AS I WRITE this, World Mental Health Day draws to an end for another year. For me, it’s a time to reflect on what it means to experience a period (whether brief or lifelong) of poor mental health, and how we as a City respond and support each other through this.
Whilst we should be proud of our City’s work in this area, our focus should really be on the sobering facts that the research raises
This year seems particularly pertinent, considering the content and impact of a new report from Public Health Consultants in Leeds reporting on deaths by suicide from within our area.
Leeds is beginning to create a rich body of mental health research. Recent work to be proud of includes the Northern IAPT Practice Network which helps to increase the number of professionals getting involved in research and makes that research more accessible to a wider audience, the COBRA Trial which explored less intrusive treatments routes for depression, and this month the aforementioned report on suicides in Leeds.
Whilst we should be proud of our City’s work in this area, our focus should really be on the sobering facts that the research raises. Between 2011-2013, 213 people died by suicide in Leeds. Whilst on a spreadsheet this is only a 1% rise since the 2013 audit, that equates to an additional 34 lives lost through suicide.
The report looked at factors like age, ethnicity, sexuality, gender, social isolation, employment, and economic situation to create a framework which helps explore how these areas all interact to predict risk factors for suicide, and therefore how we might be able to do something about it.
The report paints quite a sad profile of those who died. The majority were aged 40-49, and five times more likely to be male than female. These deaths were also linked to social isolation, with 70% of the people who died being single, divorced or separated. This pattern of also extends to economic isolation with over half (55%) of those who died living in the most deprived parts of Leeds, with 40% experiencing financial issues, and 35% being unemployed. This link with economic hardship is - in my opinion - crucial in terms of learning (and this article in The Guardian suggests I’m not the only one thinking this).
The report states that a significant majority of those who died were white and heterosexual, but in this area there are glaring (and in fairness to the report's authors – acknowledged) gaps of knowledge regarding the deceased’s sexuality and ethnicity due to the way data was collected.
We know that as individual populations, LGBTQ, immigrant, and refugee communities have higher rates of self-harm and suicide, and to ignore this distinction in the research and recommendations could be a very serious omission if not looked into fairly soon given the current political climate.
One huge finding for all of us working within Leeds NHS was that nearly half (45%) of the people who died by suicide in this period visited a Primary Care setting (such as a GP or non-crisis mental health service) in the month before their death.
Was anything said at these appointments that could have been followed up? What questions should we be asking routinely that we might not be to help detect and prevent these deaths?
It's a difficult question as some would argue that we already ask a lot from Patients regarding risk, but this 45% is an important number.
While the recommendations of targeting the most at-risk groups is a great idea, we need to make sure we actually are taking the right groups into account. That's not to say ignore straight, white men in their 40’s, but let's also follow up research on LBGTQ, immigrant and refugee people and suicide and look into this locally to ensure we’re meeting the needs of all the vulnerable groups in our City.
There is an increasing sense of hopelessness and powerlessness in the UK, both of which have strong correlations with depression and suicide.
The report also focuses on ensuring all groups working with at-risk people are more closely linked. As a mental health professional, I couldn't agree more.
I've seen first hand how our effectiveness of mental health support increases when charities, the NHS and Social Services work closer; any increase in guidelines on this can only be a good thing.
The report also encourages better working with local media to reinforce guidelines on reporting deaths by suicide, which follows some fantastic work demonstrating the impact of responsible reporting both on reducing future deaths, and reducing the impact of deaths of family and friends of the bereaved.
One of the last recommendations centres on reducing access to means of suicide, basing this on the evidence that a significant number of deaths in this report occurring outside of people’s homes occurred from the roofs of high buildings.
Whilst there is evidence that reducing the means to suicide can reduce deaths, this also somewhat diminishes the focus that the majority of deaths in this report occurred in people’s own homes. Perhaps what we should be focusing on is why there continue to be deaths by suicide in Leeds and across the UK?
Whilst this is a powerful report it doesn't talk about the wider political situation we find ourselves in and what this means for the future. There is an increasing sense of hopelessness and powerlessness in the UK, both of which have strong correlations with both depression and suicide. It would therefore be helpful to increase our focus on this bigger picture to build on current research in suicide prevention.
Toby Chelms works for a local charity providing mental health services, and the views expressed are his own. "I Read So You Don't Have To" is his blog dedicated to de-jargoning mental health research.
Help is out there though and in Leeds we have a number of organisations offering it. If you or someone you know is in need of immediate support due to a mental health crisis then you can call the mental health single point of access on 0300 300 1485 and depending on the need help can be provided the same day. If risk is not immediate but there are concerns about a downturn in mental health then you can also access the Improving Access to Psychological Therapies (IAPT) service. There is also a useful list here of the variety of crisis services and out of 9-5 services here. If you would like to explore a broader range of local services then MindWell is a great online hub of mental health resources and links.