Suicide by mental health in-patients continues to fall, most clearly in England where the decrease has been around 60% during 2004-14. This fall began with the removal of ligature points to prevent deaths by hanging but has been seen in suicides on and off the ward and by all methods. Despite this success, there were 76 suicides by in-patients in the UK in 2014, including 62 in England.
Suicides after discharge:
The first three months after hospital discharge continue to be a period of high suicide risk. In England the number of deaths rose to 200 in 2014 after a fall in the previous year. Risk is highest in the first two weeks post-discharge: in a previous study we have shown that these deaths are associated with preceding admissions lasting less than 7 days and lack of care planning. There has been a fall in post-discharge deaths occurring before first service contact, suggesting recognition of the need for early follow-up. In all there were around 460 patient suicides in acute care settings – in-patient and post-discharge care and crisis teams – in the UK in 2014.
First of all I want to say that every suicide is a huge tragedy and must be prevented at all costs. Behind each of these numbers are precious lives and beautiful people. I don’t allow myself to forget that even when I am angry. This blog is a mere observation on how I have seen politics being played in front of my eyes in the last week. In light of the above findings, in consultation with his expert advisors and in all his wisdom, Mr Jeremy Hunt has decided to focus his attention on in-patient deaths – a group that is manned by the most highly trained professionals in a very controlled environment, a group that is on the list of ‘never-events’, a group that has already shown a decrease by 60%, a group where even a small reduction in numbers will amount to a big percentage and will make him look good.
With all good intentions, he has converted a healthy aspiration of Zero-suicide in the community to an unhealthy target for in-patients creating huge anxieties. Last week at the NSPA conference I heard Mr Hunt speak in the most self-congratulatory of tones about how wonderful it is that UK is the first country to legislate for ‘Parity of Esteem’. I am sorry Sir, that means nothing on the ground. The workforce coming in contact with the majority of suicidal people in the UK is largely untrained. They don’t even know how to talk with them, let alone ‘look-after’ them. The massive funding cuts focus on mental health which in turn results in poor training of junior doctors. When questioned directly about ‘parity of training’, he masterfully slips and slides away.
Homeless people are amongst the most vulnerable in our society. The average age of death of a homeless person is 47 years for men and just 43 for women, as compared to 77 for the general female population.
Drugs and alcohol abuse account for just over a third of all deaths. Homeless people are over 9 times more likely to die by suicide than the general population. Other common causes of death are traffic accidents, infections,falls and violence against them.
Walking around London it is clear that despite significant investment in the NHS and improvements in homelessness services they are not getting the help they need to address their health issues.
Walking around Trafalgar Square, one can’t miss the majestic Georgian church, St Martin-in-the-fields . It is a hospitable, vibrant, open and inclusive, forward thinking community with worship at its heart. The Revd. Dr Sam Wells is full of grace and wisdom. He always speaks to my heart. I look forward to hearing him at the special service being held there on Saturday, the 4th of March for families bereaved by suicide.
This poem by Sir Andrew Motion is a part of an Arts project run by the Church and is inscribed on the balustrade encircling the lightwell in the open space near the church:
Your stepping inwards from the air to earth Winds round itself to meet the open sky So vanishing becomes a second birth. Fare well. Return. Fare well. Return again. Here home and elsewhere share one mystery. Here love and conscience sing the same refrain. Here time leaps up. And strikes eternity.
One of the French companies worst affected by suicides has been the telecommunications giant, France Télécom/Orange, where 12 employees took their own life in 2008, nineteen in 2009, 27 in 2010 and 11 in 2011. Despite a new agreement on workplace conditions negotiated with the trade unions, there has been a renewal of suicides in recent years with eleven cases in 2013 and ten suicides in 2014.
Suicides took place at a time when the company was restructuring, including a plan to cut 22,000 jobs in three years. Suicidal individuals shared a similar profile: these were typically skilled male engineers or technicians in their fifties who had been forcibly redeployed into low-skilled roles, often in call-centres.
On 17 January 2014, a 42-year old employee dealing with business customers at a France Télécom/Orange office in Paris, threw himself under a suburban train on his way to work. His sister, who is pursuing a claim against the company, contends that her brother had repeatedly complained to his bosses that he was a victim of bullying by his manager. Occupational doctors had also reported a deterioration of working conditions at the agency where he worked, with a rise of workplace stress as a result of company restructuring. Prior to his suicide, the victim had sent e-mails to family members complaining of an unmanageable workload and of constant surveillance and he referred to “humiliation”, “intimidation” and “bullying”. He held several meetings with senior management where he complained of harassment by his manager. Five days before his suicide, he sent an e-mail to his head of service in which he reiterated his request to change teams. These e-mail exchanges are being used as evidence in the investigation by the public authorities into his suicide.
Whilst in France work place suicides are an urgent public health phenomenon, in the UK, despite severe deterioration in working conditions, workplace suicide is not recognised in legislation and there are no specific official mechanisms for data collection. Even when it takes place in the workplace, suicide is presumed to be an individual and voluntary act and according to Health and Safety Executive (2016) legislation: “All deaths to workers and non-workers, with the exception of suicides, must be reported if they arise from a work-related accident.”
They have a specific term for it in Japan – ‘Karoshi’.
It means death from overwork. One fifth of the workforce in Japan is at risk of it. 2000 people die of work related stress every year and many others due to heart attacks, strokes, suicides and other serious health problems, giving rise to resignations, law suits and calls to tackle the problem. Japanese salarymen work significantly longer hours than their counterparts in other modern economies.
Ichiro Oshima, a 24-year-old Dentsu (an advertising firm with a notorious reputation) employee, killed himself in 1991 in Japan’s first recognised case of karoshi-related suicide. Oshima had not had a day off for 17 months and was sleeping for less than two hours a night before his death.
The number of suicides and attempted suicides in the City of London (the financial district) has doubled in the first 8 months of this year, particularly from bridges. Could that have something to do with the brutally competitive atmosphere in the Square Mile? Officers are making more use of Section 136 of the Mental Health Act to take people to a place of safety, usually a hospital. Ambulances are often unavailable so officers resort to using police vans, almost criminalising people by transporting them thus. Invariably when patients are assessed they are not deemed to meet the threshold of admission to a mental hospital and released. Police are asking NHS Trusts to provide details of patients so they know if they have been released so that they can be put a plan in place to safeguard them.
City police have also set up a Bridges Working Group including officials from NHS mental health trusts, the Samaritans, the RNLI (Royal National Lifeboat Institute) and the Coastguard.
Only a small percentage of employers in the UK have family-friendly policies or personal support services in place so as to achieve a good work-life balance. Although it is improving, we still have a long way to go.