On 22 January 2019 the Government published its latest suicide prevention plan, which aspires to tackle the high levels of death by suicide in the country (Department of Health and Social Care (DHSC), 2019a). As part of the plan the Government has also established a National Suicide Prevention Strategy Delivery Group (NSPSDG) (DHSC, 2019b). This group will oversee the implementation of the Cross-Government Suicide Prevention Workplan and steer the strategies that have been designed for all sectors of national and local government to take steps to reduce suicides.
All political parties are concerned that there are 4500 suicides each year in England, with approximately 13 people ending their life every day (DHSC, 2019c). Men are three times more likely to end their life by suicide than women, making suicide the leading cause of death in men under 50, and, worryingly, suicide is now a leading cause of death in young people.
The Prime Minister appointed Jackie Doyle-Price as the UK's first Suicide Prevention Minister in October 2018. Part of the minister's role is to work across local and national government to carry out the national suicide prevention strategy, published in 2012 (Department of Health, 2012). She will also address some of the more disturbing aspects of contemporary suicide such as the role of social media in glorifying self-harm. By coincidence this latest government report was published shortly after the death by suicide of 14-year-old Molly Russell, whose family believes that social media had a large part to play in her death. The Guardian reported that after Molly's death a review of her Instagram account was found to contain numerous citations about depression and suicide (Adams, 2019). Following the public outcry, and a meeting with health secretary Matt Hancock, Instagram has announced that it will ban all graphic self-harm images as part of a series of changes it is making (Marsh and Waterson, 2019).
The new policy urges social media companies to take greater responsibility for their online content, especially subliminal and overt content that promotes methods of suicide and self-harm. This new initiative will concentrate on how social media and the latest computer technology can identify those at risk of suicide. It also aims to improve the data collected on the causes of death among former armed services personal to help better appreciate the causative mechanisms that can result in someone taking their own life.
The suicide prevention plan outlines the key actions the Government is taking across the NHS, local government and the criminal justice system to address suicide, which include (DHSC, 2019a):
The scale of the problem
With 4500 suicides each year in England, this equates approximately to one person dying every 2 hours as a result of suicide. When someone is so emotionally troubled as to take their own life, the effect on their family and friends is overwhelming. Many others involved in providing support and care, including nursing staff, also experience the impact of the fatality (Cerel et al, 2008)
The Government has an explicit ambition to reduce the number of suicides in England by 10% by 2020. Official data published by the Office for National Statistics (ONS) for 2017 suicide registrations showed that the suicide rate in England had reduced for the third consecutive year and was at its lowest for 7 years (ONS, 2018), prompting optimism about reaching the target. Importantly—but not to be complacent—the suicide rate in men was at its second lowest level since 1981.
The new strategy highlights the need for NHS staff to have sufficient training as part of the existing safeguarding bundles. This will ensure that suicide awareness within staff training becomes widespread and that key competencies and capabilities can be identified for suicide prevention training. The Government recognises that self-harm is a significant predictor of future suicide and nurses among others need to factor this into any patient assessment. The increasing levels of self-harm, especially among the young, are especially concerning throughout society.
Proposed actions to tackle suicide in England
To help alleviate the problem Health Education England (HEE) and the National Collaborating Centre for Mental Health (NCCMH) have recently launched a series of self-harm and suicide prevention frameworks (HEE, 2018a). These frameworks are configured within different populations and contexts:
On World Mental Health Day, 10 October 2018, HEE launched a new e-learning resource, designed to help health professionals identify the early warning signs of suicide (HEE, 2018b). Entitled ‘We need to talk about suicide’ this e-learning module takes between 60 and 90 minutes to complete and it aims to provide support for health professionals and others: enabling them to recognise early warning signs of suicide, support patients and their families, as well as offering additional health services in this time of need.
In light of several reported cases (eg. BBC News (2018)), the Government wants to reduce the number of deaths by suicide across NHS-funded mental health settings, and learn from deaths by suicide when they do occur. It is anticipated that all mental health trusts will have a plan for the zero-suicide ambition in place by the end of 2019.
One of the areas the suicide prevention plan aims to tackle is ensuring that people who present at a general hospital with mental health needs get the appropriate care and treatment—in the same way someone with a physical health emergency can expect care irrespective of the time or day of attendance. (NHS England et al, 2016) To help achieve this goal the Government intends to invest £249 million to create liaison mental health teams in every acute hospital trust in England (DHSC, 2019a).
Public Health England is also now working with NICE to develop quality standards on suicide prevention. It is anticipated that the new NICE Quality Standards will be published in September 2019.
The suicide prevention plan also addresses the problem that men are three times more likely to die by suicide than women. The Government is conscious that other factors that may impact on men—such as relationship problems, financial difficulties, alcohol/drug problems, and body image, especially in young men—need to be more fully addressed. In particular, the plan shows that this difference in the suicide rate primarily occurs among those men who work in the lowest skilled jobs, which are also the lowest paid, when compared with all men in the population. The plan aspires to address the stigma men can feel when it comes to talking about mental health problems, which remains a significant barrier. The DHSC awarded grant funding for the ‘Time to Change’ initiative (http://tinyurl.com/y5oqmsox) up to 2020/21. In April 2018, Time to Change launched an awareness campaign in partnership with Ford (the maker of the Transit van), encouraging men in particular to speak more openly about their mental health (Time to Change, 2018).
The Government plan (DHSC, 2019a) also recognises that frontline health centres and GP surgeries are pivotal in the mission to reduce suicide and it proposes specific training for GPs and GP surgery staff in awareness of suicidality and safety planning. To achieve this HEE has commissioned a toolkit for primary care nurses and GPs and its application will ensure that primary care staff are better trained and their awareness of the mental health needs of patients is raised (http://tinyurl.com/yyuqurrk).
A group of people whose mental health is worsened by post-traumatic stress are military veterans. It was because more British soldiers and veterans took their own lives in 2012 than died fighting the Taliban in Afghanistan over the same period (BBC News, 2013) that NHS England has continued to expand the mental health services and case management for military veterans. It is recognised that a comprehensive and regionally accessible range of services to meet this group's particular needs should be further developed.
Conclusion
The Government intends to publish a detailed analysis with best practice and areas for improvement in spring 2019. Specifically the Government intends to reduce access to means of suicide. For example, it seeks to embrace the British Transport Police's Suicide Prevention Strategy and the rail industry suicide prevention initiative (http://tinyurl.com/yyzpu599) and to work with other stakeholders to develop effective mental health crisis care and suicide prevention across the whole of the rail network. The Government would like to see and replicate the efforts of the rail industry cascaded to other areas of the transport network such as highways and waterways. As with any health initiative nurses will be pivotal in helping bring this plan to fruition.