The Bigger Picture on Suicide

By Anabel Unity Sale

A few months ago, weapons expert Dr David Kelly told a colleague he thought he would “probably be found dead in the woods” if Iraq was invaded. In the middle of July he was, suspected of killing himself, writes Anabel Unity Sale.

In ancient Greece and Rome suicide was seen as an honourable form of death, a belief that remains today in Japan. Until the 1950s people who attempted suicide in Britain were sent to prison until the Suicide Act 1961 repealed the law. England and Wales were the last two countries in Europe to decriminalise suicide.

The suicide rate in the UK reached a post-war peak in the early 1960s, and declined between 1963 and 1975. In the four years from 1996 to 2000 there were 20,927 suicides and probable suicides in England and Wales. Each year 140,000 people attempt suicide in England and Wales. Three-quarters of all suicides in the UK are by men. It is estimated that 10-15 per cent of people in contact with health care services as a result of their first suicide attempt do eventually kill themselves.

– Between 1975 and 2000 the rate for male victims of suicide continued to increase steadily for men aged 15-44.
– Suicide committed by men aged 45 or more has decreased slightly, other than a temporary rise in the mid-1980s.
– The highest rate of suicide among 15-24-year-old young men was recorded in 1998, with 17.2 suicides per 100,000 of the male population. That year the suicide rate for men aged 25-44 was also its highest, with 25.6 suicides per 100,000 men.
– The lowest rates for both 15-24-year-old and 25-44-year-old men were in 1974, with 8.6 suicides and 14.1 suicides per 100,000 of the male population respectively.

Significantly, from 1975 to 2000 the suicide rate among women older than 25 has fallen gradually.

– The rate for 25- to 44-year-old women in 2000 was 6.4 per 100,000 women, having peaked at 9.1 suicides per 100,000 in 1976.
– More women aged 45-64 killed themselves in 1979, with a rate of 17.1 per 100,000, which fell to 6.3 per 100,000 in 2000.
– Fewer younger women kill themselves, with a high of 5.5 per 100,000 in 1977 and the rate in 2000 being 4.4 per 100,000.
– Although fewer women kill themselves than men, research shows that south Asian women are three times more likely to commit suicide than other women in the UK. This could be because of many factors, including racism and social exclusion.

So why does the female suicide rate continue to remain lower than for men?

Andrew McCulloch, chief executive of the Mental Health Foundation, says some women who feel suicidal may be better at seeking help than their male counterparts. Alison Cobb, policy officer at mental health charity Mind, agrees. She says girls and women are more likely to identify their feelings and talk about their distress before a crisis. “It is often much harder for some boys and men to express their vulnerability.”

The means available to those wanting to kill themselves has changed in the past 30 years. In the 1970s doctors moved from prescribing barbiturates to tranquillizers. The result of this mainly affected women because females tend to choose non-violent methods of suicide, such as taking an overdose of painkillers with alcohol. Cobb says: “Tranquillizers are not as lethal as barbiturates because they are less toxic.”

Women are more likely to make several goes at killing themselves whereas men are more often successful on their first attempt. Men also use more violent methods, like jumping or hanging themselves.

Suicide prevention is high on the government’s agenda. Last September it published the National Suicide Prevention Strategy for England, pledging to reduce the number of suicides by at least 20 per cent by 2010.

In 200, the Department of Health published ‘Safety First’, the five-year report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. It made 12 recommendations on how to improve mental health services:

– Staff training in the management of risk – both suicide and violence – to be held every three years.
– All patients with severe mental health problems and a history of self-harm or violence to receive the most intensive level of care.
– Individual care plans to specify actions to be taken if the patient is non-compliant or fails to attend.
– Prompt access to services for people in crisis and for their families.
– Assertive outreach teams to prevent loss of contact with vulnerable and high-risk patients.
– Atypical anti-psychotic medication to be available for all patients with severe mental illness who are non-compliant with “typical” drugs because of side-effects.
– Strategy for dual-diagnosis covering the training on the management of substance misuse, joint working with substance misuse services, and staff with specific responsibility to develop the local service.
– In-patient wards to remove or cover all ligature points, including all non-collapsible curtain rails.
– Follow-up within seven days of discharge from hospital for everyone with severe mental illness or a history of self-harm in the previous three months.
– Patients with a history of self-harm in the previous three months to receive supplies of medication covering no more the two weeks.
– Local arrangements for information sharing with criminal justice agencies.
– Policy ensuring post-incident multi-disciplinary case review and information to be given to families or involved patients.


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