Take action to reduce suicide risks
Suggested citation: Davie E, Strathdee G, Zamperoni V, Ambrose J, Kousoulis AA, Crepaz-Keay D. “Take action to reduce suicide risks.” London: Zero Suicide Alliance and Mental Health Foundation, 2020.
Having mapped 11 important suicide risks across England, the Zero Suicide Alliance and the Mental Health Foundation are recommending actions to reduce those risks.
The Covid-19 crisis has significantly worsened many risks - unemployment, poverty, domestic abuse, alcohol misuse - related to those we have mapped making action to reduce them even more urgent.
Health inequalities have also been highlighted by Covid-19 mortality rates are four times higher for black people in the UK than white people [i]. These kinds of inequalities are also reflected in rates of serious mental illness and suicide, the latter rates being higher among young black men and middle-aged black and Asian women, than among their white British counterparts. [ii]
To tackle these inequalities and improve outcomes Zero Suicide Alliance promotes a population approach to mental health care and suicide reduction.
It is vital that local service commissioners, providers and community leaders carefully examine and seek to improve the circumstances in which local people are living. A good starting place for this is the Joint Strategic Needs Assessment (JSNA) which needs to carefully take account of demographics and environmental, economic, social and health needs – some of which can be found through the Public Health England (PHE) Fingertips Tools. Public Sector Equalities Duty (PSED) reports for all lpublic services should also be developed and shared and to inform the JSNAs. These are mandatory under the Equalities Act (2010) and set a baseline for different needs, levels of access, crisis response and recovery.
Only with these two core pieces of information, a comprehensive JSNA and PSED reports can the right support be commissioned and provided. This support must start with the social determinants, the social and environmental factors that can reduce or heighten risk, before looking at services that provide rapid access in crisis, effective early intervention and care that delivers holistic social, mental and physical health care that promotes recovery to a high quality life. In our companion publication to be published in September, the focus will be on commissioned and provided mental health care and we will show the complementary baseline of health services in every area. For the time being this resource tends to focus more on primary prevention in the social determinants area.
Suggested actions in this resource, based on a literature review of evidence-based and informed interventions, are principally aimed at local and central government and NHS bodies, but everyone can play a role in making them happen.
It is important to look at all the factors as a whole and understand that they interact with one another. For example, poverty makes Adverse Childhood Experiences (ACEs) more likely, and both poverty and ACEs are strong predeterminants of mental ill health and substance misuse. In turn parental substance misuse and mental ill health also makes poverty and ACEs more likely. [It would be good to have a diagram to illustrate this interconnectedness] It is therefore vital that we treat people and their communities holistically and work to improve people’s circumstances, access to appropriate support and their experience of the services they may need.
If we managed to substantially reduce poverty, ACEs would also be cut which would, in combination, reduce mental illness and substance misuse as well as suicidal thoughts, attempts and completions.
The recommendations also draw on and are intended to amplify the suicide prevention resources and guidance [iii] produced by Public Health England (PHE) and the review of suicide prevention plans [iv] carried out by the Samaritans.
This resource is not exhaustive, tends to focus on primary prevention rather than treatment, and does not cover issues such as reducing access to lethal means, for example, so those designing suicide reduction plans must also refer to the PHE guidance.
Office of National Statistics dataiii shows that every day in the UK there are 18 suicides resulting in grief and loss for families, friends, colleagues and communities which in turn increases the suicide risk of those left behind.
It is estimated that each suicide of a working age person costs £1.7 million in services and lost incomeiv.
And for every death there are many more suicide attempts and an unknowable amount of suicidal thoughts.
Together suicide, attempts, self-harm and suicidal thoughts represent a major public health challenge.
No one person, agency or tier of government can address all the factors that we have identified and it will take concerted effort by individuals, local and national government and other bodies to really make more progress on this vital issue. Most areas will have a local suicide prevention partnership that has a prevention plan – we applaud this work, hope our resources provide some support and would welcome input from people on their own examples of good practice.
Working with Zero Suicide Alliance the Mental Health Foundation have identified 11 major risk factors for suicidal thoughts, attempts and completions which we then mapped and compared across the nine English regions and between local authorities within each region.
These risk factors were selected by experienced mental health researchers on the following basis:
Factors known to be related to an increased risk of suicide or suicidal ideation.
Data relating to the risk is no more than five years old
Factors must be influencable by local action
Data relating to the risk must be comprehenisive, available publicly and at local authority level
These eleven risks fall into three main categories: