In September, the Department of Health took the unprecedented step of publishing a strategy in the absence of a minister. The Protect Life 2 strategy, a cross-departmental policy, published on World Suicide Prevention Day, has been welcomed by many but there are also concerns that it does not go far enough and is reliant on future funding.
The long-term strategy to 2024 sets out a headline ambition to reduce the suicide rate in Northern Ireland by 10 per cent in five years and target improvement of prevention services in areas where the suicide and self-harm rates are highest.
While the ambition of a 10 per cent target has been welcomed, critics have argued that the target does not go far enough in a region with the highest suicide rate in the UK. A three-year rolling average for the annual rate of suicide in Northern Ireland (between 2015-17) was 16.5 deaths per 100,000 of the population and the new target would reduce this to 14.9 deaths. In 2017, the overall rate in the rest of the UK was 10.1 deaths per 100,000.
At a time when five people die from suicide in Northern Ireland every week, campaigners who have sought the long-awaited strategy update are hoping that with adequate funding, the strategy has a greater impact.
Funding for the strategy has raised some concerns. Currently, the Department of Health, through the Public Health Agency, invests £8.7 million annually in suicide prevention, 0.16 per cent of the overall annual health budget, and this figure is set to increase by just 15 per cent in 2019/20. Dr Michael McBride, Chief Medical Officer, has previously highlighted an estimated wider societal cost of £1.55 million for each life lost.
While it is recognised that total investment in suicide prevention exceeds the Department’s funding, such as that of mental health services, which receive separate funding, the £1.35 million secured for 2019/20 through the transformation programme for Protect Life 2 initiatives is the only clear indication of additional funding outlined to date.
A statement published on the Department’s website simply reads: “Full implementation of the strategy will require additional funding in future years.”
In September, the Department published research in to the economic cost of suicide and self-harm in Northern Ireland. It estimated that in the 2017/18 financial year, the economic cost of suicide was £473,864,181. The estimated direct costs for the year was £3,460,225, based on 305 suicides in 2017. By contrast, the new strategy, if it achieves the 10 per cent reduction, would save £0.14 million of direct HSC costs on the basis of 2017/18 values.
The new strategy follows on from the original strategy published in 2006 and refreshed in 2012 and contains 10 objectives and 44 actions. To be welcomed, is that the Government’s long-term ambitions are defined and clear pathways to improvement are identified. It also provides an initial financial commitment, allowing services to initiate across the region and increasing the onus on future budgets to support these services.
A significant focus for the strategy is the recognition that suicide and self-harm are amongst the starkest indicators of inequality in Northern Ireland. Suicide rates in Northern Ireland’s most deprived areas are three times greater than of those least deprived and this figure rises to four times for self-harm statistics.
As well as the deprivation gap, the strategy recognises a gendered aspect to suicide, with men more than three times more likely to die by suicide than women in Northern Ireland.
An assessment of the risk factors and protective factors in Northern Ireland within the strategy states: “Suicide and self-harm in Northern Ireland appear to be associated with high levels of mental ill-health, exposure to community conflict and the legacy of the conflict, and exposure to stress particularly economic deprivation. The cultural relationship with over consumption of alcohol also appears to be a contributory factor to our relatively high suicide rate.”
To that end, the 10 objectives of the strategy set out by the Department are outlined below:
- Ensure a collaborative, co-ordinated cross departmental approach to suicide prevention.
- Improve awareness of suicide prevention and associated services.
- Enhance responsible media reporting on suicide.
- Enhance community capacity to prevent and respond to suicidal behaviour within local communities.
- Reduce incidence of suicide amongst people under the care of mental health services.
- Restrict access to the means of suicide.
- Enhance the initial response to, and care and recovery of people who are suicidal.
- Enhance services for people who self-harm, particularly for those who do so repeatedly.
- Ensure the provision of effective support for those who are exposed to suicide or suicidal behaviour.
- Strengthen the local evidence on suicide patterns, trends and risk, and on effective interventions to prevent suicide and self-harm.
Following on from the 2016 consultation report on a new Protect Life Strategy, a number of areas were identified for service enhancement and service development in pre-crises intervention. The Department is clear to point out within the strategy that in attempts to address gaps through Protect Life 2, some actions may be subject to the availability of additional funding. The main areas identified include: Safer mental health services; additional training across sectors for front line staff; support for those not known to mental health services/engaging men in suicide prevention; linkages with substance misuse services; a focus on college and universities; and safer custody.
In terms of areas for enhancement in crisis intervention, the areas highlighted include out-of-hours crisis de-escalation and safe places; self-harm services and support for families of suicidal individuals.
An action plan has been developed outlining the key objectives and associated strategic actions underpinning the Protect Life 2 strategy. However, the Department says that the strategy will be “underpinned by a more detailed implementation plan, developed by the PHA, and by robust governance and monitoring arrangements”. Under Protect Life 2 a new Strategy Steering Group will be set up to drive delivery and report on progress. This group will be chaired by a senior official from the Public Health Agency.
The Department adds: “The new Protect Life 2 Steering Group and its sub-groups will have broad-based representation, with direct responsibility for strategy delivery. In light of this the previous Suicide Strategy Implementation Body and Bamford Protect Life groups will be discontinued.”