The statistics would have you believe we are in the throes of a suicide epidemic right here in the UK – and they’d be right.
Some say we are too quick to attribute the notion of an epidemic to suicide rates – calling it callous or unethical – even though one person dies by suicide in the UK every 90 minutes. Globally, one person takes their own life every 40 seconds.
If we were being semantically accurate in a world where we acknowledge mental health is just as important as physical health, we’d call it a pandemic.
It’s hard to reduce the lives of the many who die by suicide to a number, or a turn of phrase usually reserved for medical textbooks, but knowing who takes their own life – and when – is fundamental to preventing suicide.
In 2017, 5821 people killed themselves in the UK. The latest statistics provided by the Office of National Statistics show 1077 people in England took their own lives in the first quarter of 2018 alone.
That’s 12 people every day. 12 lives lost to a preventable disease – and an estimated 20 times as many attempts.
The NHS offers advice if you are feeling suicidal, or you’re worried about someone else:
It’s an unthinkable number, representing deep sadness and pain in homes across the country. A statistic simply can’t expound that kind of loss.
But examining certain demographics can help prevention charities and organisations look out for those most at risk, such as middle-aged men or those experiencing social deprivation, isolation or discrimination.
Statistics tells us suicide prevention is, in the words of the World Health Organisation (WHO), a ‘global imperative’.
So it’s alarming to discover the so-called suicide epidemic is ‘very likely’ much worse than the numbers show, potentially underestimated by 30 per cent.
Furthermore, the number of suicides among young people could be as much as 50 per cent higher than official figures suggest, as coroners can be disinclined to record a verdict of suicide.
A 2015 study conducted by Professor Colin Pritchard at Bournemouth University found a ‘strong indication’ of under-reported suicide in the UK, Portugal, Switzerland, Sweden, Denmark and Germany.
On a global scale, WHO say the ‘problem of poor-quality mortality data is not unique to suicide’ but, given the sensitivity of the subject, ‘under-reporting and misclassification are greater problems for suicide than for most other causes of death’.
In Preventing Suicide: A Global Imperative, WHO corroborates the study findings saying the likelihood of under-reporting is partly because of archaic legislation, in nations such as Japan, where suicide is considered illegal, but not punishable.
Believe it or not, we are experiencing the fallout of the same such archaic views right here in the UK.
But there are charities, organisations and individuals out there trying to fight stigma:
Ruth Sutherland, CEO of Samaritans told UNILAD the stigma around taking your own life has influenced coroners’ reporting of suicide – informed not just by the law but also by cultural, religious and social conventions – and created the notion that a verdict of suicide is something to be avoided.
There’s been a view that it’s somehow ‘kinder’ to record a verdict other than suicide. This compounds the stigma rather than challenges it.
It can take months or even years for a suicide to be registered in England and Wales, leaving a dark shadow over the bereaved and a life lost, yet left in limbo in the eyes of the authorities.
Professor Pritchard thinks the oversight is hiding – and even compounding – the ‘double-edged’ tragedy of suicide.
Back in 2014, Samaritans joined forces with Sense about Science to bring this issue to the attention of the Prime Minister, David Cameron, in an open letter, championed by Madeleine Moon MP, the Chair of the All-Parliamentary Group on on Suicide and Self-Harm Prevention.
The open letter detailed the ‘obvious implications’ of failing to register suicides in a timely manner, saying the system failure would ‘hinder our understanding of suicide unless they are addressed’.
It gave real time examples of the failings and their impact on research and prevention:
Researching whether there was a spate of suicides after the onset of the financial crisis, for example, requires analyses by death-year, not by the delay-staggered registration-year of suicides.
The reduction in road traffic accident fatalities following legislation on the wearing of rear-seat belts was obscured in official statistics due to delays in registering these deaths but was immediately evident to police forces on the ground.
The statistical system in England and Wales is embarrassed by its unacceptable failure to properly count the dead.
Samaritans asked the government to reduce the time it takes to register deaths and emulated the processes in Scotland – where the maximum time between a death and initial verdict on the cause of death is eight days.
Three years later, in 2017, the Samaritans Suicide Statistics paper referenced their demand and said ‘there have been no improvements since’.
You’d think, then, with delays in coroners’ verdicts prevailing, suicides would be more accurately registered here in England. But Professor Pritchard found they are mis-categorised and marked in WHO stats as ‘undetermined’ or ‘accidental’ at a concerningly high rate.
His team also found the UK has a disproportionately higher rate of undetermined deaths in every age band than any other country.
Moon said she feels ‘certain’ some suicides were missed in the past ‘as part of national statistics’.
A spokesperson from the ONS told UNILAD there are some ‘narrative verdicts’ handed down by coroners which are classified as ‘hard-to-code’ by the ONS because the coroner does not explicitly state whether the death was accidental or not – and these vague verdicts are not included in the ONS mortality figures for suicide.
In 2017 there were 2,579 hard-to-code narrative deaths in England and Wales, 1250 of which had external causes, the majority of which are chalked up to accidents.
Citing a 2013 press release, the spokesperson added:
The rules for coding cause of death mean that, if no indication of intent has been given by the certifier, a death from injury or poisoning must be coded as accidental.
But the ONS do estimate a simulated number of suicides to take these potential discrepancies into account.
They calculate the number by assuming half of the deaths given a hard-to-code narrative verdict – in other words, officially coded as accidental hanging or accidental poisoning – were in fact intentional self-harm.
That simulated number is 4959. That’s 148 more than the 4811 registered suicides last year.
In practice, even where a person took steps to end their life, the coroner or a jury can return an alternative verdict, like ‘narrative’ or ‘open’, because it’s seen as ‘kinder’ to the family, Sutherland said.
While Moon states some coroners have been cooperative with researchers where evidence indicates suicide, in other cases, coroners have been alleged to avoid a suicide verdict, knowing families and friends can be comforted by the thought that their loved one didn’t mean to take their own life.
The implication of their actions speaks to society’s strained relationship with those who have died by suicide – and unjustly implies it’s wrong or shameful to have suicidal thoughts, thus stigmatising the ailment and isolating sufferers further.
Sutherland understands the sensitivities in these matters, and doesn’t wish to normalise suicide, but does believe acknowledging the ‘intolerable’ truth of suicide and its prevalence in this country is important in fostering compassion and transparency.
Furthermore, Arun Chidambaram of the Mersey Care Trust and Zero Suicide Alliance’s Deputy Medical Director and Consultant Forensic Psychiatrist told UNILAD:
Under reporting has an impact on our ability to interpret data in a timely way to see if the measures we have in place make a difference.
In terms of what we have been doing as a Trust is to investigate suspected suicides as you would investigate definite acts of suicide. This ensures the learning is not lost.
Despite these measures, the ‘grey area’ in some coroners’ reports has been challenged consistently by campaigners and MPs sitting on the All-Parliamentary Group on on Suicide and Self-Harm Prevention.
In July this year, the High Court ruled coroners must now use the civil standard of proof ‘on the balance of probabilities’ in reaching a conclusion of suicide at inquest, instead of the the criminal standard, which requires a verdict ‘beyond all reasonable doubt’.
The ONS are ‘unable to tell in advance the impact that the change in law will have’, but will be monitoring any changes subsequently.
Moon, who has raised the issue in Westminster, added:
Whether it is the right change and the most effective change will be a matter for analysis by academics and others.
Right or wrong, the ruling goes some way to expelling the narrative which sometimes still equates suicide to criminality, still perpetuated over 50 years after the government acknowledged it was unethical and unjust to criminalise someone desperate enough to take their own life.
Glenn Flynn, PAPYRUS chief executive, said the judgement will ‘ultimately save young lives’:
Suicide remains a real taboo subject, largely because it was once a crime. Despite a change in law over 50 years ago, we still talk about ‘committing suicide’ as though it were still a crime.
The new ruling means that there will be more deaths recorded as suicides, hence giving us a truer picture of the numbers of people taking their own lives.
More importantly, the new ruling addresses the stigma around suicide and will help people of all ages to discuss openly issues around suicide.
The new ruling should also eliminate the ability of coroners to only register deaths as a suicide when there is no other option, as they are want to do to appease the heartache of those left behind.
You might assume this coronial undercutting protects those who have lost someone to suicide.
But, not only does it have a detrimental impact on suicide prevention plans, it also hampers the ability of the bereaved to get the appropriate help, from pioneering practices like The Western Health and Social Care NHS Trust, in Derry, Northern Ireland which developed the first postvention service in the NHS.
Moreover, inaccurate suicide statistics also means exposure to suicide is underestimated too, Dr. Sharon McDonnell, Managing Director of Suicide Bereavement UK and Honorary Research Fellow at the University of Manchester’s Centre for Mental Health and Safety, tells UNILAD.
The most recent study suggests up to 135 people are affected by every suicide.
Suicide bereavement is multifaceted, traumatic and influenced by numerous factors which are often interrelated, Dr McDonnell said, and those experiencing it need to be able to seek help.
Dr McDonnell continued:
Exposure to suicide is widespread and hugely underestimated. A single suicide affects many individuals.
The majority [of those left behind] experience an array of emotions – despair, shame, blame, guilt – and feel judged, stigmatised and ostracised by their communities.
These emotions often evoke a sense of helplessness and hopelessness, which are key risk factors for suicide.
Dr McDonnell, who also lost a loved one to suicide, says people bereaved by the sudden death of a friend or family member can ‘suffer from suicidal ideation and complicated mourning’.
Citing a 2016 study, she adds they are also 65 per cent more likely to attempt suicide compared to those whose loved ones died by natural causes.
It’s important to identify signs of potential risk:
Accurate figures can prove suicidal thoughts can affect anyone, don’t discriminate, and are not wrong or shameful. They can show us how to take better care of those at risk.
They can quantify collective grief, show no suicide is an isolated event, and help those affected feel less alone. But they have to be reported correctly and understood to be used as a tool in suicide prevention.
Under Theresa May PM, the government have committed to reducing suicides in England by 10 per cent by 2021 to support the ‘zero suicide ambition’ for mental health inpatients announced by Secretary of State Jeremy Hunt in January, 2018.
But one question remains.
If the government fail to see the under-reporting of suicides is perpetuating the societal taboos which still hinder the suicide prevention mission – and do a disservice to the lives lost to suicide, registered by another name – how can they hope to usher in a new era where fewer people feel so desperate as to take their own lives?
While McDonnell says it’s important not to allow the semantics of the ‘zero suicide mission’ impact negatively on the bereaved, Moon dubbed the mission for zero suicide a ‘laudable goal’ and emphasised the importance of enabling and empowering local authorities in determining how best to reach out to those at risk through suicide prevention services.
The Government also have a responsibility for coordination. It is important that all of the agencies involved in suicide prevention work together.
The police, heath staff, coroners, third sector organisations, Local Authorities, media, academics, as well as political figures, locally and nationally, have a role to play.
No one agency carries full responsibility or capability to tackle suicide, which is why suicide prevention planning is vital at both a local and national level.
All the while, we can all contribute to a healthier and happier society with reduced – even zero – suicide if we learn to rid the narrative of stigma and listen to others without judgement.
This week is National Suicide Prevention Week in the US. Follow UNILAD’s Suicide Prevention series every night at 8pm BST over the next week on our social channels to find out more.
If you’ve been affected by any of these issues, and want to speak to someone in confidence, please don’t suffer alone. Call Samaritans for free on their anonymous 24-hour phone line on 116 123.
In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found at Suicide.org.
Save a life. Take the free suicide prevention training provided by Zero Suicide Alliance today.