Preventing suicide: Supporting those who don't reach out directly for help
Trigger warning: this blogs discusses suicide
Statistics can tell us a lot. They tell us that in the last recorded year (2016), 5,688 people died by suicide in Britain. That men are around 3 times more likely to die by suicide than women, but that the female suicide rate is at its highest since 2011.
They can tell us that suicide is the largest cause of death for men between the ages of 20 and 49 years old in England and Wales. But statistics don't tell us everything.
They can never tell us why someone decided to end their life. They can never convey the devastating impact that suicide has for a family and the wider community.
Dan and Edward
Four years ago, my older brother, Daniel, took his own life. It was a decision that was both fatal and final. But the more I understand about mental health, the more convinced I am that Dan’s decision could have been prevented.
I thought of Dan last year as a coroner’s inquest gave its finding into the death of 18 year old Edward Mallen, who was living with depression and ended his own life.
The inquest found that Edward's GP had referred him to a specialist mental health team following a disclosure of suicidal feelings and recommended that he be seen within 24 hours. However, following a conversation with a triage mental health nurse he was downgraded to a five-day wait.
The NHS Trust in question commented: "It's not clear that if the Trust had done everything it could have done that Edward would have lived, but the Trust didn't do everything that could possibly be done, so we can't know and we must therefore accept some responsibility."
It was a similar conclusion that I came to following the inquest of my brother's death who died in the hospital grounds of an institution charged with his care.
These deaths raise a key issue in the prevention of suicide. In physical health early intervention is recognised as being crucial – in cancer care for example, services are designed to ensure that people can access care and treatment as quickly as possible following diagnosis in the knowledge that this improves the chances of recovery. This same message also needs to be embedded into mental health, and it is the message that has galvanised Edward Mallen’s father, Steve.
Steve Mallen made a commitment at Edward’s funeral that some good would come out of his death – his response was to set up the MindEd Trust "which is focused on the prevention of mental illness in young people and early intervention strategies for those experiencing trauma."
Steve is responding to the desperate need, as evidenced by Edward’s death, to prevent children and young people from reaching crisis. It is about the healthcare system responding to clear signals of distress and providing adequate and timely support. It’s not an easy fix, but achievable with adequate funding and training (and a much needed commitment to bring about change, which Steve is fighting hard to achieve).
We know that suicide prevention works, a global review of suicide prevention strategies published recently in the Lancet Psychiatry concluded that combinations of evidence based approaches do work. Be that and including restricting access to the means of death, school-based awareness programs and the effective treatment of depression. All of which are crucial starting points. But, these approaches alone will not enable us to significantly reduce death by suicide.
The knowledge that prevention works raises the question: how can we reach and support people who don’t directly reach out for help?
The big task ahead of us is to tackle the causes of distress, such as the real or perceived pressures of expectation. These pressures can be societal or individual to the person that experiences them but among young people and adults can include concerns about present, academic attainment and future success and pressures to conform and fit in. In older people these pressures can be around finances, debt, unemployment, addiction and isolation.
We also need to cultivate a culture where it’s okay to not be okay and the opportunity to be heard in a safe space exists. We need to be looking beyond the surface, past any veneers which could create the illusion that things are going well for a person who in reality, is in pain. There’s a disparity between our hidden ideas of who can legitimately experience mental health problems, and the reality in which anyone can.
Increasing mental resilience may form part of the solution, but as a society we also need urgently define what these pressures are and seek ways to tackle them. Answers will not be easy, they are likely to require whole-community approaches and the consideration of the wider impact of government policies on mental health. But as a society we need to begin to ask whether we are willing to accept the continued price of lost lives by suicide, and if not strengthen the movement to bring about change and aim for zero suicides.
We need your help
We are striving for a world with good mental health for all. Suicide rates have fallen in recent years, proving that prevention programmes can be extremely effective so now is the time to act to push the suicide rate down further still. To achieve this, we need your help. Please consider a donation today.