Are Zero Suicide targets just an aspiration?

There are suicide prevention strategies in the 4 countries of the UK to address concerns that the national suicide rate had not fallen since 2018. The strategy for England reported over 5,000 deaths by suicide each year but, in contrast, a 35% fall in suicides in mental health inpatient settings between 2010 and 2020. This fall has been linked to improvements in patient safety in mental health services that have adopted the Zero Suicide approach based on research by Henry Ford Health in the US.

In my current role as an NHS non-executive director, I chair the Trust’s Patient Safety Senate. Its focus is on learning from adverse incidents and although self-harm and suicide are very sad, they are essential discussions on our agenda. A key part of our deliberations is the recognition that, in the case of an inpatient suicide, our aim is not to blame individual staff for what has occurred, but to learn why the system has not met our aspirations of providing effective care. Nationally, staff shortages remain a significant issue in compromising quality of care. 

In my former role as a director of public health, there was a focus on promoting mental health, including suicide prevention. As the new suicide prevention strategy recognises, the major challenge lies in the number of people who take their own life, but who are not known to mental health services. It is for that reason that I question whether Zero Suicide can be more than a laudable aspiration. To be clear, I want to support and give hope to anyone who feels that their life is no longer worth living. But our challenge is that many of the people who take their life have not sought support from health services or charities.   

Take a situation that I dealt with recently when a possible cluster of suspected suicides were reported. There had been several deaths among men who were under 50 years of age, all living in a very small geographic area. All were registered with a general practice, but none had been identified as having mental health concerns. That such men are 3 times more likely than other sections of the population to take their own life is recognised in the suicide prevention strategy. With statutory and voluntary sector partners, we ran a targeted campaign in venues that men in this age group were likely to go, with the provision of sources of support. Pubs, betting shops, workplaces and other likely locations were targeted. To date, there have been no other reported suspected suicides in the targeted area, but how do we assess this campaign was a success? Given the funding pressures on statutory and voluntary sector organisations, how do we sustain such campaigns? In England, the sum of £10m has been allocated to support suicide prevention campaigns between 2023-25. The fund is intended to support hard-pressed charities, and though commendable, it is time-limited to only 2 years of England’s 5-year strategy.   

In addition to my involvement with an NHS Trust, I’m also a trustee of a mental health charity that provides support to families who have lost a family member to suicide and who are at increased risk of another family member taking their own life. The charity is seeing an increase in the demand for its services. We also face a challenge of recruiting appropriately qualified counsellors to match the demand, but have insufficient funding to do so. 

Of course, I support the aims and aspiration of England’s new suicide prevention strategy, but I must question its chances of success. The limited investment identified by the UK government to support the strategy calls into question how serious it has been about achieving zero suicides. I urge the next government to commit more funding to help make this target more than just an aspiration.