Suicide - the only way we will reverse the flow

Of all the methods of dying, suicide is arguably the one we struggle most to get our heads around.

I have a vision that in my lifetime we will create a movement, independent of government and professional health services and made up of people who share a common belief that most suicides can be prevented. Collaborating as a trusted community across the UK and globally, this movement will identify and plug existing gaps in support which frequently mean that too many people lose all hope and choose to end their lives rather than continuing to face further mental pain and anguish.

Try and put yourself in the mind of someone who is about to end their own life. It's likely that you will have planned this moment. You know when and how you intend to carry out an act that will provide you with a permanent solution to what is likely to be a temporary problem but one which is causing you an indescribable level of mental (sometimes physical) pain.

The moment arrives. How are you feeling? Relieved that you will soon be free from pain? Traumatised and upset that it has come to this? Terrified? You act. It's all over..... for you at least!

I often find myself reflecting on my son, Jordan, and his final moments. Sitting at his kitchen table writing a farewell letter to us, whilst the radio plays a soothing orchestral movement from the station Classic FM. Jordan had an eclectic taste in music and perhaps at this moment he needed calm - no lyrics, just strings and woodwind to ease his thoughts as he contemplated preparing himself for the unthinkable.

Farewell note written, he would get up from the table, a half eaten bowl of porridge pushed to one side, alongside a partially drunk glass of water, a shopping list containing 3 every day items (still planning to visit the dentist) and a contact card for the mental health charity Mind . Walking into the hallway of his home for very the last time, he climbs the staircase..........I'll stop there. Even I try not to dwell on what happened next.

We probably all fear death to one degree or another. Often it's because we have no control over the illness or the event which will end our existence on this earth. But what about when we do have control?

We often hear about those who have been severely depressed for long periods of time, whose mood suddenly and inexplicably lifts because they have finally found a solution to end their pain. What most of us would consider to be the most irrational of acts is often rationally considered by someone who has lost all hope and no longer wishes to live.

17 people die by suicide every day in the UK - approximately 6500 each year - 200 of these will be school children. According to the World Health Organisation , more than 700,000 people, globally, die by suicide annually.

• 6500 x 135 equals 877,500 impacted by suicide (compounded every year)
• 700,000 x 135 equals 94,500,000 impacted by suicide (compounded every year)

Each suicide will impact, directly or indirectly, approximately 135 people. This might include those who arrive on the scene during the immediate aftermath, such as first responders (ambulance crews and the police). Then there are the immediate and extended family members and loved ones who need to be informed.

As the ripple spreads, initially like a tsunami, neighbours and work colleagues of the deceased and close friends are informed. During the days, weeks and months following a suicide, the ripple reaches others such as friends, ex-colleagues who had maybe lost touch. Almost 3 years on, I still meet or speak with those who knew Jordan and are only just hearing about his suicide.

Few escape the ripple effect of a death by suicide. Even those who were less closely associated with the person who died are impacted - think of celebrity suicides. In our case, this included the many people I had to inform about Jordan's suicide, such as the young counter assistant where he banked, a front line call operative at the local council, call handlers at the utilities companies from where Jordan received his energy supplies, his mortgage firm, his dentist and many others. All were sympathetic, some were visibly/audibly upset by the reason I had to give for needing to settle and then close Jordan's account. I remember how upset Jordan's GP sounded when I telephoned the surgery to say that Jordan would not be attending his scheduled appointment to review his prescription for antidepressants in 2-days time.

When discussing the experience of suicide, we often refer to the term 'ripple effect'. This effect occurs when an ever increasing number of people are impacted by a single suicide. What if we were able to create a more positive ripple effect, one where increasingly people knew how to support someone who is at risk of suicide? It takes one person to train someone else, who in turn shares that knowledge with another and so on. As a society, we just have to care enough to want to make this happen.

Suicide is the biggest killer of young men and women under the age of 35 - not cancer, heart attacks, diabetes or road traffic accidents and the age is getting younger. Suicide is the second biggest cause of death among 15-29-year-olds globally. In the USA, suicide is the second leading cause of death among those aged 10 and 34 years of age. Hospital accident and emergency departments in the UK are experiencing the highest ever recorded levels of young people, under 19, presenting with self-harm.

75% of all fatal suicide attempts are by men, although more women attempt suicide and experience depression. More young women in particular are now dying by suicide, which may be partially explained because they are choosing more lethal means.

What needs to happen to move toward a Zero Suicide society?

Suggesting any kind of target, especially one which aims for zero, is open to legitimate challenge. "If we haven't been able to achieve a 10% reduction, how do you expect to prevent all suicides?!" A potential conversation stopper if ever I heard one.

Think of Zero Suicide as a philosophy rather than an absolute target.

In 2019, the Cross-Government Suicide Prevention Workplan was published. The UK government's Five Year Forward View for Mental Health set out an ambition to reduce the number of suicides in England by 10 per cent by 2020, and said: "We are committed to achieving this". They didn't!

Why didn't the government?achieve its target? Many will have their views.

The reasons why people choose to end their own lives are often complex but might include; feelings of entrapment or not belonging, a sense of inequality, gender related stigma, severe physical pain, addiction or general poor health, cultural pressures, financial worries, social and environmental hardship. These issues and others can lead someone to feel a general sense of hopelessness, culminating in a desire to longer want to be alive.

Who could have foreseen the Covid pandemic wreaking such havoc physically and mentally on our societies? Although evidence suggests that deaths by suicide did not increase during the pandemic, we have yet to fully understand what the long-term impact of Covid and associated lockdowns will be? Mental health issues tend to emerge 12-18 months following a traumatic period.

The war in Ukraine is another traumatic time in our history. Now impacting on economies globally, the war is directly affecting the cost of living in the UK and in other countries. Thousands of people are increasingly becoming trapped in debt and poverty, unable to afford basic essentials they need to exist day-to-day. Increasingly, the sense of hopelessness will become too much for many and suicides will increase.

Setting a target to reduce suicides by 10% 25%, 50% or more, suggests that everything in the world will remain as it is at the moment that goal is established. This is not the case now, nor will it be at any time in the future.

Zero Suicide - the concept

Zero Suicide as a concept was initially inspired by health care systems that saw dramatic reductions in patient suicide. The most documented of these health care systems was Henry Ford Behavioural Health, in Detroit, USA, which was the first to pioneer and conceptualise “zero suicides” in 2001 as a goal. A care pathway was developed to assess and modify suicide risk for patients with depression. This landmark approach led to zero suicides for 18 months in 2009-2010. This innovative work was recognised with?The Joint Commission’s Ernest Amory Codman Award ?and the American Psychological Association’s Gold Award.

In the case of Henry Ford Behavioural Health, the reduction in suicides to zero was part of a controlled environment i.e. it involved those known to have mental health problems, in this case depression. Of course, here in the UK, fewer than 30% of people will have engaged with mental health services in the 12 months prior to their suicide attempt. This means that many people are not part of the mental health care system. It would be reasonable to assume therefore, that if this scenario remains unchanged then most suicides cannot be prevented and that 'Zero' is simply a pipe dream? At The Jordan Legacy CIC we don't believe this has to be the truth.

Achieving and sustaining a Zero Suicide society through collaboration

With NHS waiting lists at an all time high, exacerbated by staff shortages, often caused by absenteeism due to mental health illness and with budgets stretched to breaking point, we should not expect our healthcare system to solve the suicide epidemic in this country. All of us can and probably should play our part in us moving toward a Zero Suicide society.

Parents, teachers, company bosses, amateur sports clubs, shopping centres, supermarket check-out staff, construction firms and designers of bridges and buildings, digital and tech companies, local councils, Police, Fire, Ambulance services, GP clinics, pharmacies, railway operators, neighbours, friends, co-workers, all of us can make a difference. We just have to care enough to want to make that difference and secondly take time to understand how to help and support someone who may be suicidal.

In New South Wales, Australia, Minister for Women, Minister for Regional Health and Minister for Mental Health, Bronnie Taylor , recently announced that the NSW Government is partnering with?LivingWorks Australia ?to create a network of safety by training 200,000 parents to be mental health 'first responders '. This online program will train people to recognise the signs someone may be thinking about suicide, giving them the tools to intervene, and refer them to further help.

If you're a parent reading this, just imagine if you were trained to be a mental health first responder. Instead of avoiding the 'suicide' conversation with your child, you were able to confront the elephant in the room head-on. Then, recognising that your child was possibly at risk of suicide, you knew how to develop a safety plan and refer them for professional help. Now consider if your child's school teacher was similarly trained.

The training and support required to help us continually move toward a Zero Suicide society is already out there. Right now, you can visit a website like the Zero Suicide Alliance and take a suicide prevention video course for free.

Currently, in the UK, we have more third sector support for those who are suicidal or who have been bereaved by suicide than we have ever had. I know many of these amazing individuals and organisations personally, many I count as close friends. Often, we support each other, when the going gets tough. We engage and share each other's social media content and we attend joint events and conferences. In some instances, partnerships are formed and suddenly there is strength in numbers. In my view though, this is not happening enough.

If we are to truly move toward an ever decreasing number of suicides and the philosophy of Zero Suicide begins to feel more than just a concept, the third sector must collaborate more.

Collaboration means:

• strength in numbers
• sharing of knowledge, skills and expertise
• greater aligned thinking and strategy
• a unified approach when lobbying government
• increased media awareness
• being part of a support network - too many people who work in mental health and suicide prevention are trying to save the world on their own
• we truly can move the needle toward zero and help more people find the hope they so desperately need

I don't have the knowledge, skills or expertise required to prevent cancer, heart attacks or diabetes and I don't have enough years left to learn either. However, I am continually developing my understanding and ability to support someone who is struggling with their mental health or who might be feeling suicidal. I don't need a PHD or a Masters or 7 years of training to learn these skills, I just need a reason to do so. You can see my reason below.

Almost 3 years ago, my son took his own life. I had neither the awareness or the skills to be able to talk to him and prevent his death. Do I regret this? Yes. Every single day and I will continue to believe for the rest of my life that had I been better prepared and taken Jordan's mental health more 'seriously', he may still be with us today.

As a society, in our communities and workplaces, we can no longer accept the loss of of 17 people to suicide every day in the UK. We must come together as a movement so that we can work toward Zero and a world where suicides become rarer and rarer events.

If you have been affected by any of the content in this article, please visit The Jordan Legacy's website and our Help menu resources.

Steve Phillip is a former training consultant, turned suicide prevention advocate, following the death of his son, Jordan, to suicide in December 2019. The Jordan Legacy CIC's mission is to be at the forefront of the advancement of mental health and preventing lives being lost to suicide. Our focus and hope is that we can influence a significant reduction in the annual suicide numbers in the UK

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