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Suicide & Self Harm

Introduction

While the number of people who lose their lives to suicide in Reading is small, each individual suicide comes at a high cost to society (an estimated £1.67 million, including the direct costs of care, indirect costs relating to loss of productivity and earnings, and the intangible costs associated with pain, grief and suffering) and, on average, ten other people are directly affected by each suicide, often at a significant detriment to their wellbeing (Knapp, McDaid and Parsonage, 2011; Platt, Maclean, McCollam et al, 2006). The risk of death by suicide is not the same for all local people, but is higher in key risk groups (those with mental health problems, those using drugs and alcohol and involved with the criminal justice system, those with a history of trauma and abuse, and those living in deprivation and poorer social conditions), which are likely to include some of the most vulnerable and disadvantaged members of our local community. Local and national policies to target suicide prevention initiatives on reaching these groups and responding effectively to self-harm, both in its own right and as a potential warning sign for suicide, are likely to help reduce the impact of suicide on local people.

What do we know?

Suicide is the act of intentionally ending your life and is most common amongst men and amongst those aged 30-59 (ONS, 2016). In 2015, across all age groups, the rate for men was around three times higher than for women. A death is included in UK suicide statistics where a coroner has recorded that the reason for a death was intentional self-harm or events of undetermined intent (these are customarily assumed to be self- inflicted but where there is insufficient evidence to prove that the deceased deliberately meant to kill themselves) (ONS,2016). A coroner can record a verdict of suicide in anyone aged 10 years or older.

While the number of people who take their own lives in England has reduced over the last 30 years, rates started to increase from 2008 and, in the most recent three year period, were similar to those seen in 2001-03. Men are at greater risk of suicide than women - 15.8 per 100,000 men died between 2013 and 2015 compared to 4.5 per 100,000 women - with the highest rate amongst men aged 35-49 (DH, 2012; ONS, 2017). However, registrations for 2015, the most recent statistics available, showed a small decrease in the number of suicides by men and an increase in the number of suicides by women (ONS, 2017).

Table 1: Age-standardised suicide rate by year by gender, deaths registered between 1981 and 2015 (England)
Table 1: Age-standardised suicide rate by year by gender, deaths registered between 1981 and 2015 (England)

Source: ONS, 2017 https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/suicidesintheunitedkingdom/2014registrations#main-points

As you would expect, the number of deaths attributed to suicide in Reading is small compared to the number seen nationally. Between 2013 and 2015, 44 deaths in Reading were recorded as suicide or resulting from an injury of undetermined intent. As the numbers are so small, it is much more difficult to identify trends from local data in isolation. The number of suicides by women in Reading is too low for the rate per 100,000 people in the population to be published for comparison by Public Health England (PHE) as the results are likely to be too unstable and fluctuate too widely to be meaningfully compared to rates in other populations, especially when adjusted for different population's age profiles. In the latest (2013-15) period, the suicide rates for men and for all persons, while statistically similar to the rates for England, are both higher than the England rates (11 per 100,000 in Reading compared to 10 per 100,000 for all persons in England and 19 per 100,000 for men compared to 15.8 per 100,000 for men in England), but both were lower than the England rate in preceding periods. While this may represent real changes in the local area, the low number of cases and the possibility that the differences may be the result of chance makes these figures difficult to interpret (Table 2).

Table 2: Suicide rate per 100,00 people (2001-03 to 2013-15) Reading and England
Table 2: Suicide rate per 100,00 people (2001-03 to 2013-15) Reading and England

Source: Public Health England (Based on ONS Source), Public Health Outcomes Framework indicator 4.10

Risk factors for suicide include drug and alcohol use, a history of trauma or abuse, being unemployed or having poor job security, social isolation and family breakdown, living in deprivation or poor social conditions, imprisonment and involvement with the criminal justice system, and living with a mental health condition (Mental Health Foundation; NHS Choices)

Another key risk factor for suicide is a history of self-harm, and indeed this is the single factor which most reliably indicates increased suicide risk. More than half of all people who die by suicide have a history of self-harm (NHS Choices). Self-harm is more prevalent amongst younger people (NICE, 2011) and can take the form of self-poisoning with medication, giving an injury (such as by burning or cutting skin or pulling hair, or hitting or punching) or can include harmful drug or alcohol use, some kinds of eating disorders such as bulimia nervosa, and excessive exercise (Mind, NHS Choices, NICE, 2011). Self-harm has been linked to social problems and experiences of trauma (for example, being bullied, problematic relationships with friends and family, abuse, coping with the death of a loved one) and in some cases with psychological causes such as intrusive, uncontrollable thoughts or feelings of disassociation from self and surroundings.

National and local strategies

A cross-Government National Suicide Prevention Strategy for England was published in 2012. This included commitments to tackling suicide in six key areas:

  • Reducing the risk of suicide in high risk groups;
  • Tailoring approaches to improve mental health in specific groups;
  • Reducing access to means of suicide;
  • Providing better information and support to those bereaved or affected by suicide;
  • Supporting the media in delivering sensitive approaches to suicide and suicidal behaviour; and
  • Supporting research, data collection and monitoring.

In 2016, an independent Mental Health Taskforce presented a report - The Five Year Forward View for Mental Health - to the NHS in England. The Taskforce recommended setting a national ambition to reduce the suicide rate in England by 10 per cent by 2020-21, and that every local area should have in place a multi-agency suicide prevention plan. These local plans are expected to align with local Crisis Care Concordat action plans, and to reflect local ambitions for prevention planning.

The 3rd Progress Report on Preventing Suicide in England (published in January 2017) contains further guidance on local suicide prevention plans. Local plans should be in place by 2017, set out targeted actions in line with the national Suicide Prevention Strategy and new evidence around suicide, and include a strong focus on primary care, alcohol and drug misuse. Each plan should demonstrate how areas will implement evidence-based preventative interventions that target high-risk locations and support high-risk groups within their population.

Suicide prevention work is part of promoting good mental health more broadly, and there is an increasing focus on mental health as a vital part of overall wellbeing. In January 2017 the Brighter Berkshire (Year of Mental Health) campaign was launched. This is aimed at reducing stigma and improving access to support networks.

Reading's Health and Wellbeing Strategy 2017-20 includes 'reducing deaths by suicide' as one of its eight priorities, with a further two priorities complementing this very closely:

  • Promoting positive mental health and wellbeing in children and young people
  • Reducing loneliness and social isolation

Reading's Suicide Prevention Plan support both the local Health and Wellbeing Strategy and the Berkshire-wide Suicide Prevention Strategy (based on the national strategy) endorsed by Reading's Health and Wellbeing Board in March 2017.

What is this telling us?

While it is difficult to determine the relative risk of suicide to people in Reading compared to people living elsewhere in the UK, it is possible to identify key risk groups within our population (those with mental health problems, those using drugs and alcohol and involved with the criminal justice system, those with a history of trauma and abuse, and those living in deprivation and poorer social conditions). Local and national policies to target suicide prevention initiatives on these groups and to respond effectively to self-harm, both in its own right and as a potential warning sign for suicide, are likely to help reduce the rate of suicide locally.

What are the key inequalities?

It is well acknowledged that there are key groups that are at greater risk of suicide than others and both local and national policies have acknowledged the need to ensure that interventions are targeted effectively. Each of these groups is likely to include some of the most vulnerable and disadvantaged members of our local community.

Reading's Suicide Prevention Action Plan includes a series of plans to ensure actions are aimed at reducing the health inequalities in this area:

  • A review of services commissioned to reach younger men
  • Raising awareness of support for those bereaved by suicide
  • Raising awareness of local support for survivors of sexual abuse
  • Addressing suicide risk through the implementation of the Domestic Abuse Strategy
  • Supporting delivery of the Future in Mind programme to improve mental health in children and young people
  • Ensuring drug and alcohol support services include suicide prevention objectives.

This section links to the following sections in the JSNA

Mental health

Offenders

Drugs & Alcohol

Deprivation by Ward and Lower Super Output Area

References

Department of Health (DH) (2012). Suicide prevention strategy for England. DH, London.

HM Government (2017). Preventing suicide in England: Third progress report of the cross-government strategy to save lives. DH, London.

Knapp, M, McDaid, D and Parsonage, M (eds) (2011). Mental Health Promotion and Prevention: the economic case. London School of Economics and Political Science, Personal Social Services Research Unit.

Office for National Statistics (ONS) (2017). Suicides in the United Kingdom: 2015 Registrations. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/suicidesintheunitedkingdom/2015registrations [Accessed 6th March 2017].

National Institute for Health and Care Excellence (NICE) (2011). Self-harm in over 8s: long term management. NICE, London.

Platt, S, McLean J, McCollam, A et al (2006) Evaluation of the First Phase of Choose Life: the National Strategy and Action Plan to Prevent Suicide in Scotland. Edinburgh: Scottish Executive. 

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