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Roula Khalaf, Editor of the FT, selects her favourite stories in this weekly newsletter.
The writer is a bereaved father and campaigner
Every day in England and Wales, 17 people take their own lives. Five of them are in contact with mental health services and four of those five would have been assessed as at low or even no risk of suicide at their last interaction with services. In July 2020, my son Tom was one of those four. That’s when I began campaigning to reform the system of how we assess suicide risk in individuals.
The publication this week of new NHS England guidance “Staying Safe from Suicide” is a landmark. I co-chaired the writing group together with Dr Adrian Whittington of NHS England. The guidance provides 10 principles for mental health practitioners to adopt in dealing with their patients, all based on best practice — such as, reaching a shared understanding about the person’s safety and the changeable factors that affect it. It spells out that the system, and mental health practitioners in their day-to-day work, should stop trying to predict or stratify suicide risk into low, medium or high.
Instead, they should concentrate on taking an approach centred on each individual patient, to develop understanding and trust. This needs to consider the patient’s physical and psychological condition, as well as their social situation.
It is futile to predict suicide risk because suicidal impulses are very transitory — they can change in minutes. Someone who has suicidal thoughts can be feeling fine one minute but suicidal 10 minutes later. That’s why attempts to predict risk are wrong over 95 per cent of the time.
The National Institute for Health and Care Excellence understood this as far back as 2011 when it advised: “Do not use risk assessment tools and scales to predict future suicide”. In 2022 it said: “Do not use global risk stratification . . . to predict future suicide”. This message was repeated in the government Suicide Prevention Strategy in 2023.
My son had been seeing a private sector trainee counsellor even though he presented with suicidal thoughts and moderate to severe anxiety and depression. He should have been referred on to an experienced, qualified counsellor. I pushed for the new guidance issued this week to apply to all mental health practitioners, not just in the NHS — including private and charity sectors. Thankfully, the Professional Standards Authority, which regulates private practitioners, is now involved. All members of associations for private practitioners will have to adopt the new guidance for NHS England.
It’s going to be a big job to implement across the many thousands of mental health practitioners in the country, but otherwise it remains just words on a page. Previous guidance has been ignored for far too long. The four out of five, the so-called “low risk paradox”, has been known about for over 25 years. Practice has to change.
Let’s look again at those figures. Only five of those 17 who go on to take their own life are in contact with mental health services — the other 12 are not. There is still far too much stigma about suicide.
One thing I learnt during the campaign is that three times more men than women take their own lives. Why is that? The answer seems to be that men find it much more difficult to ask for help, believing it is a sign of weakness or of failure. If we are serious about preventing suicide, a lot more effort needs to be made on both a national and a local level to tackle this stigma.
The system of suicide prevention has many moving parts. I believe that the main reason suicide rates remain stubborn is that there is no one person at the top of the system whose job it is to prevent suicide. My central request is for health secretary Wes Streeting to appoint a suicide prevention supremo, someone accountable for reducing suicide and with the power to make it happen. There is an awful lot of inertia in the system and we need someone to jolt it into changing.
