Alison* dreads facing this time of the year. Two years ago in September, her brother Mark* took his own life. Alison remembers the shock, sadness and guilt that overwhelmed her when she got the news.
Mark had moved to Leicestershire from Lincolnshire, where he found a temporary job after the breakdown of his relationship. The loneliness and isolation took its toll. He started drinking, became depressed and dropped out of work. He stopped keeping contact with family and friends back home, gradually slid into poverty and then started sleeping rough. He had not registered with a GP and did not seek help for his problems.
His sister did not know these details at the time of his death. She found it hard to talk about Mark’s suicide and started isolating herself too. She did not know who to turn to, to express her complex mix of emotions and process her grief. With the help of her friends, she has sought an appointment with her GP and is looking to attend a suicide bereavement support group in the community, but is finding it hard to get one in her vicinity. Alison feels she has a lot to offer to people in positions of power and influence about what can make a difference in our approach to suicide prevention.
Sadly the above story is all too familiar for those of us who work in health and social care. But each time I hear a story like this, it still produces a shockwave and ache in my heart. The people who took their lives felt so hopeless and alone. Surely we can change this narrative if we in health, social care, voluntary sector, first responder services and those bereaved by suicide work together?
The Samaritans report ‘Dying from Inequality’ highlights the profound effects of poverty on suicide. For example, the unemployed are two to three times more likely to die by suicide and men are more vulnerable to the effects of economic recession, including suicide risk. The rates of suicide nationally rose around the time of the global recession in 2008/9 and linked to the austerity programme later.
The higher the level of deprivation in an area, the higher the suicide rates. This is a scandal and an indictment on us as a society – we need to address health and social inequalities first of all if we are to drive down suicide rates.
Alison and Mark’s story also illustrates some of the key risk factors for suicide and the importance of listening to bereaved families’ voices. We know, for example, that here is a correlation between relationship breakdown, unemployment, homelessness and poverty and an increased risk of suicide, especially for men. Also, far too many people with mental health problems are unable or are not supported to go to their GPs to seek help. Loss of social supports and a feeling of alienation worsen suicide risk.
The latest figures released by the Office of National Statistics show that 6,507 suicides were registered in the UK last year, significantly higher than that in 2017. Some 75% of suicides were in men, and middle aged men continue to be the group at highest risk of suicide. Rates of suicide among young people have also been increasing in recent years. The steepest rise is around the age of 19. This shows that the various changes happening at this time, including moving away from home due to work or higher education all have an impact.
Also a more fundamental question – are we failing as a society to instil hope and aspirations for the young people? As Prof Louis Appleby, a leading figure in suicide prevention research has said, “we need to give young people a positive message about their place in the world…to replace anxiety with optimism and confidence for themselves and society as a whole.”
This year’s suicide figures also reveal increasing rates of suicides among young females. Again the causes are complex, but there is a link between anxiety, depression, domestic abuse, past history of trauma and suicide risk.
So my message to all of you: World Suicide Prevention Day (10th September) has passed, but let us not forget the key messages around suicide prevention. GP services, specialist mental health services, support groups in the community, social care, emergency response services and patients and bereaved carers need to work together to ensure non-stigmatising help and support is available in a timely way to anyone who needs it. As an active partner in the development of the Lincolnshire suicide prevention strategy, this is what I and other members of Lincolnshire Partnership NHS Foundation Trust will be doing.
You can play your part by taking 20 minutes of your day and learning skills that may save a life by completing free online suicide prevention training www.zerosuicidealliance.com/get-involved
Dr Ananta Dave is Medical Director at Lincolnshire Partnership NHS Foundation Trust.
*names have been changed