures set out by the Prime Minister in January, in addition to the five year forward view for mental health, with a focus on earlier intervention and prevention in mental health services, because those improvements will be essential if we are to make the progress on suicide prevention that all of us in this House want to see?

I thank my hon. Friend the Minister for her comments and agree with her absolutely about the importance of prevention and early intervention. I look forward to the strategies to which she has referred and to working with her to do all that we can to improve mental health and to reduce the terrible toll from suicide.