‘Died by suicide’ is the term we tend to use nowadays. The old fashioned way, saying that someone ‘committed’ suicide, implies that a crime has taken place – which has not been true since The Suicide Act of 1961 decriminalised killing oneself. Unfortunately that culturally resonant judgement is still there in our attitudes to this ultimate way of ending the distress caused by one’s mental state.  People, (especially men) are often still too ashamed of feeling suicidal – which is a big part of the problem of course.

A coroner talks about someone being of “unsound mind” at the time of the event and I tend to agree with that. To kill oneself is, almost inevitably, an act of someone suffering from an unsound mind. I’ve been there, with the friends, the relatives, and everyone involved in the misery and distress of a life lost in such circumstances. All those people saying “I just wish he’d talked to me”:  but it’s such a very difficult topic isn’t it? It’s not just really hard to talk about, it’s tough to even think about. So let’s plunge right in and start by looking at some of the raw data.

The facts

According to Samaritans, who really do know what they are talking about, in 2017 there were 5,821 suicides in the UK. So that is almost 500 per month – or 16 every day. It sounds really terrible when you put it like that doesn’t it? So how about the fact that 12 of those 16 will have been men? How about the fact that the highest suicide rate in the UK is for men aged between 45-49? So who are you thinking about now?…

Actually, truth be told, there has been a significant decrease in suicide numbers, especially in those male suicide numbers, in the UK. The male suicide rate is now at its lowest in over 30 years. At least some of that is due to the fact that a lot of resources are now being pushed at the problem. Unfortunately, we can’t claim to be on top of the issue yet as we can still do much more, and in the end, every suicide is a devastating event for someone. Knowing that fewer people in this country are now killing themselves doesn’t make it any easier for anyone who has lost a relative this way. Sadly, the suicide of someone close to you is something that really never ever leaves you.

The feeling

I’ve worked in mental health for over 30 years. Anyone who has worked in the field for even a short time will have their own indelible memories of patients they have lost through them killing themselves. For me the one that comes to mind wasn’t a man – it was a woman. She was a thirty-something teacher who gave a really good account of herself on her first morning on the ward and was so upfront about her history of moderate self-harm and so chipper and positive that we were all sure that she’d been wrongly referred to our service. She was found dead in her room just two hours later.

It just made you question everything you thought you knew. At those times it doesn’t matter how ‘professional’ we all were, or had to be, we just felt bewildered and doubting of our own abilities. You cannot help but feel it personally too: I remember a particular young man with whom I had a long professional relationship, who, after a decade of slowly losing his battle with schizophrenia, simply gave up: he absconded from the secure ward I was working on and found a tall building. I remember how angry I was with huge shame. It’s a cliche, but it is true; I still sometimes wonder, if I had been in that morning, whether I could have changed things. You can’t help it – because you didn’t help it.

The family

The fact is, statistics only tell a tiny part of the story. The waves from each of those deaths spread out and swamp loved ones, families, communities, (and those teams of dedicated professionals who try their best,) with a terrible sense of loss – and failure. Not just at the time but for years afterwards. There is a bit of me that is really glad that I’m not there on that front line any more. I’m a designated safeguarding officer now – and a hugely important  part of my work is about trying to safeguard against suicide.

My work

There are two parts to my job. The first bit is the boring bit: it’s the job of making sure that everyone is thinking about safeguarding; making sure that everyone has done the training, seen the video, read the policies; making sure that everyone knows to come to me to get advice; making sure that they have ticked the boxes….

I really wish that that was all of my job. The second part of my job is investigating if a service I am working with has failed someone. Sometimes that is just about being able to say that we had done the best that we could; sometimes it is about learning lessons; but, sometimes,  and at its worst, it can be about apportioning blame. That’s why I try to spend as much of my time as I possibly can trying to interest people in the boring bit – because it isn’t really boring – it’s crucial. It’s all about prevention.

What is being done

Of course a suicide is not “just” an issue for our overstretched mental health services. Approximately two thirds of those who kill themselves are not even in contact with mental health services according to Public Health England. I’m glad to say that the Department for Health and Social Care, Public Health England (PHE) and NHS England have now commenced  a 3-year programme worth £25 million that will aim to reach the whole country by 2021 as part of the government’s commitment to reduce suicides in England by 10%. This will support the zero suicide ambition for mental health inpatients announced by Jeremy Hunt in January 2018.

So what else can they do? Of course there are no easy answers or handy solutions when it comes to helping an individual wishing to end their own life to avoid taking that drastic decision. However, those of us who work in the field know that some things really do help: the Samaritans are really on the frontline of supporting people who perhaps might decide to have one more throw of the dice and call them up. They do a wonderful job. You might think that you see their number everywhere nowadays – and I hope you are right. This is simply because people like the police, local authorities or just thoughtful individuals have made the effort to place small notices with the Samaritans’ number on it in strategic locations; railway platforms and bridges for example. There is statistical evidence that this reduces suicides and suicide attempts in those locations.

Another area where the authorities are trying to be more proactive is by supporting the families of those bereaved by suicide. There is statistically a higher prevalence of suicide in families and relationships where there has been a previous suicide, so it makes really good sense to provide some extra help there. The NHS has produced ‘Help is at Hand’, a booklet offering support to those close to someone who may have died by suicide and it is actually a pretty helpful little book, dealing with the practicalities as well as the emotional and health related fallout from a death by suicide. I would go as far as to say it’s an informative read for health professionals too and I try to get everyone who is involved in working in mental health to read it. It has good clear ‘what to do’ and ‘what not to do’ guides and gives us all some solid clues as to how we can support someone going through what must be amongst the worst of times they will ever experience. If you know someone who has been affected by suicide I recommend that you have a look at ‘Help is at Hand’ if you want to help them – or yourself.

Don’t give up – what else can you do?

Nobody has the definitive answer when it comes to preventing a suicide. Ultimately it’s going to be the sum of all the little things that we all do that may reduce those statistics, bit by bit. So every one of us can do one little thing to help – you too can talk to someone about suicide.

Just have a look at your friends and neighbours and think about whether any of them might need someone to talk to.  Then have a little look at yourself. Do you need to talk about suicide with someone? You should do.

Talk to a friend;

Talk to your GP;

Talk to us;

Talk to the Samaritans – 116123.

Talk about Suicide

Steve Wilcox

Psychiatry-UK  Designated Safeguarding Lead