Suicide Prevention

Across a range of posts I have written, I have alluded to what we should try to call “suicide prevention”.  The police have a crucial role to play for very obvious reasons, as we are often called to crisis situations where other options are limited, or where the nature of the crisis becomes an emergency.  Section 136 of the Mental Health Act is often used in the arena of suicide prevention, because it allows officers to take a coercive decision to protect someone where the legal criteria of necessity are met.  However, this power is limited to public places and officers often find themselves invited into private dwellings to protect vulnerable people.

The Government will today publish a new 10-year strategy for suicide prevention.  This comes against a backdrop of economic and social factors which have given rise to suicide levels, including amongst younger male adults who are three times more likely than women of similar age, to take their own lives.

Some criticism of the use of s136 is that it is considered wherever someone threatens to kill themselves and I want to spend a paragraph on this.  To use s136 officers must be satisfied of the need for emergency intervention in a public place, but on the grounds of mental disorder.  Is it a mental disorder to threaten to kill yourself?  Not inherently.  There could be any number of issues ongoing, without the presence of mental disorder, which lead to such statements being made.  There are two possible reactions to this, in my view:  are police officers the appropriate professional people to be making those judgements of whether a particular threat is or is not an indicator?  Secondly, on what grounds should they try given that the context of that judgement will range from situations involving long periods trying to “talk someone down” from a height, or acting in an instant to prevent an imminent or expected disaster?  Practicalities dictate that the longer you have to explore the context and background, perhaps to involve specialist “Crisis Intervention” negotiators, the more likelihood that officers may reach a nuanced decision that threats are not indicative of a mental disorder.  The less time you have, the more you may have to assume it is for the want of time and skill to tell.

I have recalled before a particular incident of my officers and I meeting a young man sitting in a communal grassed area hear his home, drinking alcohol but far from drunk and clearly very depressed.  A local resident had called the ambulance service because he was sitting rubbing a bottle against his neck and the ambulance service requested police support.  Officers got there first and established that he had lost both of his parents in the previous few weeks, both suddenly and separately, and he was struggling with his grief.  The bottle had caused a minor mark to his neck – not even a cut – that required no formal treatment, perhaps just cleaning.  The paramedic who arrived asked us to remove him to a place of safety but having spent 20 minutes talking to him, we weren’t convinced of a mental disorder.  When directly challenged to confirm that the paramedic, as the lead healthcare professional, was stating that this man was “suffering from a mental disorder within the meaning of the Mental Health Act”, he declined to do so.

So these can be complex judgements to make in some situations.  The more obvious point to make, is that we cannot and should not rely on s136 or other police interventions to sustainably lower suicide rates, because by the time it comes we already have “one foot off the bridge”.

We know that men are three times as likely to kill themselves as women and we know that patients and those with unmet health needs sometimes have to find themselves with “one foot off the bridge” before they can access mental health assessment or support.  We also know that about 87% of patients with mental health problems are under the care of their GP, not their mental health trust.  So when patients need to access out of hours assistance, they can often hit the problem of not being known to 24/7 Crisis Services run by mental health trusts, but being unable to access their out-of-hours GP for mental health support.  This often leads people to emergency services, such as Accident & Emergency, the Ambulance Service and increasingly, the police service.

Of course, none of these emergency providers are equipped, commissioned or constituted to provide anything other than the most basic intervention.  The ambulance service can choose to do nothing or take someone to A&E; the Emergency Departments themselves undertake basic triage and make referral to out-of-hours mental health trusts; the police can either do that – it is rarely popular – or utilise the “Section 136 pathway” to remove someone to a Place of Safety.

Police forces are actively looking at suicide prevention and I am sure we will see later, the role of the police noted within the new Suicide Prevention Strategy, launched today on September 10th.  British Transport Police in particular, have well documented problems around the prevention of suicide, not least because of the tragedy this represents to individuals, but because of the absolutely enormous cost to the UK economy of shutting railway lines for investigations.  As we know, suicide rates have been rising, which probably contributes to perceptions around increased use of s136.

I am very much looking forward to reading the new Strategy and I will link it at the foot of this post once it is published, but what we can already say is that it will need to re-address gaps which we have existed for years and which we know are spoken of, time and again.  I also fear that it will be unable to address the underlying political, social and economic issues which we know contribute to suicide levels, alongside medical and psychological factors.

____________________________________________________________________
The Mental Health Cop blog

Badgewon the ConnectedCOPS ‘Top Cop’ Award for leveraging social media in policing.
won the Digital Media Award from the UK’s leading mental health charity, Mind
– won a World of Mentalists #TWIMAward for the best in mental health blogs

ccawards2013 was highlighted by the Independent Commission on Policing & Mental Health
– was referenced in the UK Parliamentary debate on Policing & Mental Health
was commended by the Home Affairs Select Committee of the UK Parliament.

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6 thoughts on “Suicide Prevention

  1. We (GMP Contact Management) are currently developing a process for assisting call handlers to involve Samaritans in calls where people are distressed and possibly suicidal.
    Right from the start it seemed obvious to me that Samaritans are imminently more qualified
    than police to help someone who is in mental or emotional distress.
    The challenge has been that once someone has contacted the police there is a
    responsibility on the police to sort out the problem.This sets off a whole session of
    risk-based worrying about whether we can confidently pass the management of that situation
    to Samaritans who deal on an anonymous basis and would not have details of location/identity
    of caller etc.

    You can imagine the scenario where somebody subsequently commits suicide – the management of
    the incident would be subject to a good deal of scrutiny.

    We are currrently planning to trial an approach that allows us can, with the callers
    permission, to pass details of the caller to Samaritans (where there is no imminent risk to
    life).

    The point of the exercise is to introduce the distressed person to someone who is sufficiently
    skilled to help. I hope the new strategy aims to do this too.

    1. Agreed, I was aware that this was in development and it’s a great idea. Only last night, I was contacted via social media from someone in need of help and support and in the particular circumstances could think of nothing other than police / Samaritans. Neither was what the person needed, but either was better than nothing at all.

      Would love to hear more about how it goes when it’s running.

    2. I think this is a great idea. As an emergency call handler I spend many hours “counselling” people over the phone who are wanting to commit suicide. Often they don’t tell us where they are which makes it more difficult in finding them. I have had no mental health/counselling training, which makes it very difficult when you are speaking to them for such a long time.

      I think we often make a decision to sec 136 someone when we cannot honestly say whether they have a mental health condition, or if they have just had a very bad day/week/month, as in the male you mentioned who had lost his parents.

  2. I should be very vexed were I to be frustrated in my attempt to kill myself. I’m not joking. I do have a plan if the need arises or the urge is irresistible. And I am certainly not a candidate for sectioning. In some cases doing away with oneself seems the most sensible option.

    I shall say what I always say in these cases – what business is it of the police? Let the original caller approach the person and speak to them. This is the trouble. Where does the buck stop? Anywhere but ME! Let some ‘professional’ or other deal with it. I despair. If you are worried about someone in your daily travels and travails then get stuck in.

    Poor bloomin’ police.

    1. I agree to a certain extent with you but once someone gets involved the WORSE thing they can do is walk away at a later stage leaving it just to the professionals as it often gives the already distressed person a feeling of abandonment. If you genuinely think you want to help it will’should be a lifetime commitment!! A professional is only there for a time. Also if the person you are worried about disappears the sooner they are found the better – especially teens and youngsters – and the Police are the best equipped to help find them.

  3. Although I don’t have an actual plan I live with suicidal thoughts on a daily basis, I have learned that it is actually in my best interests to keep quiet about them – and tbh the fear of the consquences of admitting suicidal intent actually now prevents me from making that admittance. It’s the fear of putting your trust in someone and that someone going off shift / passing onto someone else which results in having to explain to more people, to relive the fears and emotions, often several times over, to different people, keeping it all fresh in your head.

    And then there is the fear of being trundled off and locked up alone in a cell or “safe” room with nothing to distract you from the same non-stop scary thoughts, to wait for something to happen to you (with the added fear of the unknown chucked into the emotional mix), and the impact that being trundled off somewhere, not knowing where, or how long for, or who with, has on your every day life (usually detrimental – the existing problems just get worse if you end up hospitalised as there’s little chance of sorting things out from a psych ward 50 miles away from home with no carer. family, friends etc to “pop in” to bring post, clean clothes, food etc) which in turn increases the feelings of hopelessness and pointlessness.

    It’s that fear of repercussions – known and unknown – which is such a barrier to being honest about suicidal intent. And that fear is often heightened when sense of control over immediate environment and life choices is removed. And then there is the shame of what people will think if it’s not successful – the condemnation and gossip and fear of being written off as merely a “cry for help”. Of course it’s a cry for help but the bottom line is that there really isn’t any help, not the kind of help which would actually help and make a big difference both immediately and in the longer term – compassion, kindness, acceptance, trust, responsibility – perhaps that’s why the Samaritans do make such a difference – they help people who feel completely dehumanised start to think and believe that they are human. They do it because they want to, because they care, not because it’s their job or they need to keep a paper trail or cover their backs. They are human and they treat you like a human. Or at least that’s how it feels to someone who has discussed suicide at length with the Samaritans and who is still alive, but who is terrified at the thought of having a similar discussion with MH services or Police.

    The best GP i ever had (now retired) once told me that as I live only a few feet away from a railway line, and only a few 100m from a motorway bridge, there was nothing he could say or do other than sectioning me to prevent me from attempting suicide, and as we were merely discussing suicidality and I had not openly expressed an intention or plan, he couldn’t section me. But he (gently) pointed out the impact both those methods would have on other people. That was the best thing anyone could have said. It made me take some responsibility, to think about consequences for others. That was a powerful safety tool used effectively and never forgotten by me.

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