Plenary, 06 Apr 2000

Meeting date: Thursday, April 6, 2000

Official Report 676KB pdf

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Suicide

The final item of business today is a members' business debate on motion S1M-418, in the name of Mr Kenneth Gibson, on suicide. The debate will be concluded, without any question being put, after 30 minutes. I remind members that business is not over for the day and that those leaving should do so quietly.

Motion debated,

That the Parliament notes with deep concern the death of 874 Scots by their own hand in 1998; is aware that since 1984 the proportion of male Scots aged 35 or under whose deaths can be attributed to suicide has increased from one in nine to one in four, and for females from one in twenty to one in seven in the same age category, making suicide the most common cause of death in young Scots; recognises that in Scotland the suicide rate for males and females of all age groups is 32 and 10 respectively per 100,000 and increasing, whereas in England it is 18 and 6 per 100,000 and decreasing; believes the reasons for suicide to be complex, multi-functional and poorly understood, and calls upon the Scottish Executive to commission, at the earliest date possible, wide ranging, comprehensive research into the issue of suicide, analysing what makes people take their own lives, why the suicide rate in Scotland is increasing, why particular groups in society are more vulnerable than others, how other countries prevent suicide, and introducing an early warning system of diagnosis and intervention.

I welcome the opportunity to debate this important issue and thank the members from all parties who have made discussion of this distressing subject possible and remained in the chamber to participate in the debate.

I acknowledge the important work of organisations such as the Samaritans and of individuals such as Professor Stephen Platt, director of the research unit on health and behaviour change at the University of Edinburgh medical school.

Between January 1997 and December 1998, 1,752 Scots took their lives. Every one was an individual: a mother's son or daughter; a brother or sister; a friend or colleague. Suicide is a silent tragedy, both for those who kill themselves and for the families left behind to grieve. More than a quarter of all Scots have known personally someone who has taken their own life. Among males aged under 35, more than a quarter of all deaths were from suicide, compared to one in nine a decade and a half before that period. Among the female population, one in seven of the same age group died by their own hand, compared to one in 20 in the mid-1980s.

Among young males, suicide so far outstrips other causes of mortality, with 550 deaths over the years 1997 and 1998, that the next two most significant causes—motor vehicle accidents and drug dependence—combined resulted in 514 deaths. Although, mercifully, the number of deaths of young females from suicide is lower—147 over the same period—suicide became the most common cause of death for that group for the first time in 1997, and remained so in 1998.

In Scotland, the level of mortality from suicide among all age groups is at an historic high and is increasing, whereas, as the text of the motion indicates, it is thankfully decreasing in England. We need to understand why. A concerted and co-ordinated response by practitioners, policy makers and researchers is overdue; I hope that the Deputy Minister for Community Care will directly address that point.

Over three decades, the number of suicides among young people and people aged between 35 and 64 has not just increased, but has done so relentlessly. That worrying trend requires urgent action from the Scottish Executive. Although I accept that mental health is recognised as a priority for the national health service in Scotland, the white paper "Towards a Healthier Scotland", published last year, did not mention suicide reduction. By contrast, in the white paper for England and Wales, "Saving Lives: Our Healthier Nation", not only has mental health been given a leading priority, but a target has been set to reduce deaths from suicide by 4,000 over 10 years.

Before I suggest how a reduction in the number of suicides may be achieved, I wish to touch briefly on how people commit suicide and on who is most vulnerable. What are the most common methods of suicide? Among men, hanging accounts for almost half the cases, and self-poisoning or self-gassing account together for more than a third. More than half the women who commit suicide die by self-poisoning, and almost a quarter by hanging.

Who, in socio-demographic terms, is most at risk from suicide? Factors of gender, marital status, social class, occupation, job insecurity and unemployment all play a part—divorced people, unskilled workers and men employed in farming, medicine and allied occupations are particularly at risk. Female nurses and health, education and welfare professionals also have relatively high levels of mortality.

What of the individual psychopathology of those who kill themselves? Sadly, between 10 and 15 per cent of people with either schizophrenia or an affective disorder will go on to commit suicide, as will a similar proportion of individuals with a history of deliberate self-harm. Former psychiatric patients, alcoholics, heroin addicts, homeless people, remand prisoners and an increasing number of people suffering from clinical depression are particularly vulnerable.

We must accept, however, that many people who commit suicide fall into no obvious category. Population measures are thus essential if we are to impact on this serious problem over time. What strategies are required for effective suicide prevention? We must examine high suicide-risk groups, including people recently discharged from psychiatric hospital, those with a history of deliberate self-harm and of attempted suicide and those who have suffered sexual, psychological and physical abuse.

We must consider population-based solutions, such as reducing the toxicity of analgesics, car exhaust gases and anti-depressants; improving safety measures and installing freephone helplines at known suicide hot spots; introducing an early warning system for diagnosis and prevention; improving the availability of professional counselling and support mechanisms; more responsible portrayal of factual and fictional suicide in the mass media; suicide prevention work in secondary and tertiary education; and improving overall social well-being.

It cannot be doubted that the Executive faces a difficult and complex task. However, Canada, Finland and Sweden have shown that the dual approach of high-risk population solutions can work. To achieve success, the subjects of mental health and suicide need to be taken seriously and need to be seen to be taken seriously. We must work to break down barriers, including the taboo that mental health issues and suicide still have in our society. We should consider prosecuting under common law anyone who encourages or assists another to take their own life. We need integrated solutions, with health boards, local government and the voluntary sector co-ordinating their activities. We need realistic and obtainable targets to be set for suicide reduction. I urge the Executive to carry forward this process.

No fewer than seven members would like to be called to speak in this debate. However, if they were all successful, they would have a minute each to speak. We will see how we get on.

I commend Kenny Gibson for raising the subject of suicide for debate and for speaking to the motion in such a compassionate and well-informed manner.

It is important that we highlight the discrepancy between the falling suicide rates in England and the rising rates in Scotland. If this Parliament is to work effectively, it has to find Scottish solutions to Scottish problems. I have no doubt that we are all committed to doing that.

We must address the stigma on mental health. We can do that by encouraging open debate, discussion, understanding and greater sensitivity around the issue. We have made a start by addressing the issue today.

We also need to consider funding. Richard Norris of the Scottish Association for Mental Health recently gave evidence to the Health and Community Care Committee. He said:

"It is beyond dispute that mental health spending is not keeping up with general health service spending, despite the fact that mental health has been declared a priority.

Two recent Scottish Health Advisory Service reports into mental health services in Renfrewshire and Fife have identified a lack of investment as causing problems—affecting staff levels, the planning of new services and morale."—[Official Report, Health and Community Care Committee, 8 March 2000; c 628.]

Norris also highlighted the severe financial pressures facing local and voluntary sector mental health organisations—including the Scottish Association for Mental Health. He told us that the mental illness specific grant has been frozen since 1995-96.

We can do quite a few things to address this enormously complex issue. Kenny Gibson has alluded to people being discharged from psychiatric hospital. There is an enormous job still to be done to find seamless care for patients, not just the elderly and disabled, but also the mentally ill and the vulnerable.

By midday today, my desk was covered with research and data on suicide. I found it hard to come to a conclusion from the complex information and decide on a clear way forward. I believe that the Executive should collate such information at a national level and set out a strategy or a protocol to address the problem. I am particularly aware of the high and rising suicide rate in the Highlands and in the agriculture sector. We need as many solutions as there are complexities to the problem. Within the agriculture sector, the culture and the traditions of independence mean that people do not readily access the services that are available.

Some research suggests that general practitioners can help, whereas other research suggests otherwise. For example, the University of Aberdeen concluded that medical contact near to the time of the suicidal act was rare.

The most alarming figure in Scotland is the suicide rate among young men. On average, it is 50 per cent higher than in the rest of the UK. We need to examine why young men do not make good use of health services or take time to care for their health or well-being. We need to examine why they have low self-esteem, why they feel socially isolated and why they are more afraid of expressing emotion. We need to examine why they do not have the confidence to seek help when they need it. There are many reasons, including poverty and discrimination. The information that we are discussing today seems to present a direct plea from a vulnerable strand of our community. I welcome this debate, which is the first step towards addressing a tragic problem.

I welcome this debate and would like to make two points. In 1996, the Edinburgh City Youth Café had some success with a trial scheme, "Time to Talk", which was funded by Lothian Health. The scheme was limited to one counsellor with only eight sessions a week. However, because there was good preparation and because of the informal and relaxed setting, 15 young people attended. They kept 81 appointments—71 per cent of all the appointments, which is a much higher proportion than is usual—and the young men attended more often than the young women. There were also more young men involved than is usual. The young men averaged eight and a half attendances each. In a small way, that shows that a well-prepared scheme to advise and support young people can help. The setting is important. I suggest to the minister that one way forward is to develop more of that type of thing, using existing, popular youth facilities in different parts of the country.

The other lesson that I have gained through a long involvement with the youth café is that we have not yet got our act together in terms of joined-up government. Young people who have behavioural problems, or who are in mental turmoil, also usually have difficulty in accessing money and in finding somewhere to stay and something to eat. We must provide the practical support that those young people need as well as the behavioural support. We must build up a system that deals with such people—from those who cause trouble in the classroom to those who might commit suicide. I know that that is a tall order but, if we organise our services better, we will save lives, unhappiness and money.

I congratulate Kenny Gibson on lodging this motion for a members' business debate. I should declare that I am still registered as a psychiatrist. I am pursuing research, and have completed some research in this subject.

As a general practitioner, I came across a common belief that, because many suicide victims consulted shortly before they committed suicide, general practitioners should in some way be able to identify potential suicides. However, when the matter is studied in depth, one finds that it is extremely difficult to pick out those who will commit suicide.

We recently undertook some research with Professor Kevin Power of Stirling University, which took a retrospective look at some 40 suicides in the Forth Valley area. We found that the suicides fell into two different groups. One group consisted of infrequent consulters, who saw their GPs far less often than the average of 3.8 times a year. Members of the other group had much more frequent consultations. A research-based approach would therefore provide opportunities for us to begin to turn back the tide of suicides among young men in particular.

The group to which Kenny Gibson referred—those who have mental health problems—is important. People who have suffered schizophrenia or manic depressive psychosis are much more likely to commit suicide, and it would be helpful to identify people with mental health problems more clearly.

We must be realistic about the incredible increase in drug and alcohol abuse that we face. The co-morbidity that is associated with the abuse of drugs and alcohol by people who have mental health problems leads to situations in which suicide is more likely to occur.

Suicide has been researched since Dirkheim produced his seminal study, back in the 1880s. He referred to a condition that he called anomie, which still exists today—a condition of isolation and poor self-esteem.

Those issues are compounded by drug and alcohol abuse and by unemployment. In its work with the social inclusion partnerships, the Executive is right to tackle some of those root causes in order to improve the situation, as that would help.

The question "Why we are we facing a rising tide of suicide?" was asked at recent conference. Richard Holloway gave an extremely worthwhile talk on that occasion and described the situation as being at least partly due to the increasing pace of change in a complex society, to the fact that, particularly for men, the values and certainties of life are much less concrete than they were, and to the fact that people are excluded from education and from employment. He also talked about drug and alcohol abuse.

Why should suicide be more common among young men than among young women? The answer may involve gender perceptions, as perhaps, for men, changes in gender perception appear greater.

The mental health framework gives us an opportunity to move forward. I am concerned that, although mental health has been a priority under both the previous Government and the present Government, as yet there is no great evidence that the health service is shifting adequate funds into mental health issues. We must constantly ensure that that shift in prioritisation is driven forward.

I am particularly glad that Kenny Gibson has brought this important motion to the chamber. I declare an interest, as the newly elected rector of the University of Edinburgh, where student suicides have, in a sense, attracted unwelcome publicity.

Colleges and universities in Scotland have student welfare services, counselling services and college wardens. In the first year, they do what they can, through peer support, to get students to support one another. The suicide rate among university and further education students is no higher than that among the rest of that age group of 18 to 25-year-olds, but suicide affects universities and university students in a particular way.

Anything that the Executive is able to do, in pulling together research and other measures so that universities and colleges can be assured that it is doing everything it can to make student suicides less likely, would be most welcome.

I, too, congratulate Kenny Gibson on securing the debate.

I support the remarks made by Mary Scanlon, as I am particularly concerned about the higher incidence of suicide in the Highlands, in comparison with the rest of Scotland. One can speculate why that should be but, as Richard Simpson and Kenny Gibson said, it is difficult to isolate with any certainty a definite causal connection. Therefore, I am sure that everyone is concerned to do what can be done.

I wanted to speak in the debate because of my experiences as a lawyer dealing with people who have serious debt problems and who have been sequestrated. My experience is that sequestration results in significant and most severe social problems, such as the loss of esteem, often the loss of a job and sometimes the loss of one's home. Sometimes, the attitude of banks and building societies can be described as obdurate and unhelpful at best. Another social problem that can result from sequestration is the loss of a partner and the breakdown of a marriage.

Therefore, while sequestration is a small part of life—only a few thousand people are sequestrated every year in Scotland—I thought it worth mentioning so that the minister, when he leaves to consider what should be done in response to the debate, is able to raise with the Minister for Justice the issue of reform, so that the stigma can be removed from the law of sequestration. We are close to that position, but the Parliament could remove it explicitly, which might begin to help those who, in future, suffer that multiple loss that can be the consequence of misfortune in business.

Kenny Gibson is to be thanked for raising this extremely distressing subject. Any preventive action that can be taken effectively should be welcomed.

I first became aware of the problem when I was deeply shocked when students whom I knew committed suicide, several of them because they were afraid of failing their degree exams, although I suspect that there were other pressures on them, too. Richard Simpson's description of isolation and poor self-esteem summed up the situation well. If those people had had appropriate counselling and had got through that difficult patch in their lives, they would have viewed things in an entirely different light a few years later. I suspect that many of those with mental health problems who feel intense depression at certain points, if they could be helped through those difficulties, would come to see matters from a wholly different and more objective perspective.

Research is necessary. I know that the managers of the Empire State building had to take precautions to stop people throwing themselves off the top. I mention that because, when I was a minister, I became aware of a place in Scotland where people had been committing suicide. I will not say where it is, because I do not want to put the idea into anybody's mind, but I immediately asked my civil servants to take steps to make it impossible for suicides to happen at that place. I believe that that had a salutary effect. The importance of research is that it points the way to effective solutions. In the past, the Scottish Office had some extremely able researchers, whose research was of great benefit to the public. Kenny Gibson's call for research has considerable merit and I hope that the minister will give a positive and favourable response.

There is time for one more speaker. I call Christine Grahame.

Suicide is not an individual matter, but a matter for society. Two disparate groups have high suicide rates: Scottish farmers and people on remand. The simple reason for the high suicide rate for Scottish farmers is financial pressures. I know that every member would want to help, so we must address the real crisis in farming. The very nature of farmers' work means that they are isolated, although they have come from generations of farmers who were used to being proud and isolated.

The second group is prisoners on remand. We know from Clive Fairweather's report that the current system is dreadful and that remand prisoners are housed in the worst conditions. We know that just under 50 per cent of remand prisoners end up with no conviction, but the most vulnerable among that group of prisoners are the ones who take their own lives. Cornton Vale has made huge improvements under Kate Donegan, and I hope that Iain Gray and Jim Wallace will consider improving remand conditions so that we can remove those people from the suicide chain.

I thank members for their self-discipline in keeping their speeches short. I call Iain Gray to wind up.

I am grateful to Mr Gibson for raising this difficult and serious issue. It is not the first time that he has raised the matter in the chamber, and I am sure that it will not be the last. I am glad that many MSPs have supported the motion and have spoken in this evening's debate.

One life ended through suicide is a tragedy. More than 1,000—the figure mentioned by Mr Gibson—is a huge and unacceptable waste, bringing in its wake untold grief for families, friends and loved ones. There is little point in further rehearsing the statistics that Mr Gibson gave so succinctly. We must do all in our power to stop this appalling loss.

We must consider the variety of contributing factors. Mental illness plays a significant part and contributes to about 30 per cent of the total number of suicides, of which around 15 to 20 per cent spring from severe depressive illness, and about 13 per cent from schizophrenia. However, there are other factors. Misuse of alcohol or controlled substances is often implicated, creating intolerable personal and domestic problems and loosening inhibitions, facilitating the act of suicide.

As many members have said, life circumstances cast a sombre shadow. Poverty, unemployment, inhospitable environments, money problems and dreary housing conditions can all combine to make life seem no longer worth while.

It is worth returning to the focus of Mr Gibson's motion, that young men are particularly vulnerable. The reasons for that, which have been referred to, are correct. They may lack helpful family support. They may have poor prospects of a worthwhile job. They may lack a sympathetic ear to confide in. Indeed, they may find it difficult to confide even if that sympathetic ear is available. They therefore deserve our special attention.

Against that background, there is much that can be done, and is being done. A raft of measures are being taken by the Executive to improve quality of life, to enhance job prospects, to deal with social exclusion, and to create a climate of tolerance, support and social well-being. They are all necessary, and will help to tackle the problem. However, I agree that we need to take more specific steps. Some have already been taken. For example, in September 1998 the Government introduced important new measures to reduce pack sizes of paracetamol and aspirin, which was aimed at reducing the incidence of impulsive overdose, and introduced new warnings on labels to emphasise the risks associated with overdose.

Richard Simpson referred to the framework for mental health services in Scotland, which offers best practice in the organisation of care and preventive measures. It recognises the isolation that can lead to suicide attempts, and encourages health boards and their partner care agencies to organise programmes of assertive outreach, which ensure continuing contact with those considered to be at risk. Indeed, the framework also promotes suicide prevention projects in collaboration with interest groups and the voluntary sector, as Mr Gibson said.

Mental health is one of the three main clinical priorities for the national health service in Scotland. That is signalled in a number of ways. Spending on mental health has kept pace with general health spending over a period of years, but this is not the debate to pursue the point that Mary Scanlon made. We are increasingly conscious of the need not just to deal with mental health problems, but to promote positive mental health. Clearly, that could have an impact on suicide prevention.

There has been much discussion of research. The chief scientist office and I are open to suggestions for research that will help to reduce the suicide figure. A good deal of research is on-going. For example, the Executive is contributing to the funding of the national confidential inquiry into suicides and homicides by people with mental illness. That inquiry is examining the health records of all individuals who have committed suicide or homicide and who were in contact with mental health services in the period up to the incident. The study hopes to identify common behaviour patterns, symptoms and so on in exactly the way that many members have referred to tonight. Indeed, the first report of the inquiry, entitled "Safer Services", which covered only England and Wales, was published last year. We are looking at its recommendations, and we await its next report, to be published shortly, which will cover Scotland. We hope that it will give us the information that we need to take our strategy forward.

The chief scientist office, which has responsibility for encouraging and supporting research into health services, has awarded funding of more than £135,000 in the past three years for two projects related to suicide and deliberate self-harm, but that is part of a wider national and international research effort. Indeed, the national research register lists 168 current research projects on suicide, so much research is being done, but Mary Scanlon was right: it is difficult to see what evidence there is for the effectiveness of prevention strategies. Many trials have been too small to generate conclusive findings. Even in high-risk groups, for example, those with a history of self-harm, fortunately, suicide is still a rare occurrence. Although in such a group its incidence is 100 times what it is in the general population, the suicide rate is still only one in 100. Sometimes it is difficult to move from research to practical measures.

Mr Gibson is right that there is experience elsewhere. Susan Deacon visited Finland earlier this year to discuss with her opposite numbers their approaches to a number of matters. One of them was suicide prevention, in which they have had some success. We are reflecting on the Finnish experience and whether it could be applied here. One of the lessons that was learned was that it takes 10 to 15 years to see the effect of trying to reverse such a tragic trend as that to which Mr Gibson's motion refers.

I am sorry that I cannot, in the time that is available to me, respond to all the points that have been raised, but I would like to conclude by welcoming the interest of Mr Gibson and other members in this very emotive issue. It is an issue that the Executive is determined to tackle through both general and specific measures that are informed—as is appropriate—by the available research.

It is incumbent on the Executive to listen to suggestions and we will examine those that have been made by Mr Gibson and others in the debate.

Meeting closed at 17:41.