Earlier this month the Government published its new suicide prevention strategy, pledging to reduce the number of suicides in England within two-and-a-half years.
Sadly, suicide rates have been rising for the last four years and are currently the highest they have been for a decade. So it is vital we have a national plan with common priorities national and local organisations can focus on, with a target the Government can be held accountable for.
As president of the Association of Directors of Public Health, I broadly welcomed the strategy’s publication, which emphasises the need to support people at an earlier stage and also focuses on providing support for children and young people’s mental health.
I was particularly pleased to see the recognition of issues such as online safety and gambling and the inclusion of targeted support for a wider range of priority groups including people with autism and those experiencing domestic violence. However, despite an emphasis on society’s collective responsibility to support and destigmatise people who find themselves considering ending their lives through suicide, the plan underplays the vital work being done on a local level.
This mismatch between the rhetoric and the action plan will hinder the strategy’s efforts to achieve its intended outcomes.
In 2017, I was one of the co-leads of the joint national suicide prevention strategy review for England. Everyone recognised then that local authorities play a crucial role in suicide prevention work. In addition to commissioning drug and alcohol treatment services, directors of public health (DPHs) and their teams lead local suicide prevention partnerships, create local action plans, co-ordinate use of NHS England (NHSE) funds and develop real time suicide surveillance. They also support the commissioning of bereavement support services, help shape workforce development and training programmes and support the identification and co-ordination of action for higher risk locations.
For example, in South Yorkshire, Real Time Surveillance for suspected suicide, which was launched in 2020, is helping the community understand the circumstances surrounding a suspected death from suicide and inform effective intervention initiatives.
In this scheme, local public health teams receive a notification within 24 hours of a reported death, triggering a local response. As well as specialist support being offered to all those affected, including any children involved, a confidential enquiry form is completed to build up a picture of the years, months and days leading up to the death, identifying what could have been done differently as a community and on a population level.
As a result of the programme’s monitoring, the team have been able to identify potential contributory factors including a lack of bereavement support, prevalence of long-term conditions and unmanaged chronic pain. The region has worked together and used these findings to create bereavement and chronic pain workshops along with ‘Walk With Us’, an award-winning toolkit to support children and young people and families affected by suicide.
Yet despite local authorities having a mandate for suicide prevention, the action plan within the Government’s new strategy is almost entirely focused on national organisations and, out of around 160 actions in the strategy, only two involve local authorities. Much of the work DPHs do is in partnership with the voluntary and community sector, who last month were encouraged to apply for funding from a new £10m suicide prevention grant fund in England. Although all funding is welcome, this, like so many other funding announcements, is only a short-term commitment.
Ringfenced funding for suicide prevention for local authorities has ended and although we all want to continue supporting successful projects, it is increasingly challenging to implement effective suicide prevention programmes given the consistent cuts to the public health grant in England. Put simply, there are a multitude of competing demands which inevitably mean that difficult decisions are having to be made.
What is very much welcome news is the confirmation of suicide bereavement funding through NHSE. However, what is missing is a clear commitment to consistent, sustainable funding and the reality is that without it, action plans and initiatives to identify and support people when they need it most, just cannot be implemented.
We are all in agreement that suicide has devastating consequences. We must get better at ensuring people get the support they need when they need it and are not stigmatised as a result.
However, as well as the passion to drive change, any successful strategy needs to include actions at every level, backed by adequate funding to make them happen. Otherwise, all we are doing is creating false expectations which will ultimately lead to yet more people needing, but not receiving, the support they deserve.
In order to make a real difference, the Government must increase resources and commit to sustainable funding for already established, successful programmes alongside new initiatives. Only then will we be able to support more people and ultimately, save more lives.
Professor Jim McManus is president of the Association of Directors of Public Health
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