Nick Clegg has been quoted this week as calling for the NHS “to commit to a new ambition for zero suicides”. That is an aspiration that nobody could argue with, but it is unrealistic to believe that it can quite be achieved. Throughout human history and in every kind of society people have died by their own hand, and it would be naïve to believe that a government initiative can single-handedly change that. Nevertheless, he is right to identify suicide as a “massive taboo”. He is also right to raise awareness of the risk. He was speaking particularly in relation to mental health, but we should not infer from that that everybody who contemplates suicide is mentally ill, even though many people suffering from mental illness may indeed see suicide as an escape from an unbearable life.
He was also speaking in relation to the NHS’s role. To be fair, doctors and psychiatrists do routinely ask patients who are depressed or otherwise at risk whether they are suicidal, and many involved in the medical profession are trained to recognise indications of suicidal thought. And everybody who arrives in A&E departments after a suicide attempt is supposed to be seen by a psychiatrist before being discharged, but inevitably many people will simply be returning to the situation from which they were trying to get away. We should also recognise that, among all those in the care of a government-funded organisation, the risk of suicide is rather greater among people sentenced to prison or remanded in custody than it is among those cared for by the health services. Sadly, calling for better emotional support of prisoners does not have the same electoral appeal as concern about the NHS.
The International Association of Suicide Prevention describes suicidal behaviour as “a complex phenomenon that usually occurs along a continuum, progressing from suicidal thoughts, to planning, to attempting suicide and finally dying by suicide”. We shouldn’t underestimate the proportion of the population that, at some stage in life, will contemplate suicide. Most will not die that way and the majority will not attempt it, but those who do – even if only half-heartedly – are more numerous than many would think. Anyone who has answered calls for the Samaritans will know that many people who contact expressing suicidal thoughts do not really want to die; they want to live, but for whatever reason can no longer bear to live their lives as they are. Many others will harbour no suicidal thoughts at all, but their need for emotional support in times of distress may be no less, yet they feature in nobody’s statistics. At the other end of the scale, any Samaritan will be familiar with the unspoken feeling – “If that were me, I would want to die too”. We should respect those for whom choosing to end life is a wholly rational decision. Maybe that’s another reason why Nick Clegg’s ambitious aspiration can never be fully achieved.
* John Lawrie is something of a legend in the Scottish Party. He is an authority on matters constitutional, experienced senior returning officer, a former Scottish Treasurer and Edinburgh Councillor, who has been a member of the party for almost 60 years.
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5 Comments
I have no problem with the aspiration but I fear that so many problems stand in the way of success even at the very hard problem of making people feel valued when such huge discrepancies in living standards mean as mentioned above when released back into society no options to move on are on offer.
John’s article was written before today. It’s worth pointing out that Nick Clegg was asked on Call Clegg and (by me) in a mental health q and a with Men’s Health about the issue of suicide and self harm in prison. This is what he told me:
Caron – you’re right to be worried. The statistics out this morning reveal the unacceptable scale of prison suicides. As it happens, I was discussing this with Chris Grayling yesterday in the Mental Health Taskforce which I chair in Government. I hope we’ll be able to announce some new steps to improve for eg liaison and diversion projects which get mental health experts into police stations and courts at the earliest possible opportunity. This spring there will also be a big step change in the individual help/support offenders get as they leave prison to help keep them on the straight and narrow. That will make a big difference in giving prisoners contemplating life outside prison a greater sense of hope.
John Lawrie
Two quotes: 1. ‘ choosing to end life is a wholly rational decision’
2. ‘Anyone who has answered calls for the Samaritans will know that many people who contact expressing suicidal thoughts do not really want to die; they want to live, but for whatever reason can no longer bear to live their lives as they are. ‘
This is the problem when trying to make a distinction between assisted-suicide and suicide. The truth is we all know that suicide and suicidal thoughts and determination to die are often the result of mental illness, or a cry for help or fear or another existential reason.
How can one really tell the difference between someone who says they really want to die and really don’t and those who want to die because they are tired of their lives etc…
The truth is we can never be certain. We must not in my view get into the mind-set of making distinctions between the terminally ill and everyone else ie: the ‘rational’ and ‘irrational’ or acceptable suicide and unacceptable suicide.
That is a recipe for trouble.
There seems to have been a bit of a negative reaction from some people towards the Lib Dem’s ambition of zero suicides. I think it is important not to take this too literally and understand the new emphasis on getting to the causes of severe mental health problems and trying to address them.
Personally I get worried that people think the vast majority of the solution is simply more counselling services, but I still took delight in the new emphasis to tackle this serious problem.
“We must not in my view get into the mind-set of making distinctions between the terminally ill and everyone else”
Of course we must. In one case the person is facing certain and likely very painful death that is beyond their control or that if anyone else and suicide returns control, alleviates pain. No mental illness is involved. In the other case however painful a person’s life may currently be, there is hope and help that their lives will turn around and they will regain control over their destiny. Mental illness is likely. And is treatable. There is a huge distinction.
Counselling may be effective for some, drugs may be effective for others, but no-one knows why many people turn back from the brink because the data is uncollected perhaps uncollectable. People with suicidal intentions will often lie through their teeth to counsellors that are forced on them.
There is something about this ambition for zero suicides that makes me very uncomfortable. It is that the objective implies it is possible. Thus every suicide is avoidable, and if it nevertheless happens people around the victim have failed them. You are saying to parents, family and friends that it is their fault, somehow they missed something they should have spotted. And of course there will be many cases where there were no signs or where nobody and nothing could have stopped the death. At that point you have to reassure the grieving family and friends that there was nothing they could have done differently. Which is it? Zero suicides ambition and guilt trip the families of those who fail the target, or accept that zero suicides is silly and unachievable so you can legitimately reassure families that it isn’t their fault?