SOAPBOX: Suicide – the public health crisis of our times

Carrie Montgomery is deputy chief executive at Contact NI. She has led Lifeline since its 2006 pilot inception and in this article shares her vision of society free from suicide.

In 2014 the World Health Organisation declared suicide as a preventable harm, calling for a 10% global reduction in suicide deaths by 2020.

Suicide rates have fallen across UK and Ireland, especially in Scotland. Yet Northern Ireland still has the highest and rising general population suicide rate.

The latest available figures for 2015 report the highest number on record: in Northern Ireland, 318 people died by suicide, devasting families and communities. That’s a preventable death almost every day.

If suicide is preventable, who is responsible?

The strapline of recent times ‘suicide is everyone’s business’ comes to mind. It is true that all government strategies, particularly social welfare should give careful consideration to safeguarding against suicide. A good example is Finland’s recent success in declaring the eradication of homelessness. It has provided all the support needed to afford permanent housing instead of temporary accommodation, instilling hope that this will be linked to a reduced national suicide death rate.

However, for me this question has been answered in the 2014 Atlanta Zero Suicide Declaration setting the audacious ambition to render suicide as a preventable harm … a ‘never event’ for the people in the care of our health service. In other words with the right support, at the right time, suicide is preventable in every case, until the last moment of life.

In spite of that, just this week at the launch of the National Confidential Inquiry into Suicide and Homicide (NCIHS) 2017 report, lead Professor Louis Appleby commented “it’s hard to be positive after 1,538 in-year UK patient deaths by suicide but our evidence shows services are making a difference to safety”.

Critically, the NCISH report shows 90% of Northern Ireland patient deaths by suicide were assessed as no or low risk during their last contact with services. This research finding informed National Institute Health & Care Excellence (NICE) guidelines recommending that services “do not exclude on the basis of crude suicide risk scales”.

Why then has the draft NI suicide prevention stategy commended the policy implementation lead, the Public Health Agency, “provide accessible services for people at high risk of suicide”?

The draft strategy notes that “low threshold crisis intervention helplines are an evidence-based effective intervention”, yet the Public Health Agency plan to restrict Lifeline access by “targeting people most at risk”.

Surely this contradiction is unsafe?

Contact piloted what is now Northern Ireland’s 24/7 Lifeline service a decade ago and has run it ever since. With ten years service innovation and international benchmarking expertise, we have raised concerns directly with the Public Health Agency for over two years on their planned access restriction to Lifeline counselling many times to no avail.

Taking no pleasure in exposing the Public Health Agency’s imminent plans for Lifeline restructure as unsafe and unfit for purpose, last week we brought our concerns to the public’s attention. The Public Health Agency corporate response is to blame, discredit and censor Contact, chastising media attention for our safety protest.

They say “the eligibility of who can access Lifeline follow-on support will remain the same … it is misleading to print otherwise” when the evidence from the PHA’s most recently published documents (sourced by FOI) reiterate the clear intent to unsafely restrict Lifeline access.

What motivates this public authority to dismiss criticism of their contradictory published plans?

The Public Health Agency’s two recent public consultations on future plans for Lifeline are not informed by independent peer-led evaluation. A glaring omission.

Independently reviewed Lifeline evaluations found the current integrated regional service model as “exemplary for securing high quality data, exceptional service delivery and demonstrating evident clinical expertise”. Yet this finding was excluded from two public consultations. Why?

These questions remain unanswered.

I would contend the answer points towards a fundamental organisational culture clash between Contact as pioneer provider and the PHA as Lifeline commissioner.

As remarked in Sir Liam Donaldson’s 2014 review of Northern Ireland health service leadership, “a proper regard should be given to the overwhelming evidence that a climate of fear and retribution will cause deaths not prevent them”.

Or is it more a clash of confidence?

Contact’s vision is a society free from suicide, recognising suicide as a preventable harm.

In contrast the NI Department of Health noted health service “pessimism amongst staff about the preventability of suicide” in their draft Protect Life 2 suicide prevention strategy.

I suggest both factors are significant leadership culture insights, given Donaldson’s constructive criticism on limitations to health care leadership’s lamentably slow pace of change. Donaldson’s 2014 NI leadership culture review for the NHS coincided with the WHO declaration that “suicide is preventable”.

Public concern will be for the safest way forward for Lifeline, not the detailed conflict between Contact and PHA.

Protecting vulnerable people from preventable harm far outweighs protecting organisations from reputational harm.

Tackling the unacceptable suicide death rate in Northern Ireland requires courageous, transparent and determined leadership, inside and outside government.

It requires not only policies and strategies that instil hope, but a clear statement of intent to make the biggest difference in the shortest time possible.

Department of Health declaration last week for a 10% target reduction by 2022 in NI’s suicide death rate was welcomed by the NI Assembly All Party Group on Suicide Prevention as courageous, hopeful and encouraging.

It requires learning from what worked for the thousands of Lifeline clients who reported recovery from suicidal crisis, compared to the devastating outcome when a person who has sought help dies by suicide.

Meaningful learning will require independent peer evaluated review of Lifeline governance to evidence-inform how Lifeline and its many partners, commencing with health, justice and education, can improve crisis care continuity so that not one person in our care dies alone and in despair by suicide.

Our collective task is to justly and fairly challenge corporate pessimism and blame culture to create a society wide climate of optimism, hope and achievement for suicide as a preventable harm, commencing with every person in our care.

If you or someone you know has been affected by these issues, call 24/7 crisis helpline and counselling service Lifeline 0808 808 8000. Calls are free from all landlines and mobiles.