In that case, my Lords, I will start.
Let me begin by congratulating my noble friend Lady Royall on having secured this debate and on introducing it so ably. I am a bit far up the list for this, but my subject is a deeply perturbing one. I want to offer some comments on suicide and suicidal behaviour in relation to the mental health of children and young people.
Is there anything more tragic? It is not just a case of lives lost; it is a case of lives foregone. We cannot respond as a society unless we grasp the dynamics of suicide more generally. Understanding suicide poses unique problems, because by definition you cannot ask the individual why she or he acted as they did. Motives have to be inferred after the event, and this is often extremely problematic. For this reason, official suicide statistics, although they influence much public policy, are always pretty suspect. Can the Minister comment on this, given that suicide rates figure very largely in the national suicide prevention strategy, which I otherwise strongly support?
I spent a good deal of my academic career studying suicide and related behaviours. In my view, we need much more in-depth and sophisticated measures than suicide statistics if we are going to monitor the success or otherwise of prevention strategies. Some aspects of suicidal behaviour are absolutely counterintuitive. People will travel hundreds, even thousands, of miles to throw themselves off the Golden Gate Bridge in California, or in this country, Beachy Head. These include substantial proportions of young people. The youngest who has jumped from the Golden Gate Bridge was only five years old—albeit egged on by her father. Many have been teenagers and young adults, as at Beachy Head.
The Golden Gate Bridge provides the closest we have been able to get to talking to people who have committed suicide, which is otherwise a complete paradox. Throwing yourself off that bridge has a 98% fatality rate. Some of the tiny minority who survived, however, have been interviewed. They all said—this is pretty gripping—that as soon as they started falling, they regretted what they had done. One said, “The second my hand left the bar, I said, ‘I don’t want to die. What am I going to do?’ So I said, ‘Maybe if I get feet first, I’ll live’”. And in fact, this person did, but statistically it is virtually impossible to achieve. Your Lordships may ask what proportion of other suicides this would apply to, if there was data for this doubly tragic act—triply tragic in the case of children and young people.
The research also studied people who tried to jump off the Golden Gate Bridge but at the last minute were prevented from doing so by the police. Amazingly, the results showed that only 6% went on kill themselves. The rest—all 94% of them—lived out their normal lifespan. In other words, and importantly for the relationship to mental health, it is not the case that they remained suicidal personalities. In fact, that very notion is suspect.
The biggest reduction in suicides that has ever occurred in this country did not come from therapy or mental health treatment; it came when natural gas replaced coal-fired gas. Putting your head in the oven had accounted for almost 50% of suicides before that point, but then we saw a steep reduction in the suicide rate, which I am sure was real. The implications of this have to be clearly thought through. Suicide is very different from many of the things that people write about it and much more problematic in its motivation. This has to be recognised.
The suicide prevention strategy that has been rolled out at national level is a very worthwhile initiative. It is also good that substantial public funding has been allocated to organisations such as the Samaritans and the Zero Suicide Alliance. However, does the Minister think that the strategy embodies the most avant-garde thinking about suicide, in the light of research such as I have mentioned? I am not at all sure that this is the case.
In conclusion, perhaps she would like to comment on the following points. First, I know that this debate is about mental health, but it is time to move away from the mental health model of suicidal behaviour towards a more sophisticated perspective, recognising the symbolic richness of that action. Secondly, suicide, attempted and actual, is often as much a form of self-assertion as it is of despair. Thirdly, as the Harvard School of Public Health puts it:
“Intent isn’t all that determines whether an attempter lives or dies”.
The way in which it is done is often symbolically crucial, as your Lordships can see from the case of the Golden Gate Bridge. It is not often that someone says to themselves, “I just want to die and I don’t care how that happens”. More often than not, there is a deeply symbolic and rich emotional content to it.
I hope the Minister will recognise that understanding these complexities is key to the prevention strategy which the Government have quite rightly introduced.