Sunday, August 31, 2014

Suicide: a big issue

Following the tragic death of Robin Williams, suicide has caught the public's attention, especially because of the sensational news coverage, about which Mary Hamilton had some trenchant criticisms (htp: Anna Raccoon). Hamilton showed how the reportage contravened the Samaritans' media guidelines, which aim to prevent the ripple of self-destructive behaviour that can come after a high-profile case.

A somewhat more responsible follow-up came in this weekend's Mail On Sunday, in which Fifi Geldof revealed her own history of depression and substance abuse. Although her difficulties appear to date from her parents' divorce, Geldof says, "Depression just exists. It doesn’t have to be for a reason." She also says that she never seriously considered suicide, because "there are people that would hurt. And quite frankly there’s been enough death in our family. It’s not something I would do to them." And several times, she refers to putting on a mask, so that even her father would not know what she was going through.

The Samaritans' guidance echoes that first point: "There is no simple explanation for why someone chooses to die by suicide and it is rarely due to one particular factor." And the second point is corroborated by the American Foundation for Suicide Prevention, which lists some protective factors:

  • "Receiving effective mental health care
  • Positive connections to family, peers, community, and social institutions such as marriage and religion that foster resilience
  • The skills and ability to solve problems"
But as the Samaritans observe, "effective mental healthcare" is often not sought or provided:

"Most people who make suicide attempts or who die by suicide are not in contact with healthcare services in the month before their attempt or death. Only half of all people who die by suicide have ever been in contact with specialist mental health services.

"The medical and/or psychiatric conditions that could lead a person to take their own life are potentially treatable."

The third thing, the mask, is a challenge. I had a friend in a different town who had been showing signs of depression, yet when a mutual friend bumped into him one day and put him on the mobile to me, he seemed far brighter, perfectly normal even - and that was the last time we spoke. It happens to the roughest and toughest, too, as ex-SAS soldier Andy McNab recounts in "Seven Troop" - McNab contrasts the British Special Forces' lack of access to/ fear of accepting mental health care at that time with the US Army's, where counselling for these high-stress performers is routine and not seen as some kind of admission of failure or weakness. The problems of stigma and hiding rather than seeking help, are addressed in this heartfelt and disturbing article on TIP News.

Mental health issues are far more important than one might gather from TV news and drama programmes. The risk of being murdered in the UK is around 1 in 100,000 per annum, whereas suicide is about 12 times more common*. In the United States, the murder rate is higher - about 4.8 per 100,000 population - but still dwarfed by the suicide rate, which is very similar to Britain's. In Japan, one of the safest countries in the world in terms of violent crime, the contrast is even starker: 0.3 for murder, but 21.4 for suicide.

It's well known that suicide is more common among males than females, and the rate also varies with age, but there are surprising regional variations too. In small communities blips in the absolute figures make more of a difference to percentages, and stigma may also affect statistical reporting. That said, it would seem that far and away the worst risk for suicide is in Greenland (83 per 100,000), followed by Lithuania (31) and South Korea (28.1).

Contrariwise, and still bearing in mind the statistical caveats, we see that other nations can have a very high murder rate and yet be relatively unaffected by suicide - e.g. Haiti at 10.2 for murder, but apparently no recorded self-murder. However, for 70 out of 110 countries reporting in both categories, suicide is as big a problem as murder, often far bigger.

Perhaps these two categories could be taken as, respectively, very crude indicators of good social order, and (shall we say) good or healthy psychological order. At any rate, the World Health Organisation has said (in 2012) suicide prevention is "a priority condition globally... suicide is a major problem and... it is preventable... The lack of resources – human or financial – can no longer remain an acceptable justification for not developing or implementing a national suicide prevention strategy."

What are we doing about it in the UK?

Scotland chose to tackle this issue quite some time ago, and has seen significant progress:

"Since 2002 – when the target was originally set as part of the Choose Life strategy and action plan – we have seen an 18% reduction in the suicide rate across Scotland."

England followed - ten years later - with its "Preventing suicide in England: A cross-government outcomes strategy to save lives" - and produced its follow-up report a year on, here.

Better late than never.


* (but the ONS suggests the figure is 8 in 100,000 instead - see page 3 here).


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