Take action to increase and improve employment and income
According to Office of National Statistics data published in 2017,[1] the most deprived 10% of people are more than twice as likely to die from suicide as the least deprived. This means that the higher levels of deprivation in the area where a person lives can increase their risk of developing poor mental health and increase their risk of attempting or completing suicide. This is support by research on the impact of health inequalities (Institute of Health Equality, 2020).[2]
Deprivation is measured by the Index of Multiple Deprivation (IMD); a measure that takes into account a range of social factors such as income, employment, education, health, crime, access to housing and living environment (ONS, 2017).[3]
From 2016 to 2018, suicide rates for women have remained stable across all groups including those with a high IMD (most deprived) and those with a low IMD (least deprived). However, suicide rates for men who fall in the median (or middle range) of IMD have seen a significant increase in deaths from 2016 to 2018 (18.7% increase; 13.9 deaths per 100,000 to 16.5 deaths per 100,000).[3]
Our original Social Risk Factor Map does not use IMD as a measure but it does comparisons as includes a combination of health and social factors including indicators of economic relevance. These are used to identify areas of areas of deprivation and prioritise targetted action to prevent incidences of suicide.
Our latest Suicide Prevention Resource Map includes IMD as a measure of deprivation as well as data on the Lower Layer Super Output Area (LSOA). The LSOA is a geographical area with an average population of 1500 people or 650 households. This particular indicator in the map looks at the percentage of LSOAs within CCG regions across England that are in the most deprived 10%.
Additionally, our Suicide Prevention Resource Map also includes indicators on the proportion of people in receipt of benefits and experiencing fuel poverty. Research has found that people who claim Employment and Support Allowance (ESA) benefit are at a higher risk of suicide, with two-thirds of this group reporting that they had experienced suicidal thoughts (66.4%) and nearly half (43.2%) had made a suicide attempt at some point in their lives (NHS Digital, 2016).[4] Studies have also found that those experiencing fuel poverty, as a proxy measure for financial instability and general poverty, are at a higher risk of suicide (Samaritans, 2017).[5]
People with mental health issues are also more likely to experience barriers in gaining and maintaining employment (Mind, 2016).[6] This gap in employment rate is important to consider in the context of suicide prevention has been inextricably linked to the related experiences of poorer psychological and physical wellbeing (Wanburg, 2012).[7]
It has also been well publicised that people who have a Severe Mental Illness (SMI), such as schizophrenia, bipolar disorder, psychoses or severe depression, face stark social inequalities as result, with SMI not only being most prevalence in areas of low income and deprivation (National Institute of Mental Health, 2019),[8] but is also commonly associated with low levels of employment (Public Health England, 2018).[9]
People with SMI face social exclusion from society due to withdrawl from education, employment, daily tasks and activities (Langan, 2014),[10] facing problems forming new relationships and job-related functioning (Pinkham, 2014), and issues of stigma and discrimination (Thornicroft & Sunkel, 2020).[11] Having problems with substance misuse further compounds these issues as are more likely to be homeless, incarcerated and have fewer social supports and financial resource (Khokher et al., 2018).[12]
References
[1] Office for National Statistics (2017). Who is the most at risk of suicide. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/whoismostatriskofsuicide/2017-09-07 (accessed 25/05/2021)
[2] Institute of Health Equality (2020). Health Equality in England: The Marmot Review 10 Year On. Available at: https://www.instituteofhealthequity.org/resources-reports/marmot-review-10-years-on/the-marmot-review-10-years-on-full-report.pdf (accessed 25/05/2021)
[3]Office for National Statistics (2020). Recent trends in suicide: death occurences in England and Wales between 2001 and 2018. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/recenttrendsinsuicidedeathoccurrencesinenglandandwalesbetween2001and2018/2020-12-08 (accessed 25/05/2021)
[4] NHS Digital (2016). Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2014. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/adult-psychiatric-morbidity-survey/adult-psychiatric-morbidity-survey-survey-of-mental-health-and-wellbeing-england-2014 (accessed 27/05/2021)
[5] Samaritans (2017). Dying from inequality: socioeconomic disadvantage and suicidal behaviour. Available at: https://media.samaritans.org/documents/Samaritans_Dying_from_inequality_report_-_summary.pdf (accessed 25/05/2021)
[6] Mind (2016). Supporting people with mental health problems into sustainable employment. Available at: https://www.mind.org.uk/media-a/4283/supporting-people-with-mental-health-problems-into-sustainable-employment-2016.pdf (accessed 27/05/2021)
[7] Wanburg, C. (2012). The Individual Experience of Unemployment. Annual Review of Psychology, 63, 369-396. Available at: https://www.annualreviews.org/doi/abs/10.1146/annurev-psych-120710-100500 (accessed 27/05/2021)
[8] National Institute of Mental Health (2019). Mental Health Information: Serious Mental Illness. Available at: https://www.nimh.nih.gov/health/statistics/mental-illness.shtml#:~:text=Serious%20mental%20illness%20(SMI)%20is,or%20more%20major%20life%20activities. (accessed 02/11/2020)
[9] Public Health England (2018). Severe mental illness (SMI) and physical health inequalities: briefing. Available at: https://www.gov.uk/government/publications/severe-mental-illness-smi-physical-health-inequalities/severe-mental-illness-and-physical-health-inequalities-briefing (accessed 19/10/2020)
[10] Langan, M., McLean, G., Park, J., Martin, D., Connolly, M., Mercer, S. & Smith, D. (2014). Impact of socioeconomic deprivation on rate and cause of death in severe mental illness. BMC Psychiatry, 14(261). Available at: https://doi.org/10.1186/s12888-014-0261-4 (accessed 12/11/2020)
[11] Thornicroft, G. & Sunkel, C. (2020). Announcing the Lancet Commission on stigma and discrimination in mental health. The Lancet, 396(10262), 1543-1544. Available at: https://doi.org/10.1016/S0140-6736(20)32203-0 (accessed 24/11/2020)
[12] Khokhar, J., Dwiel, L., Henricks, A., Doucette, W. & Green, A. (2018). The link between schizophrenia and substance use disorder: A unifying hypothesis. Schizophrenia Research, 194, 78‐85. Available at: https://doi.org/10.1016/j.schres.2017.04.016 (accessed 16/11/2020)