That this House has considered Government action on suicide prevention.
As always, it is a pleasure to see you in the Chair, Mr Bone.
Three weeks ago today, I hosted an event on mental health and suicide prevention in Speaker’s House. We heard from two members of the band Joy Division/New Order because the event took place on the 42nd anniversary of the death by suicide of the singer, Ian Curtis. I want to take this opportunity to thank Stephen and Bernard from the band for coming along, because if it had been just me speaking about this subject, not as many people would have listened, although I am sure a mass audience is hanging on to my every word today.
At the event, we also heard from Simon Gunning, chief executive officer of Campaign Against Living Miserably, or CALM, whom I thank for meeting me yesterday in advance of the debate. I also thank Mr Speaker, who spoke movingly about his daughter’s suicide and the recent loss of his brother-in-law. We also heard from the leader of the Labour party and the Minister. I thank the Minister for speaking at the event, but I hope she will forgive me for seizing the opportunity of securing today’s debate to press her further on some of the issues we discussed then. It is good to talk, but it is even better to see action.
I am sure the Minister will remind us that the Government are consulting on their 10-year mental health plan, which will also be used to inform a refreshed national suicide prevention plan—the previous one is 10 years old. I am a little concerned that the issue is being bundled up within the one consultation and that there are only passing references to suicide in the consultation overview, which is what most people will read. In fact, suicide is not mentioned at all in the chapter on crisis, which is where I would most expect to find it, and people have to go to the mental health and wellbeing plan discussion paper to find any detail. I hope that that does not mean that suicide is being treated as an afterthought.
We are told that the details of the suicide prevention plan will be set out in due course, but given that suicidality is recognised by the Government as needing its own separate strategy, I do not understand why it does not warrant its own consultation. The latest coroners’ statistics show that deaths by suicide are at a record high, and it is obvious that the Government have not met their target of reducing suicide by 10%. Clearly, a better strategy is needed.
I accept that setting any kind of target is complex. We saw a spike in suicides after the 2008 financial crash; we are now emerging from a pandemic that has taken a terrible toll on people’s mental health and the cost of living crisis is starting to bite. A lot of factors are not in the Minister’s control, but as is often said, what is measured is what gets done, so there has to be something to aim for. To help us to get there, several organisations have raised with me the need for real-time data. The Government are developing a national real-time suicide surveillance system, so perhaps the Minister will update us on progress with that.
As the British Psychological Society has explained, suicidal behaviour cannot be understood from any one perspective alone. Suicidality is best explained as a complex interplay between risk factors across domains. Not everyone who experiences bereavement or relationship breakdown, or who is under massive pressure at work or is struggling financially, will feel suicidal. There is often an accumulation of pressures and events, sometimes stretching back to adverse childhood experiences and exacerbated by adult trauma, although sometimes it is just that something bad has happened.
It is difficult to unpick all that, but Professor Louis Appleby has suggested some priority areas for the suicide prevention plan: where rates are high, such as among middle-aged men; where rates are rising, even if they are quite low, which relates to children and young people; where there is proximity to prevention, such as among current mental health patients; and where there is public concern, such as for university students. Professor Appleby also suggests, for political reasons, that the north should be a priority. That might also be because he is based at Manchester University and he is perhaps pushing his home turf, but as part of levelling up. Economic aspects such as poverty and unemployment can be big factors.
In 2017, my constituent Jack Ritchie took his life at the age of 24 as a result of gambling addiction. I am pleased that his mother and father are in the Gallery with us today. It is estimated that there are more than 400 gambling-related suicides each year. The national suicide prevention strategy recognises high-risk groups, and my hon. Friend has highlighted the comments from Professor Appleby. Does she agree that as gambling-related suicides account for almost 8% of all suicides that group should be recognised in future strategies as high risk?
I thank my hon. Friend for his intervention. I know there was a very good debate in this Chamber yesterday morning, which unfortunately I could not attend, where such issues were raised. There are some discrete areas where a specific intervention suggests itself, such as gambling addiction, alcohol abuse, post-natal depression, or veterans’ mental health. I certainly feel that such risk factors ought to be reflected in the suicide prevention plan.
A quick win would be to obstruct people from accessing the means to die by suicide, with obstacles placed in their way. A lot of suicides are opportunistic. For example, the British Transport Police is very good in terms of how it polices stations and watches out for signs that somebody might be thinking of jumping in front of a train, and helplines can be flagged up at places such as the Humber bridge and the Clifton suspension bridge, but there are also physical measures that would make suicide more difficult. People might say, “Well, perhaps people will just go somewhere else,” but it does not always happen like that. If the moment is lost, there is a good chance a life will be saved.
Will the Minister tell us a little bit about the plans for the revised suicide prevention plan? Will it have clear priorities, with an evidence-based, tailored plan in each case for how we will bring rates down, and then targets set on that basis? One organisation described the current approach as very much a “throw everything at the wall and hope something sticks” approach. We need a far more tailored approach.
Will the Minister also tell us where the boundary falls between what is in the remit of the Department of Health and Social Care and work that requires action by other Departments? We have already talked about gambling, and the debate yesterday was answered by the Under-Secretary of State for Digital, Culture, Media and Sport, the hon. Member for Mid Worcestershire (Nigel Huddleston). The Online Safety Bill is another example of where another Department is taking the lead, and I am worried that the Government will not fully seize that opportunity to crack down on sites promoting suicide and self-harm. I gather there is a bit of a difference of opinion between the two Departments, which is particularly disappointing given that the current Secretary of State for Digital, Culture, Media and Sport, the right hon. Member for Mid Bedfordshire (Ms Dorries), was the first Minister for Suicide Prevention. Does the Minister agree that we need to strengthen the Bill’s provisions on this issue, or has she lost the battle with the Secretary of State for Health and Social Care? I hope not, and I hope that, if the Bill is not strengthened in Committee, we can improve it on Report.
I was at the Speaker’s House reception, and one of the most shocking things I heard was that two thirds of people who commit suicide have never sought any support for their mental health. What does my hon. Friend think are the consequences of that, and how should we be trying to deal with it? I think that we need to ensure that we have a holistic approach that offers support, because we all have mental health needs; we all need support. What does she think?
I thank my hon. Friend and agree with him, but I have some reservations about going down that path. A lot of the conversation about mental health in recent years has focused on the importance of getting people to open up and talk about their problems, and an obstacle in the way of doing that is that it can be very difficult for people to access GP appointments or to get the help that they need. I very much support Labour’s policy of publicly accessible mental health hubs in every community, as well as mental health support in every school. There needs to be swift and easy access to talking therapies or even to something less formal—just to someone who will sit there and be prepared to talk to the person. There is also campaigning to try to get people just to ask others how they are feeling, and that would help. I am a bit worried because there is a danger that we will focus totally on the softer end of things and talk a lot less about the more difficult areas, where people are well past the point where a nice cup of tea and a friendly chat would make a difference. At the moment, there certainly seems to be a huge problem where people are considered to be past the point where talking therapies would help. It might be that they are too high risk or too unwell to benefit from primary mental health services but not quite ill enough to access secondary services, such as the community mental health teams; they are not totally at crisis point. Often, they are left to fester somewhere in the middle, and when they reach crisis point, they finally get help, but that is too late in many cases to actually turn their mental health around. Too many people fall by the wayside because the right pathway is not available.
Currently, 40% of patients waiting for mental health treatment are forced to contact emergency or crisis services before they receive treatment. One in 10 of them ends up in A&E, and I have real concerns about whether A&E is appropriate, particularly if someone has experienced psychotic episodes. I cannot think of anything worse for them than being in an A&E department, with the sirens, flashing lights and people who have probably turned up there because they have drunk far too much or are off their heads on something or other and have got into fights on a Saturday night. Some hospital trusts are experimenting with trying to triage people very quickly away to mental health provision in A&E, which I think is a very good move.
It is a pleasure to serve under your chairmanship, Mr Bone. I thank my hon. Friend the Member for Bristol East (Kerry McCarthy) for securing this enormously important debate, and for her excellent introduction to it.
The first thing I want to say is that, according to the most recent figures we have, 4,912 deaths by suicide were registered in 2020 in England alone. Men aged 45 to 49 are at greatest risk of death by suicide, and sadly for me, the north-east region is the area with the highest suicide rate, at 13.3 per 100,000. I am certainly unhappy about that and I am working with people locally to address the issue.
Some of the issues I want to touch on have already been covered, such as the refreshed national suicide prevention plan. This is hugely important, and something I have raised with Ministers before, as the Minister is aware. The consultation is welcome, but I agree with my hon. Friend the Member for Bristol East that we must make sure that suicide is properly addressed within it. It is enormously important that we have that dedicated attention and drive forward innovation in this area.
We also have to talk about funding for suicide prevention services. The NHS long-term plan allocated £57 million for suicide prevention and bereavement services, which are hugely important to local areas, but £25 million of that funding only ran until 2021, and all funding supporting local areas will cease in 2023-24. We need renewed ringfenced funding, which is also something I have raised as chair of the all-party parliamentary group on suicide and self-harm prevention. I know from speaking to my local services, both NHS and public health, how important it is that the funding is there to continue that collaboration and detailed work at local level.
Another thing I want to touch on is the situation for middle-aged men—one of the highest-risk groups. Suicide is the leading cause of death among men under 50 in the UK, and men account for three quarters of all suicides. As I have said, men aged 45 to 49 are most at risk; rates among this group have been persistently high for many years. Men who are less well off and live in the most deprived areas are up to 10 times more likely to die by suicide than more well-off men from the most affluent areas.
It is a pleasure to serve under your chairmanship, Mr Bone. I pay tribute to the hon. Member for Bristol East (Kerry McCarthy) for securing this debate. I can see that the subject is really difficult for her to talk about and I thank her for sharing her experience. I was struck by what she said at the end about how it is the people left behind who take on the suffering. I have had a bit of an insight into what she talked about.
I have a constituent here today, Mr Philip Pirie, who I am glad has been able to join us; he is in the Public Gallery. Philip’s son Tom took his own life in July 2020. I have been working with Mr Pirie since then and talking to him about his experience of suicide and how it has impacted him and his wider family and Tom’s family and friends. Mr Pirie highlighted a particular issue in Tom’s experience, and I have been happy to work with him on a campaign. We have previously spoken to the Minister about it.
Tom was a schoolteacher. He loved to travel and spoke three languages. He was much loved by his friends and family. Subsequent to his death there was a memorial football match, which was held to commemorate him, between his former school and club teams. Tom did seek help for his mental health issues, and he spoke to a therapist just a day before he took his own life.
A troubling feature of Tom’s experience is that he was assessed by his counsellor, at that meeting the day before his death, as being at low risk of suicide. That is something that has caused Philip and the wider family a great deal of distress, because if Tom had not been deemed to be at low risk of suicide, more might have been done to save him. So Philip has taken up with me the issue of suicide risk assessments by counsellors and how they are being used. It is a big issue.
We heard from the hon. Member for Blaydon (Liz Twist) about the extent to which suicide is a public health issue. The thing that has struck me is that suicide is the most common cause of death among young people aged 20 to 34—that is how much of a risk it is to our young people. More than anything else, that is how they are losing their lives.
It might be helpful to say that we have three Back Benchers trying to catch my eye. I have to start the wind-ups no later than 10.30 am, so each Member has six or seven minutes max.
It is a pleasure to serve under your chairmanship, Mr Bone. I, too, thank my hon. Friend the Member for Bristol East (Kerry McCarthy) for securing this important debate, and for her opening speech.
Many people in the UK are, and have been, fighting silent battles for quite some time. The Government have shown their commitment to tackling this by removing the dedicated Minister for Suicide Prevention. I have struggled with mental health from a young age and in recent years, due to online abuse, threats and other life events, I have suffered with mental ill-health and suicidal thoughts. I have had to have brave conversations with my children and family but, luckily for me, I have pulled through due to my family support network, my friends and colleagues, and my access to therapy and coaching.
However, many people across the country do not have access to a strong network, as I know through my lived experience of my own struggles. Having been a trained Samaritan volunteer for a number of years in my local branch in Bradford, as a former NHS commissioner and a former chair of one of the largest black, Asian and minority ethnic mental health charities outside of London, I know that accessing mental health services through the NHS is extremely different. It has been extremely difficult previously, but covid-19 has exacerbated that, particularly in areas like Bradford.
The Office for National Statistics recorded that in 2020, 5,224 suicides were recorded; those were 5,224 preventable deaths. In 2021, 4.3 million referrals were made to mental health services in England, which the Royal College of Psychiatrists rightly labelled as an “unprecedented demand” for services. According to public health data, there were 99 cases of suicide among men or boys aged 10 or over in Bradford between 2017 and 2019; that means that the area’s male suicide rate was 15.6 in every 100,000 men, up from 14.6 between 2016 and 2018. Men accounted for the majority of suicide deaths in Bradford over that period.
As my party’s health spokesperson, I am happy to speak in this debate and to look at how we can improve the mental health services we have in place.
I thank the hon. Member for Bristol East (Kerry McCarthy) and congratulate her on her consistent efforts in tackling issues around suicide prevention and normalising the feeling of not being okay. There is no doubt whatsoever that more needs to be done to support those feeling low and I am pleased we can discuss that today.
This is a difficult subject to address because we all know people who have passed away as a result of anxiety or depression, and whose difficulties meant ultimately they could not cope with life. The framework for the NHS five-year plan in tackling suicide was first published in 2012. It aimed to help those directly affected by suicide and recognised the lasting impacts suicide can have on family and friends. I am grateful that the Government, and the Minister in particular, have set aside £57 million in funding allocated for mental health services by 2023-24. We should welcome that because it shows that the Government and the Minister have recognised the need to do something specific. I hope that that will address issues across the whole of the United Kingdom of Great Britain and Northern Ireland, as I understand some of those moneys will come to us in Northern Ireland through the Barnett consequential.
For me personally, the subject of the debate is quite difficult. The current suicide rates back home in Northern Ireland are devastating, and I use that word on purpose, because they are. Figures indicate that suicide has increased since 2015, with levels increasing from one registered suicide in 2015 to a shocking 100 in 2019. The Northern Ireland Statistics and Research Agency has not yet provided the figures for registered suicides in Northern Ireland over the two-year period of the pandemic, but I have no doubt in my mind that, unfortunately, some may have struggled all too much over the covid period. That is not to mention that, in 2018, it was revealed that more men died by suicide in Northern Ireland than anywhere else in the United Kingdom: an average of 29.1 per 100,000.
It is a pleasure to serve under your chairmanship, Mr Bone. I congratulate my hon. Friend the Member for Bristol East (Kerry McCarthy) on securing the debate, in which we have heard some really powerful contributions. I add my support to what has already been covered in the debate, including for a new suicide prevention plan. I will concentrate my remarks on suicide in the LGBT+ community, and on the important role of alcohol in this debate.
According to surveys, young LGBT+ people are three times more likely to self-harm, and twice as likely to contemplate suicide as their non-LGBT+ peers. Depending on the study we look at, gay people are between two and 10 times more likely as straight people to take their own life. We are twice as likely to have major depressive episodes. Surveys of gay men regularly find that three quarters of the community suffer from anxiety or depression, abuse drugs or alcohol, or are in abusive relationships. That is the case despite social progress and greater acceptance, and despite the fact that we have got rid of many discriminatory laws. Rates of depression, loneliness, substance abuse and suicide among gay men remain many, many times higher than for the general population.
A book that was very important to me was “The Velvet Rage: Overcoming the Pain of Growing Up Gay in a Straight Man’s World” by Alan Downs. The important message in that book is that when someone comes out about their sexuality or gender identity, the trauma is not overcome at that point. Growing up gay leaves trauma, so many people in the LGBT community require support to overcome trauma, shame and other issues of that nature. That is why counselling and therapy are important.
When we in this House talk about mental health, we rarely mention or acknowledge that addiction is a chronic mental health condition; addiction is an illness. Alcohol is a depressant that can exacerbate low mood and suicidal thoughts. It is probably the most normalised way of coping with mental health issues, trauma or suicidal thoughts; it is a fast-acting way to change how we feel. The relationship between alcohol and suicide is well established and a cause for great concern. Research by the Samaritans shows that people who are dependent on alcohol are two and a half times more likely to die by suicide. In England, nearly half of all patients who are in the care of mental health services and who die by suicide have a history of alcohol misuse. They account for almost 600 deaths a year on average.
10:26 am
Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
It is a pleasure to serve under your chairmanship, Mr Bone. I start by thanking the hon. Member for Bristol East (Kerry McCarthy) and commending her work—she is an absolute champion for this matter. She spoke extremely powerfully on the need for data collection, which I think is the crux of taking good service delivery forward. She spoke very emotively about her own personal experience, and her words resonated with many people here when she advocated for services for those families who are left behind. I thank her for being a champion of this important issue. It is often neglected, and is something that for many years has been difficult for people to speak about. The more that it can be spoken about and raised in this place, the better for everybody right across the United Kingdom.
The hon. Member for Bradford West (Naz Shah) spoke about how difficult it is to access mental health services, particularly for children and young people. I think there are gaps—chasms, actually—in waiting times across the United Kingdom that need to be addressed. As chair of the all-party parliamentary health group, I hear about that constantly. No matter where someone lives, it is very difficult for them to access services. It takes far too long and people are falling through those gaps. The hon. Member for Blaydon (Liz Twist) spoke about the importance of levelling up regional and gender disparities. I am interested in the point she made about adult males being particularly at risk.
There has been good work going on across Scotland— I am sure these exist across the United Kingdom— through the Men’s Sheds developments. I have two in my own constituency that I have visited—one in Lesmahagow and Blackwood and one in the Stonehouse area. They are doing fantastic work to reduce loneliness and isolation, and to create environments where people can begin to speak about issues and receive important social support from like-minded people. We still have a society where there is more stigma for men who speak up about those issues, so such developments are crucial. The hon. Member for Blaydon is also an advocate for this issue in her role as chair of the all-party parliamentary group on suicide and self-harm prevention. She has made key recommendations for the Government to take forward.
The hon. Member for Liverpool, Walton (Dan Carden) spoke about the LGBT community and about alcohol-related harm. What is key—and I know this from my professional life prior to Parliament, working in psychology —is that often having an addiction diagnosis on someone’s medical records can make it more difficult for them to access mental health services. That just should not be the case because, exactly as he says, having alcohol or drug-related problems is, in itself, a risk factor for suicide. Therefore, it should be something that heightens people’s access to services, rather than diminishing it. I would therefore like to thank him once again for the work that he does on these matters.
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The review of special educational needs and disability is another potential missed opportunity. It is meant to be a joint effort by the Department for Education and the Department of Health and Social Care—there is a joint foreword—but there is very little in it on child and adolescent mental health services. Given the overlap between children struggling at school who cannot get the right diagnosis and cannot get a timely education, health and care plan and children who end up in the mental health system, joint working is really important.
Obviously, it is not just children with SEND who struggle. One in six children are now said to have a probable mental health condition, up from one in nine in 2017. More than 400,000 under-18s were referred for specialist mental health care between April and October last year. These are children at the more severe end of the spectrum—those who presented with suicidal thoughts, self-harming or eating disorders. The number of attendances at A&E by young people with a diagnosed psychiatric condition has tripled since 2010.
We know that CAMHS is at breaking point. There are huge waiting lists, and severely mentally ill children are being cared for in inappropriate settings or being sent hundreds of miles away from home for treatment. It is said that half of all mental health problems are established by the age of 14, rising to 75% by the age of 24. If we do not want today’s children to be tomorrow’s suicide statistics, we need to do much more, much faster, to help them now, and I just do not see that sense of urgency from the Government. This consultation is all wrapped up in a 10-year plan, but we need a 10-day plan. We need action now.
One issue we discussed at the event in Speaker’s House was how schools could better nurture children’s creativity and give them an outlet for their emotions through music and art. We also talked about whether the current trajectory of education, with schools very focused on grades—someone described them as “exam factories”—places undue pressure on children. I agree with that to a large extent and worry about cuts to things like music education, which mean that creatively inclined children do not have that outlet. It is not plain sailing for the other 50%, the academic ones, either. Just because a child does well in education does not mean that they are set up for success in the wider world, whether that means higher education or the world of work.
I am sad to say, as a Bristol MP, that Bristol University has become known for the number of student suicides in recent years. It is obviously not the only university to have experienced this, but it has come to particular attention. There needs to be a constant process of reflection and review. We have just had the court ruling in the tragic case of Natasha Abrahart. She was a very able student at Bristol University, but she suffered terribly from social anxiety and just could not handle the oral side of her course and having to do presentations. Rather than trying to force all young people into one model of what success and achievement look like, institutions need to adapt to them. I hope that Natasha’s parents will be able to pursue their campaign to ensure that that happens in the future.
I have also spoken to various groups about data sharing, which I appreciate is a complicated area. When should parents of university students, who are adults, after all, be informed? What are the boundaries of patient confidentiality? Some students might be deterred from speaking to mental health services at uni if they think that their parents might be told, particularly if they are grappling with something like their sexuality or if they have become involved with drugs. There are all sorts of things that young people would not want their parents to know about. Some might come from abusive family backgrounds and their parents would not be helpful or supportive, but in many cases the parents would have desperately wanted to know that their child was struggling to the extent that they were.
Steve Mallen from the Zero Suicide Alliance thinks that more could be done within data protection laws to protect students, and I hope that that is under active consideration.
We have waited a long time for the Government to bring forward the mental health reforms outlined in the Queen’s Speech. We are right to be concerned about the misuse of powers under the Mental Health Act 1983. We have heard terrible stories of people with autism being detained long term against their will, and the disproportionate use of those powers against people from ethnic minority backgrounds, particularly young black men. I hope that, as part of that debate, we can also talk about how the system fails people who do need to be in hospital, whether by voluntary admission or being sectioned, because a lot of people would benefit.
We see people on the streets talking to themselves, heads bowed, and everybody side-steps them. Sitting on public transport next to someone who is clearly unwell can be uncomfortable. If people have physical health problems, the expectation is that the health service is there to treat them. I know there is a question of capacity and whether people consent to treatment, but I feel we write people off when their mental health reaches a certain state, unless it gets so bad that they are a danger to themselves or others. The system needs to gear up to help people who are broken to that extent. It might not be possible to fix them, but their lives could be made better.
The number of beds in NHS mental health hospitals has fallen by a quarter since 2010, with almost 6,000 beds lost in England alone, despite big increases in the number of people needing mental health support, and cases where people are sectioned under the Mental Health Act. Figures obtained through freedom of information requests show that on a single day in February this year, all of England’s high and medium-security hospitals were operating above the Royal College of Psychiatrists’ maximum bed occupancy rate of 85%. The NHS pays £2 billion a year to private hospitals for mental health beds because it does not have enough of its own. Nine out of 10 mental health beds run by private operators are occupied by NHS patients.
It was also revealed last month, again through FOI requests, that over a five-year period from 2016 to 2021, more than half of the 5,403 prisoners in England assessed by prison-based psychiatrists as requiring hospitalisation were not transferred from prison to hospital. Those were not people with what might be called run-of-the-mill mental health concerns; they had major psychotic illnesses or chronic personality disorders. They needed to be in hospital, not in prison, but they did not get those transfers. We can only speculate on the problems that might store up for the future.
Where there are hospital beds, the pressures on the wards and staff are immense. There are way too many tragic stories of patients being discharged too soon, being wrongly assessed as low risk, and not getting the help they needed, with inevitable results. For example, 22-year-old Zoe Wilson died at Callington Road hospital in my constituency in 2019. She was put on a low-risk ward, despite ongoing psychosis. In January this year, the inquest jury returned a narrative conclusion, having found that multiple failings contributed to her death. The prevention of future deaths reports—the regulation 28 reports—published with the latest coroners’ statistics, make very grim reading. So many of the reports point to failings such as those noted in Zoe Wilson’s case.
I am not convinced that lessons will be learned from these reports, because what is required in many cases is not actions by individual hospital trusts. I should explain what happens. The coroner notes that an institution—a university, or any organisation that might have had contact with the person prior to their death—should learn a lesson and do something in future to try to save a life. Those comments are usually directed at a hospital trust or another organisation, but I would like to know what notice the Government take. Patterns showing where there are failings in the system emerge in these reports. I would be reassured if I felt that, rather than just informing the actions of an individual institution, the reports also informed future suicide-prevention strategy. I am sure the Minister will tell us how much more is being devoted to mental health spending, but we need to acknowledge the simple fact that, despite any figures she might produce today, our mental health services are drastically underfunded, under-resourced and under-staffed, which is why they are at crisis point.
I want to finish today by paying tribute to people who have spoken up about their own family experiences, as Mr Speaker did at the event in Parliament. He spoke so powerfully, because he was clearly very upset about what had happened. I, too, lost someone to suicide last year, as many other people will have, including people who are listening today. I started off by talking about how Bernard and Stephen from Joy Division/New Order came to speak about how, even 42 years later, they are still affected by the death of their singer Ian Curtis. Another musical genius and a musical hero of mine, David Berman, took his own life a few years ago. His last album, “Purple Mountains”, was basically a suicide note. He can be very funny at times—he has this real lyrical genius—but listening back to the album now, you can see where he is going. He suffered from depression for a long time, and he has this song, “Nights That Won’t Happen”, which says,
“The dead know what they’re doing when they leave this world behind…
When the dying’s finally done and the suffering subsides
All the suffering gets done by the ones we leave behind.”
I will finish on that note, because that is very true. He felt that he was escaping from something. He escaped from it, but I hope that support services for people who have recently been bereaved by suicide is at the top of the Minister’s agenda, because those are the people who really need it.
I am grateful to the Samaritans, who provide the secretariat to the APPG, for telling me about some in- depth research they have done with less well-off middle-aged men who have been struggling with their mental health, including having suicidal thoughts over a period of time. The themes those men told the Samaritans about included a lack of many meaningful social connections, often throughout their life, and having relationships connected to substance abuse. The other main theme was financial instability, which could include an erratic work history or long-term unemployment. There is no getting away from the fact that socioeconomic factors—deprivation, unemployment and other issues—have a real impact on the figures. It is really important to recognise those issues and work with colleagues in other Departments on them.
The Samaritans are calling for a focus on early intervention and support through the full range of statutory services that men may be in touch with. Research suggests that nine out of 10 middle-aged men who died by suicide in 2017 had been in contact with at least one frontline service or agency a week prior to their death. We also need further investment in voluntary sector and community provision to provide the services and initiatives that middle-aged men often find helpful in building connections and having conversations.
The other group that I want to refer to is people who self-harm. The all-party group conducted an inquiry into self-harm in younger people. We know that not all people who self-harm proceed to suicidal ideation or completing suicide, but there is a clear link. We need to ensure that people have readily available access to support at an early stage, because self-harm is such a strong risk factor for suicide.
In that inquiry, many people told us that they were considered too high-risk for primary mental health services, but not ill enough for secondary health services such as community mental health teams, or CAMHS in the case of younger people. We need to increase capacity and build expertise within talking therapy services to support people who self-harm, allow self-harm to be discussed in a safe, supportive way, and carry out assessments of people who disclose self-harm. We should get away from the stigma, because it still happens that, when people self-harm, they are thought to be attention-seeking. Instead, we need to ensure that it is picked up as a possible sign of a path. Preventive issues are also key. Having access to the appropriate services quickly is really important, so that people can get support.
On inequality and levelling up, I mentioned that people in disadvantaged communities faced the highest risk of dying by suicide, and that financial instability and poverty could increase suicide risk. Insecure income, unmanageable debt, unemployment and poor housing conditions all contribute to higher suicide rates, so we really need a cross-Government approach that recognises those risk factors and does something to address them. Specific actions would be to prioritise in the plan tackling inequalities as suicide risks across Government policy interventions, including through employment support, social security and economic planning. We should ensure that money advice and financial support is consistently available to everyone. We should better utilise what the Samaritans call the touchpoints of the state, such as work coaches in jobcentres and others that people come in contact with.
My hon. Friend the Member for Bristol East mentioned the need for real-time suicide data. That is being developed, and it is absolutely essential. We cannot continue with the system of waiting for the coroner’s inquest to decide the cause of death. We need to know, so that we can highlight issues early and respond.
On the Online Safety Bill, which I have raised previously with Ministers, it is important that health takes a leading role to ensure that people do not have easier access to sites that promote self-harm or suicidal plans. There need to be new offences, and suicide and self-harm content needs to be addressed.
On alcohol use and suicide, I am sure others will speak in more detail, but we had a quotation from a Samaritans survey respondent:
“My hope is that professionals start to see that alcohol use is often the result of an underlying issue and not simply tell people to sober up without offering further support for how to deal with the root cause”
of the problem. We need integrated commissioning and provision of mental health and alcohol treatment services, training for all healthcare staff around the relationship between alcohol and suicide, and further funding for local drug and alcohol recovery and treatment services, many of which have seen huge cuts in the last 10 years.
Finally, suicide is preventable, not inevitable. It is important that we take real steps to ensure that we prevent unnecessary deaths and have real plans in place to make that happen.
Of the 17 people who die by suicide every day in this country, five would have been in touch with mental health services. The hon. Member for Liverpool, Walton (Dan Carden) mentioned that that is not enough, because so many people do not seek help. Of the five who have been in touch with mental health services, four will have been assessed as at low or no risk, as we have seen Tom Pirie was. That raises questions as to how we assess suicide risk, and I would like the Minister to address that.
Mr Pirie and I have organised an open letter and had a wide range of signatories to it. These include Steve Mallen from the Zero Suicide Alliance, who has already been mentioned, Mind, Samaritans, Papyrus, General Sir Nick Carter—we were very privileged to have his engagement with us—and a cross-party selection of MPs. This is really about discussing the current suicide risk assessment procedure, because we think that it needs some serious and urgent attention. We think that the standardised risk assessment tools as they are currently being used are poor predictors of suicide, and national guidelines have determined that they should not be used for that purpose. There is widespread concern that risk assessment tools are being used ineffectively, and that it is leading to the outcomes that we have seen in the case of Tom Pirie and others. We think that suicide risk assessment tools have a positive predictive value of less than 5%, which potentially means that they are wrong more than 95% of the time.
In its “Self-harm and suicide in adults” report from July 2020—the month that Tom Pirie took his life—the Royal College of Psychiatrists stated that
“the current approach to risk assessment is fundamentally flawed.”
The Government published a suicide prevention strategy for England in 2012, and they have recently announced a review and issued a call for evidence. The National Suicide Prevention Advisory Group is preparing to issue its recommendations for the review of that strategy, and the letter asks that:
“The Secretary of State for Health and Social Care ensure that the new suicide prevention strategy includes a review of the use of suicide risk assessments in breach of current guidelines and to take appropriate steps to ensure that existing guidance around not using these tools to assess suicide risk be strictly followed by both the public and private health sectors.”
That is a really important point, because there is a lot of mental health support that happens outside the NHS. Informal and unqualified support can sometimes be provided, and it is really important that the public understand and can have faith in the kinds of people who are advertising their support services for mental health patients, and that there is guidance and regulation around what is available.
In 2007, the Department of Health published a document entitled, “Best Practice in Managing Risk”, which underpinned and gave approval to some suicide risk assessment procedures. That important document is relied on by a number of institutions, including the Care Quality Commission and the coroner service, but has not been updated since 2009. We would really like to see the Department of Health and Social Care commit to updating the document alongside the strategy review, to ensure that the best current guidance is available to mental health practitioners in all sectors, that there is appropriate use of suicide risk assessment tools, and that we do not see a repeat of the situation that happened to Tom Pirie, who was assessed as a low risk the very day before he took his own life. I learned, in speaking to Tom’s father Philip, that it gave Tom the sense that he was not being listened to, and that his concerns and troubles were not being taken seriously. Obviously we will never know, but that cannot have been a helpful indicator for him at that moment in his life.
I pay tribute to Philip, who has been incredibly brave, and I know this has been a very difficult time for him. I am here today to urge the Minister to take on board my asks around risk assessment tools, because it would be a great tribute not just to Tom, but to Philip and his wider family.
While the Government have rightly committed to a national suicide prevention strategy to reduce the rate of suicides in England, clinical commissioning groups across the country are experiencing high demand, backlogs and stretched budgets at a local level. The reality is that the Government must not only reduce the backlogs but provide a fully-funded recovery plan for specialist mental healthcare provision, which should include race equality programmes, be impact-assessed, be UK-wide and also level up access to mental health provision.
A survey conducted by NHS Digital found that one in six children in England had a probable mental health condition in 2021. Over the years, many families in my constituency have contacted me regarding their inability to secure child and adolescent mental health services, such as autism assessments or mental health provision, for their children. Indeed, I have spoken about that in Westminster Hall.
It is shocking that children in my constituency of Bradford West have to wait longer for assessments and treatment than their wealthier peers. Psychiatrists have accurately described that disparity as a scandalous postcode lottery. A child in Bradford had to wait 807 days to access CAMHS services, while in Staffordshire children waited an average of seven days—800 fewer days than a child in Bradford. The Government must urgently address that disparity and provide a plan of action to ensure that people no longer suffer in silence. I look forward to the Minister’s response in today’s very important debate.
My constituency of Strangford has unfortunately had those experiences as well. In Newtownards, the largest town that I represent, there was a period that saw a spate of suicides among young men—a group of young friends. If someone takes their life, those around them are deeply affected. What thoughts does the Minister have on how to address that issue? Every one of us here can probably confirm that that is an issue—I know that I can. It was quite difficult when some of the funerals took place: that circle of friends was decimated and devastated by what took place. In addition, data is presented in the year the suicide was registered, so as inquests are a long process, there are many still to be discovered. I see that in my own constituency.
There is more that can be done in all aspects of government. In health, education, the Department for Digital, Culture, Media and Sport, and transport, there is a lot of room for much-needed improvement in suicide prevention. There are also increased suicide rates among young children. Another thing that grieves me and, I think, others in this House is that social media is one of the most prominent confidence-killers in modern society: children being nasty to other children online. We read truly horrendous stories in the press of young boys and girls taking their lives because they feel pressurised by other children, or sometimes exploited by adults. We have a duty to ensure that, through legislation such as the Online Safety Bill, they are protected and not subject to abuse. I understand that that is not the Minister’s responsibility, but it might be helpful if she can tell us about any discussions with other Ministers on how the Government can address those issues.
We have spent a lot of time discussing the pandemic and its impact on our daily lives, which is not always good—sometimes it is uplifting, but sometimes it is quite disheartening. We must not underestimate the effects of isolation on mental health. As we come out of the pandemic—in England, there are no longer requirements for isolation—people have the opportunity to seek proper face-to-face help. The issue is now whether the support is readily available and accessible for all, which is where we must step in to help with suicide prevention. We should be ever conscious of where we are and how we move forward. I know that the Minister is a lady with a deep interest in her portfolio, and that she understands the issue only too well. I am hopeful that in her response to all our requests, she will speak about what extra help there will be after the pandemic to ensure that those who face today’s complications, problems and overwhelming issues will receive the assistance that they need right now.
Suicide affects many people, and it leaves a nasty scar for friends and loved ones left behind. That is the story in my constituency, and in the cases that I have seen; there has been a spate of young lives lost. As the hon. Member for Bristol East mentioned, Mr Speaker made some powerful comments on the death of his beloved daughter. He stated:
“When it happens, you never get over it”.
How true that is for everyone. For those I know who have lost loved ones, that scar, deep pain and hurt are right in their heart. We can see it in their eyes; they do not have to say a word—look at them, and there is the story. We must learn from this and put our words into action; through legislation, through support, through normalising talking and breaking barriers, we can tackle suicide and initiate support for those who need it. Everyone here is all too aware that there is a fine line and balance between normalising talking and keeping your life, and perhaps tipping over the edge. We all have to face that line; some people have faced it and unfortunately ended their life as a result. It is about how we step in, how the Government step in and how the Minister steps in to make a difference.
Mental health has been characterised as a silent killer, but it affects us all at some stage, through our families, through our friends and through our constituencies. We all share the heartache of suicide and what it can do to families. I commend and thank the hon. Member for Bristol East for bringing forward this timely debate on such a crucial issue. As a former member of the all-party parliamentary group on suicide and self-harm prevention, I can assure her that in this House we all share the desire to do everything we can to help to address suicide prevention. We look to the Minister, as we often do, for the answers to our questions, which we seek not for ourselves, but for our constituents.
Despite that harrowing evidence, there has been no national alcohol strategy since 2012. I welcome the Government’s recent efforts on tackling illicit drugs and gambling and tobacco harm. My question is: where is the effort on alcohol? To fully understand the current scale of alcohol harm, and to provide targeted recommendations to improve outcomes for people with co-occurring mental health and alcohol-use conditions, I would like to see the Government conduct a Dame Carol Black-style independent review of alcohol harm. I hope the Minister will respond to that point.
I will finish by mentioning a place in my constituency that I have visited over the years. Paul’s Place was set up by the parents of Paul Williams; Paul and I went to school together, and he took his own life in August 2015. Paul’s Place offers bereavement support to families who have lost members to suicide. I invite the Minister and the Opposition spokesperson to visit Paul’s Place to talk about the important work it does for communities across Walton, and how its funding can be sustained.
The hon. Member for Strangford (Jim Shannon)—who is in his place in most of the debates that I happen to attend because he is such a strong advocate for his constituents—spoke about the devastating suicide rates in Northern Ireland, and something else that is very important, which was the impact of and bullying on social media. I think that that is something that really must be tackled. I know, from some work I have been doing with the Diana award in Parliament, that it has been supporting young people’s advocates across schools in the UK—anti-bullying ambassadors to give children and young people peer support—because often young people prefer to speak to peers than to parents. I know that myself, particularly from having adolescents at home who do not want to be seen with or speak to me at this stage in their life.
The hon. Member for Richmond Park (Sarah Olney) also raised an important constituency case—I am so pleased that the family is here today—that families are not listened to enough. Well, if we are not listening to families, who are we listening to? Families know people better than anybody else. I think that long gone is the time when we say, “Well, professionals know best.” It should be an assessment that involves everybody, wherever possible. Families who want to reach out to services are doing that because they have anxiety that something that is traumatic is going to happen in that case. They know that person better than anybody else, so they must be listened to.
When I worked in mental health, the training and risk assessment were very clear; it is not a static assessment; it is dynamic—it changes. That is the thing about it. The British Psychological Society issued guidance on risk assessment. A risk assessment is not a questionnaire; it is a clinical judgment with tools that help that. However, it also must highlight risk indicators. Importantly, it is not just that an assessment is completed; it is that there is a risk-management plan as well—people are aware of their risk indicators, they know when risk is heightened, they know who to seek help from, and that there is a risk-management plan that can protect them and prevent harm coming from risk. The point made by the hon. Member for Richmond Park is key, and I wish her all the support that I can give for her campaign for these matters to be taken forward and for key frontline staff to be given adequate training in risk assessment.
As chair of the all-party parliamentary health group, I hear constantly that the bar is set too high for access to services. Some of the things said are that because someone might have a personality disorder, they could not benefit from treatment. Well, we know that people with personality disorder diagnoses still suffer from mental distress, so of course they should be able to access treatment for that mental distress. That should not be a barrier to treatment. There are also psychological therapies that have been shown to be clinically valid for use in those cases, but people cannot access them.
People who have drug or alcohol problems may present at accident and emergency and be told, “Well, you’ll have to deal with your addiction and then come back and deal with your mental health problem.” However, that is not right either, because we know about the risk and the importance of services being integrated and created for dual diagnosis. Where people have more than one clinical condition, it is very important that both are treated together because, as has been said, mental health might be one of the triggers for alcohol and drug use, which, of course, exacerbates it.