Last week we saw a new Mental Health Bill whose main purpose is to prevent suicide.

Now we have the Assisted Dying Bill, to help people - in defined circumstances - take their own lives.

🧵 Not the same, but treading same difficult ground where individual choice meets social responsibility.

Legally distinct but in practice not always so far apart.

New national suicide figures are published today in a series of reports.

Headline message from @ONS is a rise in 2023, the highest rate since 1999.

But, taken together, the reports tell a more complex story. Short 🧵 First, an important reminder that these figures represent real lives lost.

No suicide rate is acceptable.

In 2023, over 6000 suicides were registered in England & Wales.

We shouldn’t be reluctant to study homicide and mental illness. It’s an important, if difficult, topic.

Equally, in doing so, we should be sensitive to stigma.

How can research tread this line? A few examples. Short 🧵 First, it’s essential to acknowledge the distress any equivocation causes to victims’ families, those who have been through the most heartbreaking loss.

We owe it to them to be honest about the risks.

Much discussion about benefits of outreach teams in mental health.

And promises to “learn the lessons” from the Nottingham tragedy - a phrase that infuriates families.

But the real question is why we unlearned past lessons & what this tells us about future safety. 🧵 First, an acknowledgment of how painful this public discussion must be for the families of the people who died.

We owe it to them to be honest about the decisions, policy & culture that have got us to this point & the need to change.

It’s a week since the Govt published my report on suicide in young people with gender dysphoria.

What did the reaction tell us about the necessary dialogue with the public on issues of evidence? 🧵 First, a reminder of the wider #suicideprevention task, beyond the focus of my report & the specific suicide claim it addressed.

Young people distressed over gender may be at risk.

And we are likely to see a rise in their number, reflecting a broader social trend.

People have raised clarifying q’s about my review of suicides in young gender dysphoria patients.

And there have been a number of - let’s call them misunderstandings.

A short summary then, tracking from aim to data source to conclusions.🧵 First though, a reminder that in my research unit we always start with.

The numbers we are examining are real lives lost.

No suicide figure, high or low, rising or falling, is acceptable.

My conclusions so far? Start with the fundamental issue.

Young people with gender dysphoria face bullying, family conflict, isolation - risk factors for suicide. The risk is real.

It is also complex. Single causes are unusual.

Depression/anxiety are common. Also treatable. 2/It’s right to point out that young people’s experience of health care may reduce risk. Applies not to one treatment but a whole system.

Non-judgemental attitudes, skilled staff in primary care & CAMHS.

Support while waiting or in a crisis.

Guidance to schools on suicide prevention in the RSHE curriculum was published this week.

It’s an illustration of how we go from a campaign by bereaved parents to Govt policy.

But what does suicide prevention in the curriculum mean? Which children? Are there risks?

🧵 & TW There is no more distressing subject in suicide prevention than the deaths of young people.

It challenges who we are as a society that such tragedies occur.

@ONS records around 100 suicides/year in under 18s. Rates have risen in the last 15 years, though not since 2018.

I’ve been looking in more detail at the 2023 suicide figures from ONS, published this week.

They showed a 6% rise, giving us the highest national rate since 1999.

In fact, the detailed picture - by age, sex & where people live - is not simple.

Short 🧵 & TW

https://twitter.com/ons/status/1775803319111327931

First, an essential reminder that no suicide rate is acceptable. Whether figures are rising or falling, they are too high.

These are preventable deaths not prevented.

Key stat in today’s suicide update from @ONS is about young people.

Suicide rates in young age groups rose steadily from c.2010. They have been a top prevention priority.

New figs confirm a different trend. Rates since 2018 are stable - not falling but the rise has stopped. Why did suicide rise in young people? Some point to ⬆️ depression, income inequality, social media.

Our study of <20s highlighted cumulative risks (graph shows escalating rates in late teens): abuse, bereavement, bullying, self-harm.

Did these factors explain an increase?

New @ONS data give us, for first time, national suicide rates month by month for Covid years 2020 & 2021, compared to earlier years.

Graph shows no rise in these years overall, or any month, or any period of pandemic, including lockdown.

What can we learn from this? It may tell us something about the protective power of social cohesion, of looking out for each other, of community, with its message of acceptance & concern.

If so, we need to hang on to it. It hasn’t looked in strong supply lately.

New figures from @ONS show 5,275 suicides registered in England in 2022, a tragic total.

This means the national suicide rate is unchanged since 2018.

But in the detail there are important new figures on young people.

Short 🧵 & TW. First, your regular reminder that these statistics & graphs represent real lives lost.

And that no suicide rate, high or low, rising or falling, is acceptable.

Manston, “invasion”, turning back boats, Rwanda. Complex issues like migration, involving vulnerable people, are rarely solved by getting tough, let alone talking tough.

Example from #mentalhealth. 10yrs ago prison policy was made more severe (remember the ban on books?). 1/6 This was meant to appeal to a section of the electorate who, misled by the media, saw prisons as too soft.

“Privileges” were curtailed.

What happened next may not have been cause & effect. Other factors may have played a part. But the timing was exact. 2/6

How can students & families tell how well a university is doing on suicide safety?

Does it talk credibly about a mentally healthy campus?

Check student/staff surveys: does experience match rhetoric on bullying, disability, international students, management style?

Short 🧵 1/5 Are all staff - academic & admin - trained in mental health & #suicideprevention?

So that if a student doesn’t hand in an essay, will they be seen as under-performing or will someone check they’re ok?

Is the physical environment safe?

2/5

Plenty of justified outrage following #BBCPanorama’s film of staff abusing patients in a secure mental health unit.

It made headline news. Investigations are under way. Staff have been suspended.

But outrage alone will not prevent a repeat.

Short 🧵 & TW. Many felt weary over a too-familiar story.

That was my reaction. 5y ago I wrote about how my mother was assaulted in a care home - the perpetrator was erased from their professional register thanks to evidence from other staff.

No action was taken against the care home itself.

Been asked for data sources re my #suicideprevention talk at #RCPsychIC. Mainly @ONS & my research unit @NCISH_UK - link to our website.

Short 🧵 on our research findings.

sites.manchester.ac.uk/ncish/ First, important reminder that graphs & data represent real lives lost, families devastated.

Discussion on Twitter this week of suicide rate in doctors, after widely-reposted tweet claiming rate in this country to be several times higher than in general population.

This is untrue in England (UK data not available).

It’s worth looking at the figures.

Short 🧵 & TW. First, a reminder that suicide statistics are real people, lives cut short, preventable deaths not prevented.

No figure, high or low, is acceptable.

Latest suicide figures for England are just published, giving us rates for the final 3 months of 2021, based on deaths registered post-inquest. Headline message: no change from previous years. But there’s something troubling there too.

Short 🧵 & TW.

https://twitter.com/ons/status/1511990122090315783

First thing to say, always, is that these figures are not dry data. They are real lives tragically lost, preventable deaths, devastated families. We should never forget this.

Often asked for advice on managing a suicide cluster.

Clusters - where there is a link between deaths - are not unusual.

They cause understandable anxiety in those handling them who may be taking urgent actions on limited information.

Short🧵 & TW. Links between deaths vary. They may be direct & causal, when one tragedy triggers another. Or indirect via shared circumstances or method.

Clusters occur more in young people & settings like schools & universities but also mental health units. The connections may also be online.

It’s become common to see an academic dropping off Twitter to escape abuse.

It starts with a tweet or media appearance commenting on evidence from their field of study. Someone takes exception to their message, outrage spreads. Their timeline becomes a torrent of hostility. This is hardly unique to researchers. Twitter is a bear pit.

Public engagement is part of the academic job. Funders expect it. A #publichealth crisis demands it. Yet we have calls for Covid scientists to #resign. One expert’s bio says simply: I block.
How did it come to this?

In 2021 #suicideprevention will remain vital to the #Covid response, so this is a good time to sum up what we know re the impact on suicide. Simple answer is that several countries have now reported no rise. But the picture is more complex, as always with suicide stats. /thread First, it’s important to stress that graphs & data represent real lives tragically lost. No suicide rate, whether high or low, rising or falling, is acceptable. Even before Covid there were over 6000 deaths by suicide per year in the UK.