Suicide Prevention: Protect Life Strategy
Edwin Poots (DUP)
With your permission, Mr Principal Deputy Speaker, I wish to make a statement on the publication of the refreshed Protect Life suicide prevention strategy and the importance of cross-departmental involvement and ministerial leadership in its delivery.
On 31 May 2012, the Executive endorsed and approved the publication of the refreshed Protect Life strategy. The original strategy was published in October 2006 and was initially due to run until 2011. At the request of the suicide strategy implementation body, it was subsequently agreed to refresh and extend the strategy to the end of the 2013-14 financial year, the aim being to maintain the momentum in addressing suicide prevention and develop further actions based on our learning from implementing the Protect Life strategy to date. Independent overall evaluation of Protect Life is being taken forward during 2012. The findings from that evaluation will help to inform the development of the next phase of suicide prevention policy from 2014 onwards.
When discussing suicide statistics, we must never forget that every death leaves a heartbroken family and many unanswered questions. Having experienced the sense of devastation felt by families and communities bereaved by suicide, I have made suicide prevention one of my top priorities. It is, therefore, important from the outset that I record my appreciation for the central role that bereaved families and local communities have played in the development and ongoing implementation of Protect Life. Their courage in the face of such personal tragedy is truly inspirational.
A lot has happened since Protect Life was published in October 2006, not least the increase in funding to support the implementation of the strategy, which now stands at almost £7 million per annum. Progress made has included the establishment of the Lifeline crisis response service, local research on suicide, suicide-prevention training and joint departmental working, such as the collaboration between my Department and the Department of Education on the development of a pupils’ emotional health and well-being programme. Despite these programmes and a very high level of commitment across statutory and community sectors, the Northern Ireland suicide rate remains stubbornly high at around 15 to 16 deaths per 100,000 of our population. This has been the case since 2006, following an unprecedented increase in suicide rates over 2005 and 2006 when recorded suicide rates almost doubled those in the earlier part of the decade.
I believe that the introduction of more robust recording processes following the restructuring of the coroner’s office in 2004 partially explains this, and that the current figures are a true reflection of the actual suicide rate in Northern Ireland. In essence, there was probably under-reporting prior to 2005 and although our high rate of suicide is unwelcome, it is better to have an accurate picture of what is happening than to be working with artificially low figures.
The bottom line is that almost 300 people a year are dying by suicide, which is almost six times the number of deaths due to road traffic accidents. Tragically, some families have lost more than one close relation to suicide, and the burden of suicide impacts more on certain areas and among certain groups. The suicide rate is twice as high in deprived areas and males are three times more likely than females to die by suicide. Young males in deprived areas are particularly vulnerable, as are marginalised groups such as those who are unemployed or people with mental illness and addiction problems.
The refresh of Protect Life has drawn on learning from a wide range of sources, including a review of international evidence-based best practice; local research; evaluation of component parts of the strategy; and engagement with community groups. Recurring themes from these sources include the need for training for front line service providers; an enhanced focus on addressing deliberate self-harm; the use of IT communications to reach younger people; a greater focus on males from deprived areas; and proactive outreach in mental health services.
These issues are picked up in the refreshed strategy. For example, while maintaining the original strategy’s long-term goal of reducing suicide rates in Northern Ireland, the refreshed Protect Life strategy sets a new aim of reducing:
“the differential in the suicide rate between deprived and non-deprived areas”.
With a marked differential in suicide rates between deprived and non-deprived areas, particularly for males in the 15 to 45 age group, I believe that reducing this differential has the best potential to save lives.
It is widely accepted that suicide is a societal issue and that no single Department can tackle this issue on its own. Enhanced cross-departmental working is vital. I have met other Ministers regularly over the past year to explore how other Departments can play a greater role in suicide prevention and I have been struck by my colleagues’ willingness to be involved. There is definitely now a greater impetus for a cross-government and cross-agency approach to suicide prevention.
An enhanced cross-departmental approach is reflected in the revised strategy, which contains a number of new actions falling to Departments other than the Department of Health, Social Services and Public Safety. These include involving sporting organisations in delivering positive mental health and well-being messages, identifying specific arts interventions that improve mental health, and providing community-based health checks in rural areas. The ministerial co-ordination group has an important role in ensuring that suicide prevention is a priority for all relevant Departments. I aim to ensure that regular meetings of the ministerial co-ordination group are held to drive forward cross-departmental working on the prevention of suicide and self-harm.
A reduction in suicide will continue to be a major challenge, particularly against a backdrop of increasing economic hardship and high levels of deprivation. The refreshed Protect Life strategy provides the strategic direction for our combined efforts over the next two years.
Go raibh maith agat, a LeasCheann Comhairle. I welcome the Minister’s statement. It would be childish of me not to welcome the fact that we have got to the point of receiving it.
The Minister has highlighted the number of people who die by suicide every year and the impact that that has, not only on families but on communities. That should not be underestimated. I commend the work that takes place daily in our areas. Without it, the reality is that we would be looking at higher figures and statistics. The Minister mentioned the commitment of other ministerial colleagues. I welcome that; I have seen that commitment. Over the past number of weeks, I met a number of Ministers, including the First Minister and deputy First Minister. I met them because, despite all the rhetoric about suicide and self-harm and it being a target and a focus, the ministerial subgroup has not met in 18 months. I do not want to sound too negative; I welcome the statement today and I welcome the commitment of not only the Health Minister but other Ministers. However, the fact that the subgroup has not met in 18 months does not send out the clear message that this is a priority for the Executive.
Although the refreshed strategy is to be welcomed, will you, Minister, give us an idea of what the agenda will be for the ministerial meeting this week? How often will the group meet? Can we have regular updates? The funding for the Protect Life strategy is being extended. Does that mean that new groups that might be formed in the wake of an incident in local areas or new fresh ideas that we gather through research cannot access the current funding?
Edwin Poots (DUP)
There are a number of issues. When I came into office last year, I met quite a number of groups that were involved in suicide. We hosted a conference to bring together all the groups. One of the things that I observed at quite an early point was that an awful lot of people wanted to assist in preventing suicide and self-harm and an awful lot of people had suffered themselves and did not want others to suffer. So many people wanted to help and to get involved, but sometimes it did not have the focus that it should have had, so we brought together all the groups to see whether we could get a better working relationship and a better understanding of what needed to be done.
I have met all the Ministers in bilateral meetings to discuss suicide and what more we can do to meet the issues. As you rightly indicated, the joint ministerial working group will meet this week. At that meeting, we will discuss things such as how we deal with this in the media. Is it something that we wish to highlight through a fairly strong and vociferous advertising campaign? We have been working very closely with the Scottish, who went down that route. Although it could not be described as empirical, the evidence that the Scots have gathered thus far indicates that that has been a positive campaign. We will look at all those things and seek to address them, and we will consider how we, as Departments, can come together and work together. The Department of Agriculture and Rural Development will be involved in the group from here on in, which I welcome.
We identified around £7 million for Protect Life. That is well ahead, in respect of funding per head of population, of any other part of the UK. We remain committed to that. I want to ensure that funding is well spent and that we do not give out funding for the sake of appeasing a group here or there. The Member represents the Colin area. Very good work has gone on in that area. As we all know, that was a cluster of suicide; we heard about it all the time. Thankfully, in the past year, we are aware of only two incidents of suicide. That is two too many, but, thankfully, that is a massive reduction in what went on heretofore. That is a demonstration of where things are working well. We need to look at where people are making the best impacts, learn from that and invest in that.
Edwin Poots (DUP)
The internet is a very powerful tool. It can be a really good thing, but sometimes it can be a really bad thing. For example, it is useful for promoting support, awareness-raising and signposting. Groups such as the National Union of Students and the Union of Students in Ireland use it to reach out to students, which is good. Lifeline operates a website, and the Public Health Agency maintains the Minding Your Head website. However, social networking sites have the potential for negative outcomes. Vulnerable people are often bullied on the internet, and some sites promote self-harm and suicide. There is also the potential for those sites to be used for memorials when someone takes their own life. That is a concern, as those often attract inappropriate tributes that diminish the finality of suicide and almost create a temporary cult status around the deceased that may encourage others to engage in copycat behaviour. We all know that the copycat effect of suicide among young people is very significant. The Member represented Ballynahinch for many years when it was part of South Down. Over that period, a number of copycat suicides took place in that small town, which caused huge consternation, shock and devastation in that community.
We need to make best use of the internet and seek to clamp down on those inappropriate uses. The UK Council for Child Internet Safety was established to help to protect children from exposure to potentially harmful content on the internet and in video games, which is useful given that there are those who promote suicide. Much is being done in respect of the internet. We need to ensure that we continue to make best use of it and, where possible, clamp down on episodes of it being used inappropriately.
John McCallister (UUP)
Like colleagues, I welcome the statement and the changes to, and refresh of, the strategy. Does the Minister agree with me that it is important that we continue with a robust evaluation of this at all times and that we should never be afraid to change something that is proven to be an ineffective intervention and change direction? This is simply too important to not get it right.
Edwin Poots (DUP)
I fully agree with the Member. Evaluation needs to be robust in the first place. On occasions, we need to say to people that, while they are well-meaning, absolutely genuine and have been working very hard, what they have been doing does not actually work and is not a good use of their time or our money. That is what evaluation is about. It is about identifying what is best, what does not work well and investing in what works well in respect of both our staff’s time and our own finances.
The initial findings of the evaluation were that community engagement in the delivery of the strategy has been very strong. It is obvious that there is huge community support for reducing the incidence of suicide. Work under Protect Life has helped to reduce the stigma attached to suicide and raise awareness of suicide. The evaluation found that there is a need for greater clarity of roles and responsibilities. Evidence on the impact of Lifeline is needed. We need more robust evaluation of Lifeline and its work. There is a need to balance innovation and evidence. It was found that there were too many actions, so those need to be reclassified and streamlined somewhat. There remains a perception that suicide is a health issue. Suicide needs to be contained within a wider range of departmental strategies. It is important that other Ministers are able to identify their role in suicide prevention within their strategies.
I am sure that the House will join me in expressing our shock, sorrow and condolences to the family of 37-year-old Christopher Stokes, who was found hanged in Maghaberry prison yesterday and, unfortunately, despite the best efforts of staff, did not survive. What steps are being taken in the prison population to ensure that young men and women who are at risk of suicide are given better support? How will the Protect Life strategy work for that group?
Edwin Poots (DUP)
The prison population is a reflection of failures in society, and when young people end up in prison it is because things have failed dramatically for many years. When I chaired the Committee of the Centre way back in 2000, we did work on young people who ended up in prison and young people in general, and we discovered that some 85% to 90% of prisoners’ children ended up in prison and about 90% of them gave birth to children before the age of 20. A cycle of children was born destined to fail.
We need to address those issues at the very earliest point in children’s lives, from pre-natal right through to early years, because there is a wide group of people who do not have parenting skills and are bringing children into the world. It may shock the Assembly, but a child who suffers three or four adverse incidents in the first three years of its life is 10 times more likely to contemplate suicide or self-harm as a young adult. So one can see that many of the problems that have been identified even in the prison population go right back to childhood and are about how a child is raised from the start. Work needs to be done by the Department of Health, Social Services and Public Safety, particularly in conjunction with the education sector, because those children are not school-ready, not nurtured properly and are not given the proper love and care when they are being raised. When they become young adults, they do not know how to form relationships, are ill educated and are far more likely to end up in the justice system.
The South Eastern Trust has now taken over responsibility for the care of prisoners. Unfortunately, massive numbers of prisoners are on prescription drugs, and there is a drug culture in prisons that goes beyond prescription drugs. There are huge problems with a legal and illegal drug culture that we need to tackle and address. It will be difficult to do that because we are dealing with people whose lives are already very fractured and vulnerable and people who have ended up in jail because, very often, they have been raised in the worst possible circumstances. Work needs to be done there.
We have good people working in prisons. Their work may often not be rewarding, but they are doing their solid best to support people in prison and to give them appropriate care. Sadly, incidents such as yesterday’s continue to happen, and we want them to be eliminated.
Kieran McCarthy (Alliance)
I welcome, as others have, the statement this morning, which is progressive and, indeed, has the potential to get on top of this very important issue. The Minister mentioned community groups, and I welcome the involvement of other Departments. He commended community groups, as I do, for trying to do what they can to get on top of the problem. He mentioned £7 million per annum, which sounds fine. However, the groups are always, as far as I am aware, complaining about delays in getting funding to carry out their work. Now there is a new organisation — well, it is new to the Ards Peninsula. I attended the opening of FASA. It has been going for quite some time and does tremendous work in prevention. The Minister mentioned prevention. I want to ensure that funding will go to organisations like that, not at the last minute, but so that they can plan their work ahead to prevent these things in the first place.
Edwin Poots (DUP)
I tend to agree with the Member. Very often, funding for organisations tends to involve long-drawn-out application processes and all of those things, whatever government Department it happens to be. Co-ordinators and people who carry out good work often spend far too much time chasing funding. That is a waste of that resource and the individual’s time. I indicated that it is very important that funding is very focused and very targeted on where we are actually delivering and can see real benefits from. We can take a little comfort that the suicide rate dropped last year. After having gone up year on year on year to 313, it dropped by 26 persons last year. That is significant, but it still falls well short of where we would like to be. There is a huge amount more work to be done. I am sure that the Member will be glad to know that we fund and support FASA, and the work that it does has credibility to ensure that it is funded.
Go raibh maith agat, a LeasCheann Comhairle. I think the Minister for his statement. It is timely because in Newry, in my constituency, three young men have, very tragically, taken their own lives in the past two weeks. Minister, in your statement you talked about setting a new aim to reduce the differential in suicide rates between deprived and non-deprived areas, and you talked about interdepartmental co-operation. Is DSD taking a proactive role in the ministerial subcommittee? And will the Minister ensure that resources are put into deprived areas to lessen the impact of benefit cuts, such as those that are coming through welfare reform in the very near future?
Edwin Poots (DUP)
DSD is one of the Departments that we have had bilateral meetings with, and there is a significant degree of willingness on the part of DSD to work with our Department on issues around suicide. One of the contributors to suicide is alcohol abuse, and a high percentage of people who have taken their own lives are found with alcohol in their system. One area that we have been looking at is the minimum pricing of alcohol, which is strongly supported by the psychiatrists who deal with suicide daily. The ‘Belfast Telegraph’ or whoever can come out with a survey that shows one thing, but all of the empirical evidence that is coming to me says the absolute opposite. We have people who are using drink to try to raise their spirits and their morale, and it actually works as a depressant. Far too many young people are getting alone or into very small groups largely based around bottles of cider and cheap alcohol. They become involved in antisocial activity and are not going out and mixing with large groups of young people. They are not having the same engagement and are becoming isolated and depressed. All of these things have very negative impacts. DSD has particular roles to play, and we will be working very closely with DSD on these issues. It will participate in the group.
Go raibh maith agat, a Phríomh-LeasCheann Comhairle. I thank the Minister for his statement, and I commend him on his continued commitment to suicide prevention. I also commend all of the groups that are doing sterling work in this regard, including Foyle Search and Rescue in my constituency. Can the Minister outline what support and services are available to families and communities bereaved by suicide?
Edwin Poots (DUP)
We have a number of bereavement organisations in Northern Ireland. Cruse is one of the better known, but there are many organisations that support people through bereavement. As I was coming in this morning, I heard a very interesting discussion on the programme, ‘Mornings with Frank Mitchell’. It was not about suicide; it was about the tragic case of the little boy who was run over by his grandmother in a completely freak accident and the support that counselling had been to that family at that time. It is important that we continue to support counselling services.
In respect of mental health services, we have crisis home team treatments; a psychological therapies implementation plan; and ‘Beating the Blues’, which is a computerised programme. Those things can be helpful to some extent. We also have counselling and bereavement support in local communities, and there is a family voices forum, which we are funding. We provide funding to quite a lot of groups that offer counselling support and counselling services. I have absolutely no doubt that some people will want to do it their own way and will not want to get counselling. However, many others will. Some people may think that they do not need counselling, but, ultimately, they will end up receiving counselling because they cannot do it on their own. Therefore, it is important to have counselling services available to people.
Sadly, we are acutely aware that, very often when one member of a family takes their own life, it can lead to other members of the family taking their own life. In my constituency, I know of two families where three members of each family took their own life. That is shockingly sad for the remaining family members.
Go raibh maith agat, a Phríomh-LeasCheann Comhairle. I thank the Minister for his statement and commend him and his Executive colleagues for the progress that they have made in taking this important issue forward. I want to ask the Minister about the vulnerability of farmers and those in the rural community who are very much at risk of death by suicide, at times even more so than our young people who are the stereotypical people you first think about. What work is his Department doing with the Department of Agriculture and Rural Development, the Ulster Farmers’ Union, NIAPA and other such organisations?
Edwin Poots (DUP)
Thankfully, it appears that the number of farmers taking their own life is not as high as it was. As I said, suicide is linked to the economy, and when the unemployment rates rises, the suicide rate rises as well. Farming is a little more profitable than it was a number of years ago. I recall so well that, in 1996, many people I knew took their own life after the BSE crisis. All of a sudden, people who had been operating relatively successfully had huge business debts that they could not contend with. Profitability was absolutely out the window.
It can be very easy for farmers to take their own life because, very often, they have accessibility to firearms, the rope in the barn or poisons. All those things are available to farmers. Greater work is going on. The Public Health Agency goes out to sale yards and places where there are large gatherings of farmers and talks to them about health issues across the board. The agency is happy to talk to farmers, whether it is about cholesterol levels or mental health issues, and, if concerns are identified, it will ensure that there is the appropriate follow-up. Farmers can become very isolated. Farming is a much more isolated line of work than would have been the case 20 or 30 years ago. Farmers who are very isolated have that opportunity to tell people that they have concerns and anxieties and, maybe, ideation of self-harm. They can have someone to talk to in the system and someone to help them in that time of need.
Anna Lo (Alliance)
I welcome the Minister’s statement. From my previous experience as a social worker and community worker, I have seen the devastation for families when a member of the family takes their own life. Obviously, that has very tragic consequences. What action, particularly cross-departmental measures, will the refreshed strategy be taking to reduce suicide rates in the Traveller community? Suicide rates are six times higher in that community than in the general population, with 11% of Traveller deaths being due to suicide.
Edwin Poots (DUP)
That is actually quite difficult to identify. Work was done on an all-Ireland Traveller health strategy, which found that Traveller males were 6·6 times more likely to take their own life than the general population. That equates to around four persons in Northern Ireland. However, as it is a small community, it is harder to assess whether that is a continuum or a one-off. In 2010, the Public Health Agency established a Traveller health and well-being forum. As a consequence, a number of initiatives have been targeted at the Traveller community. Those include a health improvement programme, emotional health and well-being training, and parent and child support programmes, which goes back to what I said about good parenting. A wider review of service uptake by Travellers is to commence in September this year. Those initiatives are partly funded under the Protect Life strategy, which contains actions to ensure that support services are available for marginalised and disadvantaged groups, such as Travellers.
Go raibh maith agat, a LeasCheann Comhairle. I thank the Minister for his statement and the way in which he has answered the questions put to him. Like the Minister, I heard that very harrowing interview on the radio this morning. What struck me is that we in rural areas do not have the same access to counselling as those in urban areas do. I want to follow on from Phil Flanagan’s question about rural isolation and farmers. Rural Support, an organisation funded by the Agriculture Department, can signpost people in distress to organisations. However, the difficulty is that, unless you are still at school, people in rural areas do not have access to ongoing counselling support. Will the Minister take steps to address that anomaly and ensure that there is equality and equity across our communities, to ensure that everybody has access to counselling support when they are feeling depressed and suicidal?
Edwin Poots (DUP)
The Member will, of course, know a little about this, having been employed previously in the role of Chair of the Health Committee and as Minister of Agriculture and Rural Development. The interests of the rural community are represented on the regional suicide implementation board by the Rural Support network, which also engages HSC structures. Rural-specific initiatives, supported to date by the Rural Support helpline and Rural Connect, include mental health and suicide prevention awareness sessions held in farmers’ markets and the health-promoting farmers’ programme, as I indicated. Community grant programmes have funded rural programmes delivering council services, bereavement support and mentoring projects for people at risk of suicide.
Where do we go from here? Obviously, we have brought the Minister of Agriculture and Rural Development in to the ministerial group on suicide. I see that as a positive thing. She can bring to it her take on what is required in rural communities. We are looking at one-stop shops, which have been piloted and which could be rolled out, and we will look at any other potential vehicles that could be used to make a difference in remote geographical areas. So there is a course of things that we can look at and address, but, again, it is about spending the money that we have wisely and making best use of our money. Therefore we need to be very targeted and focused in ensuring that the money is directed where we can see real tangible benefits. I think that that is something that we can achieve.
Sydney Anderson (DUP)
I welcome the statement and thank the Minister for bringing it forward to the Assembly. The Minister will be aware of the number of people, especially our young people, who engage in self-harm. What consideration has been given to the link between self-harm and suicide?
Edwin Poots (DUP)
Self-harm is a high risk factor for completed suicide, particularly when it is repeated. Very often, it is just a cry for help. Two main actions on deliberate self-harm are the DSH registry and the mentoring self-harm interagency network (SHINE) in the north-west. The latter is a tie-in with the Altnagelvin A&E, whereby patients presenting with injuries due to repeated self-harm are offered referral to community-based groups specialising in mentoring and counselling for people who self-harm. It has had a good rate of success. Over 95% of the participants have shown a reduction in their repeat self-harm behaviour. So that is something that we can look on positively and, perhaps, we can look at how it can be replicated elsewhere.
The lifestyle and coping survey of 3,600 16-year-olds in secondary schools in Northern Ireland found a 10% incidence of deliberate self-harm. That is very significant. The main causes were bullying, relationship difficulties, struggles with sexual orientation and, for others, exam pressures. NICE-issued guidance on long-term management of self-harm in 2011 recommended a risk management plan as part of the care plan, with an aim to reduce the psychological, pharmacological, social and relational risk factors, and offering psychological interventions.
Earlier NICE guidance on the shorter-term management — the first 48 hours — covered assessment, discharge and follow-up. That recommends supportive environments, such as quiet rooms, at A&E to minimise stress. However, we will be looking at something different. The Belfast Trust is looking to identify quiet rooms away from A&E, because, potentially, the A&E environment is not a good environment for people who are suffering from fairly significant mental health issues and contemplating suicide. In all of that, and regarding all acts of deliberate self-harm and people over 65, there is evidence of suicidal intent, and we should regard that as being the case until we can prove otherwise.
Anyone who is not present for the start of the statement or present for only part of it will be called at the end; anyone who comes in close to the end is called at the very end. That is what we did today.
We check the timings on a regular basis, but it is about trying to accommodate those who come in at the very end or close to the end and hear part of the statement. We feel that we followed that procedure today, but we will check it.