‘Died by suicide’ is the term to use nowadays, ‘committed’ suicide implies that a crime has taken place – which has not been true since The Suicide Act of 1961 decriminalised the act of taking one’s own life. However, a degree of judgement remains in our society that it is an appallingly destructive act which causes immense pain to those left behind. Suicide is such a difficult topic to deal with, even the most experienced mental health practitioners struggle to find effective strategies to support or heal their patients.

A coroner may declare that someone was of ‘unsound mind’ at the time they took their own life.  And that may well be the case, but not all people who end their lives by suicide are mentally ill as defined by the Mental Health Act 1983. Which means that in most cases a person who is actively planning to end their life is not able to be sectioned under the Act or restrained from doing so in any physical way.

These are the Suicide figures for England and Wales from the Office of National Statistics:

  • In 2020, there were 5,224 suicides registered in England and Wales, equivalent to an age-standardised mortality rate of 10.0 deaths per 100,000 people and statistically significantly lower than the 2019 rate of 11.0 deaths per 100,000.
  • The decrease is likely to be driven by two factors; a decrease in male suicides at the start of the coronavirus (COVID 19) pandemic, and delays in death registrations because of the pandemic.
  • Around three-quarters of registered suicide deaths in 2020 were for men (3,925 deaths; 75.1%), which follows a consistent trend back to the mid-1990s.
  • The England and Wales male suicide rate of 15.4 deaths per 100,000 is statistically significantly lower than in 2019 but consistent with rates in earlier years; for females, the rate was 4.9 deaths per 100,000, consistent with the past decade.
  • Males and females aged 45 to 49 years had the highest age-specific suicide rate (24.1 male and 7.1 female deaths per 100,000).
  • For the fifth consecutive year, London has had the lowest suicide rate of any region of England (7.0 deaths per 100,000), while the highest rate in 2020 was in the North East with 13.3 deaths per 100,000.

In recent years a good deal of work has been done to encourage us to talk about suicide. Currently on British TV there are a number of campaigns running, some are public information films, others are commercial brands opening up the subject. Which is hugely positive because talking about suicide to someone who is having thoughts of it doesn’t increase the risk, it has the opposite effect.

Sadly, we are all too familiar with news stories where friends and family say: I just wish he or she had talked to me. But by the time someone is contemplating suicide they are often feeling so isolated from anyone else they can’t open up about it. And there aren’t always recognisable signs to show that someone is suicidal. There are often cases when all the investigations have been done, the reports completed and the final conclusions drawn, that show the individual had reached a calm decision to end their life and, in so doing, presented a serene calm to those around them. So, as ever, there are no easy answers.

As the Safeguarding Lead at Psychiatry-UK I receive reports almost every day of patients expressing suicidal thoughts or even active plans to kill themselves. Suicide may not come directly under the safeguarding remit as outlined in the Care Act 2014 because that focuses primarily on how services respond to all forms of abuse. However, how a health provider like us responds to suicide becomes a safeguarding matter if we get it wrong.

As a remote working service, we are very limited in how we can risk assess and risk manage a situation where some may harm themselves. But we do have some excellent multi-agency supports we can, and do, draw upon: In an emergency we can request a Welfare Check by calling 999. This may result in either a police officer or police community support officer calling round to check on the patient. In some areas there are specialist ambulance crews with psychiatric nurses onboard who do the same job. We can signpost services to the patient letting them know where they can get immediate help, such as NHS Direct by calling 111, or attending A&E where they can access local mental health services. The Samaritans also do an excellent job providing frontline counselling services which in the darkest of hours have provided many a lifeline.

We are indebted to these services for the excellent job they do when things are beyond our reach. But they only work when we listen carefully and are not afraid to have that conversation about this most difficult of subjects.

Steve Wilcox

Psychiatry-UK Safeguarding Lead