Drive to zero: suicide in Northern Ireland

Deputy Prime Minister Nick Clegg has made suicide an election issue.

The Liberal Democrat leader last week called on all NHS Trusts in England to join the drive towards zero suicides, acknowledging that all such deaths are preventable and that the stigmas and taboos associated with it need to disappear.

Suicide has a greater effect on Northern Ireland than any other region of the UK. If services are modernised throughout England, it will be politically impossible for that not to be replicated here.

Clegg’s language and enthusiasm for this issue describes many of the reforms that leading experts have called for here.

Contact, an NI counselling charity which runs the regonal 24/7 crisis response and referral Lifeline service, has previously cited many of the same successful programmes namechecked by the minister.

Managing Director Fergus Cumiskey has some very clear ideas about how we can make significant inroads to our suicide statistics – which currently see more deaths caused than was the case by bombs and bullets across the Troubles.

But Health and Social Care in Northern Ireland is creaking badly, and almost all reform comes at a cost, so one question is whether we are in a positon to pay.

Another problem, however, is whether there is enough political will to make the necessary adjustments among MLAs and senior HSC officials.

Donaldson

The Donaldson report into health governance– about which Scope will write much more in the coming weeks – was released yesterday. It was coruscating. The entire system is under pressure and being questioned.

Within that system, mental health is already underfunded and under-resourced.

Speaking last week at the Heenan-Anderson Commission in Belfast, Labour party leader and potential Prime Minister Ed Miliband identified it as an area that required much greater support, saying there are “problems” with the budget for mental health provision, branding it the “Cinderella of the whole health service”.

But Cumiskey says that, while the Donaldson report has got many things right, its proposed solutions do not necessarily get to the heart of the matter.

“Following the Donaldson report - an indictment of health and social care leadership and governance’s fitness for purpose - we can all take a deep breath on where to go next for NI health care.

“It would seem following years of investment the current creaking, multiply-restructured, labyrinthine health service bureaucracy has no one in charge - a familiar finding for those of us who must engage with buck-passing leadership culture of NI public health.

“Donaldson’s expert review is helpful to the extent that it pinpoints the lights-on-nobody-home message from much of our health and social care leadership and the inevitable paralysis when ‘everyone is in charge so no-one is in charge’.”

Political will

Cumiskey told Scope that closing hospitals and increasing the salaries of senior executives “to attract the big guns from the UK” will not address local shortcomings and, while there may be some truth to the reasons behind these criticisms.

“The absence of high profile, media savvy and inspiring health sector leadership says something of the risk-averse caretaker culture so prevalent within health and social care, as opposed to the energetic, confident courageous and optimistic vision and on the ground presence that is required.”

Cumiskey says that, in order to attract leadership with the requisite courage to change well-established methods that continually fail within our health service, fresh ideas for recruitment are required – including using the input of peers, collegiate expertise and unions.

This, he said, would help find “the most dynamic people who are truly committed to entire system change over the five to ten year term” – adding that an “honourable way out” must be found for stale senior officials.

Despite his own criticisms of local HSC, he remains optimistic and, indeed, says this is a vital part of improving services.

If this can be achieved, and new procedures put in place that enable smooth and complete communications between the numerous aspects of provision, then substantial improvements can be made in tackling suicide.

“At the strategic level my Board and leadership team at Contact are committed to driving the suicide death rate down significantly over the next five years, and what’s more, we believe it is a realistic goal worthy of championship.

“We have plans at Contact to ensure best-in-class suicide risk assessment, referral and urgent care access to the right treatment and referral plan.

“For this we need to make inroads with the Royal Colleges in order to influence foundation professional development qualification routes to all health care providers and to ensure suicide prevention CPD spanning the entire cycle of risk assessment, safety planning and urgent care treatment, stabilisation and recovery.

“At Contact, through the Lifeline crisis counselling service, we are committed to ensure much improved inter-agency risk-sharing information and communication protocols, formalised by Memoranda of Understanding akin to a statutory duty to cooperate with the Lifeline service at crisis point.”

Suicide remains a huge problem in Northern Ireland. It is a problem that can be solved but, with our whole health system now in flux, the question is whether or not it will remain undernourished as the inevitable but to-be-determined changes come.