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Pushed to the brink: a rise in suicide?

18 September 2020

The Covid pandemic is sparking fears of a rise in suicide and suicidal behaviour. Journalist Jo Waters asks who are the groups most at risk and how can CPs best support them.

Mental health charities have reported more people seeking help for suicidal thoughts after Covid-19 created a perfect storm for mental illness.

During the first month of lockdown, nearly one in five people reported thoughts of self-harm or suicide, according to research published in June by University College London (UCL) (Iob et al, 2020). In a survey of 44,000 people conducted between 21 March and 20 April this year, almost 8000 had thought about self-harm or suicide, and 2174 had self-harmed during the past week. Only 42% of those who were thinking of suicide or self-harm had accessed mental health services.

Rise in suicidal behaviour

Report co-author and UCL doctoral researcher Eleanora Iod says: ‘The at-risk groups follow the findings of previous studies which indicated that young people, those from BAME communities, people with pre-existing mental health problems and those of lower socioeconomic status are at particular risk.’

‘We don’t have the official figures yet, but anecdotally we are seeing a rise in people experiencing suicidal behaviour,’ confirms Evri Anagnostara, chair of Unite’s Mental Health Nurses Association. ‘It’s due to a combination of people waiting longer to seek help because of the reduction in face-to-face appointments, fear of Covid and the isolation from their usual support networks, including work and school, family and friends.

‘Mental health services have coped well up until now, but more and more people are now coming forward and I’m worried about the capacity of our services to cope if we go into a second wave and another lockdown.’

‘They can’t sleep or stop crying. They have no money and don’t know how they are going to feed their kids’

Which groups have suffered most?

Joy Hibbins, founder and chief executive officer of the charity Suicide Crisis – which offers face to face support to people experiencing suicidal thoughts and ideation – says there was a 40% spike in people accessing its services after three weeks of lockdown.

‘Now that lockdown is easing, that has caused another spike of around 30%,’ says Joy. ‘One of the reasons for this seems to be a realisation that life may remain like this for an undetermined (and perhaps prolonged) period. It can be hard to see an end to it. If you are living alone, isolated and have other vulnerabilities, such as depression or poor physical health, then this lockdown easing period may bring little relief and indeed may be a source of greater loss of hope.’

Joy says people with pre-existing mental health problems who have been diagnosed with more severe and enduring mental health conditions, such as bipolar disorder and schizophrenia, are one of the most deeply affected groups.

‘Most NHS mental health teams are still not providing ongoing community mental health appointments and treatments, only short check-in phone calls. These haven’t been enough to stop their mental health from deteriorating, and many of them have needed to access our suicide crisis services as a result.’

The dire news about the economy includes predictions that unemployment may rise to as high as 13% early next year (Office for Budget Responsibility, 2020) and is also causing much worry and distress, says Joy. The lockdown and extended shielding period has also hit the elderly and people with learning disabilities hard, especially those who were already isolated and vulnerable. ‘For those who were already starting to struggle, the Covid pandemic has been the final straw as they have lost the social contact and support that was keeping them going.’

The LGBT community has also experienced higher levels of distress. The charity LGBT HERO reported that 11,000 people had accessed its suicide prevention webpages, up 44% on the first three months of the year (Hunte, 2020).

LGBT HERO chief executive Ian Howley says: ‘We know that LGBT people are far more likely to experience depression due to feelings of isolation, and all Covid has done is amplify this. They lost all their social spaces when the bars, cafes, clubs and restaurants closed. Some LGBT people have gone home to live with families who might not be accepting of them. Community mental health teams need to be more aware of these pressures.’

Ellie Phillips at ForgottenPAYE, a support group for freelancers who have not received government support, says many have reached crisis point. ‘I get calls from people at 3am saying they can’t sleep or stop crying. They have no money and don’t know how they are going to feed their kids. The same themes run through their cries for help: severe financial worries, worthlessness, confusion, hopelessness and feelings of being a burden on those around them. These people have to be supported, which is why we have launched Mind the Gaps, a fundraising drive to raise £1m for the Samaritans.’

What about us?

Nurses and other health professionals already had a higher risk of suicide before the pandemic. Office for National Statistics figures identified female nurses as having a risk of suicide 23% higher than women in other professions (ONS, 2017). A study of female nurses found that 281 nurses died by suicide over the six-year period of the study (University of Manchester, 2020) and 68% of these had not been in contact with mental health services.

One of the key messages of the report was the need to ‘improve access to mental health care in nurses, as in many groups. Similar concerns have previously been raised for doctors, who now have a dedicated mental health service.’

‘Suicide is complex,’ the report adds, ‘and this complexity needs further exploration in female nurses, including examining the specific effects of workplace, financial, and personal problems.’

‘Frontline workers talk about guilt at not seeing their families, the trauma of having to sit with patients who died without their families’

Liam Barnes, chair of the Laura Hyde Foundation, a charity set up in memory of a Royal Navy nurse who died by suicide in 2016 aged 27, says calls from health professionals have increased steeply since the pandemic began.

‘We have provided 20,000 hours of individual support to frontline care workers in the past five months. Many health professionals contact charities rather than NHS services when they are in distress as they don’t want it on their records ,’ says Liam.

‘There has been an 88% increase in traffic to our web site and a 94% rise in acute cases from people at risk of self-harm and suicide. They are calling to ask for help – counselling and therapy in confidence.

‘They talk about guilt at not seeing their families, the trauma of having to sit with patients who died without their families or just not having the opportunity to process everything they have witnessed.

‘I expect the same stories are replicated across the country. We are lobbying the government to provide a minimum level of support for nurses and other health professionals and have mental health champions on the board of every trust.’

Young people

Figures published by the National Child Mortality Database reported 25 child suicides in the first 56 days of lockdown compared with 26 in the 82 days before lockdown (Odd et al, 2020). In 48% of cases, Covid-19 or the lockdown restrictions were believed to have contributed (Odd et al, 2020). The authors said the figures were a ‘concerning signal’ that child suicide rates may have increased during the first 56 days of lockdown, but added that the risk remains low and the numbers are too small to draw conclusions.

Consultant child and adolescent psychotherapist Julia Mikardo, the Association of Child Psychotherapists’ representative on Unite’s Applied Psychology Committee, says: ‘In the first few weeks of lockdown it seems that the number of young people presenting with suicidal ideation to A&E departments was greatly reduced. This was perhaps linked to a fear (in them or their parents) of going out or going to a hospital due to coronavirus or being under the impression that any NHS non-Covid provision had stopped.’

‘I believe the number of presentations has gone up with the easing of lockdown, and it is likely that once young people return to school, their distress will be more evident to school and other staff, so more referrals will be made. As far as I am aware, although CAMHS have largely had to work remotely with patients via phone or video call during lockdown, there would have been provision to see emergencies face to face.’

Julia said community practitioners can help by being alert to a young person who is presenting as depressed, perhaps withdrawn, not socialising (even online), with poor eating or loss of appetite, and poor sleep patterns, concentration and motivation. They should then be directed towards CAMHS.

Health visitors, school nurses and district nurses are well placed to pick up warning signs of mental distress for younger people, says Evri Anagnostara. ‘With children due [or]back at school, school nurses could be watching out for children and young people struggling with feelings of hopelessness and helplessness, who are very unsure about their future.

‘School nurses can flag up the support services that are available – particularly those that are online. If they feel something is wrong, they should act sooner rather than later as the child may have been experiencing problems for some time but not sought help.’

More to help

Evri says health visitors can ask new mothers and young families about how they are feeling and coping and work out how to best support them.

‘There’s a real danger some clients could fall through the net, so community practitioners should be reviewing their caseloads and identifying those who may be at particular risk of a crisis and signposting them to the relevant support.

‘We have coped well so far but still have some tough times ahead and we do now have a chance to plan ahead and better prepare for a second wave.’

Picture Credit | Ikon


References:

Hunte B. (2020) Lockdown: suicide fears soar in LGBT community. BBC News. See: bbc.co.uk/news/health-53223765 (accessed 13 August 2020).

Iob E, Steptoe A, Fancourt D. (2020) Abuse, self-harm and suicidal ideation in the UK during the COVID-19 pandemic. The British Journal of Psychiatry. See: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/abuse-selfharm-and-suicidal-ideation-in-the-uk-during-the-covid19-pandemic/692FD08F3AEFF45036535F5E9CEBAA00 (accessed 13 August 2020).

Odd D, Sleap V, Appleby L, Gunnell D, Luyt K. Child suicide rates during the pandemic in England: real time surveillance. See: https://www.ncmd.info/wp-content/uploads/2020/07/REF253-2020-NCMD-Summary-Report-on-Child-Suicide-July-2020.pdf (accessed 13 August 2020).

Office for Budget Responsibility. (2020) Coronavirus analysis. See: https://obr.uk/coronavirus-analysis (accessed 13 August 2020).

Office for National Statistics. (2017) Suicide by occupation, England: 2011 to 2015. See: ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/suicidebyoccupation/england2011to2015 (accessed 13 August 2020).

University of Manchester. (2020) National Confidential Inquiry into Suicide and Safety in Mental Health. Suicide by female nurses: a brief report. See: http://documents.manchester.ac.uk/display.aspx?DocID=49577 (accessed 13 August 2020).

 

 

 

 

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