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 | You and Yours - Transcript ´óÏó´«Ã½ Radio 4 |
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| TX: 15.12.03 – NUMBER OF SUICIDES FALLS |
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| PRESENTER: WINIFRED ROBINSON ROBINSON Death rates from suicide in England have come down. The figures are published in the first report on suicide rates since the Government introduced its suicide prevention strategy just over a year ago. The strategy drew together a series of new policies aimed at preventing suicides, they included measures to identify and monitor the people most at risk and changes to the design of mental wards to reduce the opportunities for patients to hang themselves. The small decline in death rates is reported by the Department of Health in a study to assess the impact of all these changes. Professor Louis Appleby is the national director of mental health and he explained the report's findings in more detail. APPLEBY The suicide rates have generally fallen slightly over many years during the course of this century and in the last 10 years or so there have been fluctuating but generally slightly declining rates. Now this Government set a target forreducing suicide by 2010 of 20 per cent compared to the rate in 1997. And the rate in 1997 was a particularly low rate, so it wasn't a particularly easy target. And what we're seeing now is the first sign that the rate has dropped below that already very low rate. And so it is a small change in itself but it's quite significant in the sense that it's lower than the previous record low. ROBINSON But it's a rate from just over 9 per cent in 1995 to just under 9 per cent in 2002. APPLEBY Yes, what I'm saying is that the previous baseline was a very low baseline and because you get fluctuations in suicide rates we've seen a slight rise since then and now what looks like a fairly steady fall. Suicide rates are measured as three year averages, so they are the accumulation of three years data but if you look at the annual data - so the year on year change - we have actually had a fairly substantial year on year fall now for four years and it's that that's taken us down below the previous record low. ROBINSON So when we kept on reporting, just to get this straight, huge steep rises in the rates of suicide we were talking just about this sub-group of young men - is that right? APPLEBY Yes the suicide rates in the general population haven't shown huge steep rises over the last 10 or 15 or 20 years but the suicide rates in young men did rise very dramatically in the late 1970s and early 1980s and then during the 1990s they rather fluctuated but they didn't fall, that was the thing that in other groups in society, particularly older men and particularly middle aged and older women, the rates began to decline a little bit in a rather fluctuating way, whereas the rates in young men remained high and we didn't seem to be breaking into that high rate. And now what we've got are the first signs that that rate itself might also be declining. ROBINSON Is it possible to say which of the suicide prevention measures has been most successful? APPLEBY Well suicide figures, as you can tell from the discussion we've just had, tend to be quite complex and so it's very rare that you can say well - you point to one thing and say that's why the rate has come down. So I think anything that we say has to be regarded as fairly provisional and to some extent speculative. But if you look at what's happened during the time where the rate has started to fall I think there are three things. The first is that there's been much greater awareness I think, or at least there's been an attempt to make sure there is an awareness, of mental health - mental ill health and what its consequences might be, so that the aim is that people who are, for example, depressed are more likely to come forward and seek help, there's been a particular effort to achieve that, particularly in young people. Secondly, there's been I think far greater recognition across a whole range of agencies that they deal with people who are at high risk of suicide, I don't just mean the health service but social care, the police and probation and so on, all of those people deal with people at high suicide risk. And I think now they are aware of that and they seek training so that they can handle that risk well. And thirdly you find that suicide rates tend to reflect to some extent the economic circumstances that we're living in, so that if unemployment is relatively low then suicide figures tend to be relatively low as well. So I think that it's probably a combination of those three things. ROBINSON What impact do you think this strategy has had on hospital psychiatric units? APPLEBY It's always been a feature of mental health services that they've had to handle suicide risk. What's different, I think, in the last few years is that we've placed particular emphasis on the recognition of people who might be at risk, not just in the immediate future, so at the time of an assessment, I think services have always been pretty good at handling that situation, but in the longer term, so that people - I think services are now rather better at picking up when somebody might be carrying risk over a period of weeks or months and put in place the kind of support that will protect that person. There's also been a special initiative on the safety of inpatient units, where we discovered a few years ago that we were having around 200 suicides a year in England, that's an unacceptably high figure for what's meant to be a place where people are cared for. And we've put a lot of effort into trying to improve ward safety, make people aware of risks, improve staff training and in particularremove ligature points from wards because quite often people who died on wards they died by hanging and that often happened because there were structures on the ward which could be used as ligature points and it's been essential over the last couple of years that all wards should remove those things and we now see a decline in inpatient suicides. We don't know for certain that's the reason but it certainly has happened at the same time that we've had this initiative on ward safety. ROBINSON How serious a problem still though is suicide and how does our suicide rate compare with other countries? APPLEBY Well that's very important because although these figures are the first signs of some good news, there are still four and a half thousand suicides every year in England and that's far too many, there are more than a thousand suicides by people under mental health care every year, so clearly that's far too many. So yes it's the first sign that we're making some decent progress but by no means is the problem resolved. Compared to other countries - well suicide rates in this country are not high compared to other parts of the world. Rates in Scandinavia and Eastern Europe, for example, are substantially higher. So we have set a suicide target not because suicide rates are very high but because even with relatively low or moderate rates it's still a significant public health and mental health problem and we still have quite a lot to do to bring it down to acceptable levels. ROBINSON Professor Louis Appleby. 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