Archive for September, 2008

Can online therapy ease depression?

September 30, 2008
Can online therapy ease depression?

By Emma Wilkinson,
BBC News, health reporter

The UK has a drastic shortage of therapists to treat people with depression, but what if patients could log on to a chat room to get the help they need? Two NHS psychologists believe online therapy may be the answer to ridiculously long waiting lists which leave people little choice but to take antidepressants.

Economists have warned the UK needs 10,000 more therapists to treat the one in six adults suffering from depression or chronic anxiety and get people back to work.

The National Institute of Clinical and Health Excellence has also recommended cognitive behavioural therapy (CBT) as an alternative to medication.

But getting funding for, and training, thousands of therapists will take time and waiting lists for ‘talking therapies’ are currently months or even years long in some places.

Online CBT – which allows real-time therapy sessions from the comfort of the patient’s home – may offer an alternative and is now being trialled in NHS patients.


Domini Thomas, aged 56, from Bristol was asked by her GP if she would like to take part in the trial after being signed off work with stress.


  You learn how to cope with something that previously had seemed insurmountable
Domini Thomas

She said she had got to the point where she couldn’t function.

“It was horrible, you just can’t control your feelings and you don’t know how to get out of this black hole you’re in.”

“The online CBT was absolutely brilliant, you learn how to cope with something that previously had seemed insurmountable.”

She had 10 sessions of 55 minutes, where she would log on to the site at an agreed time and the therapist would talk her through tackling various problems.

“One thing she told me was to think of a photograph of something that makes you laugh and when you feel stress, you picture the photograph.

“You also have a saying that is personal to you, like a mantra, and that will bring you back from slipping backwards into depression.”

After the course, Mrs Thomas was able to reduce the dose of antidepressants she was on and eventually come off them all together.


Nadine Field and Sue Wright set up the Psychology Online service after realising patients were struggling to access therapy.


“We both work in the NHS and because of the case load and back log we thought there must be another way,” explained Nadine.

“The lack of access means people are in a bad state when they get to treatment and then it takes longer.”

Nadine and Sue have had several meetings with the Department of Health about offering the service on the NHS as, with the exception of those in the trial, individuals have to pay £60 per session.

Dr David Kessler, senior researcher at Bristol University and a part-time GP, is leading an online CBT trial which is being compared with standard GP care.


  GPs generally feel that we have been told about how great CBT is but it still remains an elusive therapy
Dr David Kessler

“We know CBT works for all sorts of things, we also know there are some computerised CBT programmes, such as Beating the Blues that are also more useful than nothing.

“But this is more like being in a chat room with your therapist.

“It has a number of potential advantages – it would be great for housebound people, people who are very busy at work and find it difficult to get to CBT appointments.

“It also has the potential to be useful for people whose first language is not English and it’s good for particular things such as agoraphobia.

“GPs generally feel that we have been told about how great CBT is but it still remains an elusive therapy.

“We’re saying we need alternatives, patients want them and they’re not available on the NHS.”

Additional measure

The trial is due to report next year but the government recently announced that all health trusts should offer computerised CBT programmes for suitable patients.

Such approaches will not be suitable for everyone, as they require computer literacy, and some patients may be more comfortable meeting with a therapist in person.

Experts also warn computer-based therapy should not take the emphasis away from the need for investment in psychology services but should be an additional measure.

Mrs Thomas said she personally would have felt much more awkward having face-to-face therapy.

“It’s so easy just to write down your thoughts.”

“The online sessions got my confidence back almost without me realising it.”


No separate Mental Health organisation for Wales.

September 30, 2008






Title:   Mental Health  

Date:   29 September 2008 

By:      Edwina Hart, Minister for Health and Social Services    



On 3rd June 2008 I initiated a discussion with interested parties on the report I had commissioned from Professor Michael Williams. His paper, ‘Iechyd Meddwl Cymru – A Well Being and Mental Health Service Fit For Wales’ envisaged the establishment of a single body for mental health that would provide a comprehensive service combining the expertise of NHS trusts and social services to deliver care throughout Wales in conjunction with primary care and the voluntary sector.


I am sincerely grateful to Michael for the care and diligency he gave to the preparation of this paper and for the excellent way in which he conducted the discussion on his ideas and raised the profile and interest in mental health in Wales. I was very encouraged that this wide debate has taken place.  368 written responses were received and 3 Regional consultation events were held, attended by almost 500 delegates.


The one consistent message that came through these discussions was that mental health services in Wales must improve and urgently.  However no overwhelming view was expressed either to support or to reject the ideas for improving services in Professor Williams’s paper. An analysis of the responses show that 41% were in favour of his proposals, with 44% against leaving 15% undecided.


Health organisations, local authorities and the learning disability sector were overwhelmingly against the proposals whilst service user groups, individual service users and some local and national charities were in favour of his ideas.


I have considered carefully all the points made and whilst there is a great deal of merit in the ideas put forward by Professor Williams, on balance I have been persuaded by the arguments against establishing a separate mental health organisation for Wales.


In coming to this decision I have specifically noted the following arguments:


  • There is good evidence of co-morbidity of mental illness and physical illness. This requires close working across mental and physical health and social services particularly for older people. A separate mental health organisation could make this more difficult
  • A single all-inclusive mental health organisation would stand the risk of becoming isolated and stigmatised. It will also depend on a complex weave of partnerships which could confuse and create boundaries to seamless working
  • There was great concern about the inclusion of learning disabilities within a single health organisation model. These services have been driven by a social model of wellbeing and any such proposed new body could medicalise these services.

 I have decided that mental health services will become a fundamental part of the new integrated local NHS bodies. However I am determined that the resources currently available for mental health services, at a minimum will be fully protected in the new organisations. I shall expect significant progress to be made to implement fully the NSF for mental health across Wales over the next 3 years.. I intend to ensure that mental health services are no longer a “Cinderella” service but have a strengthened presence within the new organisations.


Whilst much has been achieved over the last 6 years since the original National Service Framework (NSF) for mental health was published there has to be an improvement in the access to and quality of the services available throughout Wales.  No change is not an option and I will ensure that in the re-organised NHS mental health services have a very high priority.



Ten thousand views.

September 16, 2008

Today has to be some sort of celebration as our page views pass the ten thousand mark.  Now onto twenty thousand!

Stigma – a Canadian viewpoint.

September 14, 2008

Have a look at the following clip about Stigma and mental illness.

Survey shows steady improvements in community mental health services

September 11, 2008

Published: 11 September 2008

A Healthcare Commission survey of people using community mental health services, published today, has shown continued improvements in care.

A larger percentage of service users say that they have confidence in mental health professionals, receive copies of their care plan and have a number to contact out-of-hours when in a crisis situation.

Overall, most respondents continued to rate their care highly, with 78% describing it as “excellent”, “very good” or “good”, 13% as “fair” and 9% as “poor” or “very poor”. These figures remain consistent with previous surveys.

But the survey also shows there is still some way to go before community mental health services are accessible to all people who need them and include all service users in decisions about their care.

The Healthcare Commission coordinates an annual survey of service users in NHS trusts providing community mental health services in England.  In 2008, these included mental health trusts, as well as foundation trusts and primary care trusts providing community mental health services, and more than 14,000 people responded.

The survey invited feedback from people who were receiving care under the Care Programme Approach (CPA), which was established in 1991 for those who regularly access mental health services. The CPA sets out guidelines for how care should be coordinated and how service users should be involved in decisions.

Under the CPA, all service users should know who their care coordinator is and should receive a copy of a care plan, which they should have been involved in developing and agreeing.  They should also have regular care reviews to discuss their care and treatment with health professionals.

In 2008, 74% of respondents say they know who their care coordinator is, up from 67% in 2004. Over the same period, the proportion of service users who say they received a copy of their care plan increased from 49% to 59%.  The proportion reporting not having had a care review in the last year has fallen from 51% in 2004 to 45% in 2008. 

However, the survey shows that more attention needs to be paid to involving people in their care. In 2008, almost a quarter (24%) of people say they were not involved in deciding what was in their care plan, suggesting no significant improvement over previous years.  Furthermore, 16% of service users say their diagnosis was not discussed with them.

The survey also showed room for improvement around access to counselling services such as talking therapies. Of the 62% of service users who did not receive any counselling almost a third of those (32%) would have liked to.

There was continued improvement in the number of people who say they have the number of someone from their local NHS mental health service to call out-of-hours, up from 49% in 2004 to 55% in 2008.  However, this still leaves 45% of service users without access to a crisis number to call out-of-hours.  

A greater share of service users report that they are definitely involved in decisions about their medication, up from 40% in 2004 to 44% in 2008. But almost a third (32%) of those who had been given new prescriptions over the previous year say that they were not told about possible side effects – although this has fallen from 35% in 2004.

The survey also showed continued improvement in service users’ relationships with healthcare professionals.  A greater proportion report that they have confidence in their psychiatrist, up from 59% in 2004 to 63% in 2008, and that their psychiatrist “definitely” listens carefully, from 68% in 2004 to 72% this year.  Likewise, 75% report that they “definitely” had trust and confidence in their community psychiatric nurses (CPNs), up from 73% in 2004.

Since the survey, the Care Programme Approach has been revised by the Department of Health. As of October, a new system will be introduced whereby only those with more complex mental health needs will be part of the programme. While many of those currently on standard CPA will no longer be part of this formal approach, an assessment of their needs, the development of a care plan and a review of that care by a professional involved, will continue to be good practice for all.

Commenting on the survey results, Anna Walker, chief executive of the Healthcare Commission, said:

“The survey shows steady improvement in how service users rate key aspects of their care. This is good news for trusts and good news for the people who access community mental health services. But more must be done to improve access to care, in particular to talking therapies and out-of-hours crisis care, and to involve people in decisions about their treatment.”

Speaking about the changes to the Care Programme Approach, she said:

“People may need to access a range of community mental health services from a number of healthcare professionals, so it’s critical that the care is coordinated and accessible. We also know that treatment is more effective when people are involved in their care and are supported to make decisions about their treatment.

“While the improvements are to be commended, the survey shows that there remains a significant number of service users who say that their care is not coordinated and that they aren’t involved in decisions about their treatment.

“When the new system comes into effect, trusts should ensure that the principles of the CPA should continue to apply to every service user and that the improvements made over the last few years are sustained and built upon. Service users’ care should be co-ordinated by one person, they should be involved in decisions about their care and they should have access to a range of therapies and services.”

The Commission welcomed the government’s announcement last year of an extra £170 million to improve access to talking therapies for people with a wide range of mental health problems.

The Healthcare Commission will use the survey results to assess mental health trusts in the 2007/2008 annual health check performance rating. In 2008/2009, the annual health check will use a broader set of indicators to assess the performance of mental health trusts, looking at many of the issues identified in this survey. The indicators include a focus on coordinated care in mental health, access to crisis resolution services, mental health data quality, and will continue to incorporate the views of service users.

The survey was co-ordinated on behalf of the Commission by the National Centre for Social Research (NatCen).

Survey of users of mental health services 2008

Information provided by the Healthcare Commission: Link below:

BBC – ‘Mental risk’ of Facebook teens

September 11, 2008
Any comments from Facebook users on the following report? 

Children growing up alongside the rise of social networking websites may have a “potentially dangerous” view of the world, says a leading psychiatrist.

Dr Himanshu Tyagi said sites such as Facebook and MySpace may be harmful.

He told the Royal College of Psychiatrists annual meeting people with active online identities might place less value on their real lives.

And the West London Mental Health NHS Trust expert added this could raise the risk of impulsive acts or even suicide.


  It may be possible that young people who have no experience of a world without online societies put less value on their real world identities
Dr Himanshu Tyagi
West London Mental Health NHS Trust

Dr Tyagi said that people born after 1990 did not know a world without the widespread use of the internet.

He warned that the current crop of psychiatrists were perhaps not fully prepared to help young people with internet-related problems.

While social networking sites offered great benefits, he said, there were potential pitfalls.


“It’s a world where everything moves fast and changes all the time, where relationships are quickly disposed at the click of a mouse, where you can delete your profile if you don’t like it, and swap an unacceptable identity in the blink of an eye for one that is more acceptable.”

He said: “People used to the quick pace of online social networking may soon find the real world boring and unstimulating.

“It may be possible that young people who have no experience of a world without online societies put less value on their real world identities and can therefore be at risk in their real lives, perhaps more vulnerable to impulsive behaviour or even suicide.”

He called for more investigation and research into the issue.

However, Graham Jones, a psychologist with an interest in the impact of the internet, said that while over-use of social networking sites could lead to problems, the risks posed by them had been overplayed.

He said: “For every new generation, the experience they have of the world is a different one.

“When the printing press was first invented, I am sure there were crowds of people saying it was a bad thing.

“In my experience, the people who tend to be most active on sites such as Facebook or Bebo are those who are most socially active anyway – it is just an extension of what they are already doing.”

Published: 2008/07/03 12:30:52 GMT


September 10, 2008

DIPEx shows you a wide variety of personal experiences of health and illness. You can watch, listen to or read their interviews, find reliable information on treatment choices and where to find support.

The site covers cancers, heart disease, mental health, neurological conditions, screening programmes, pregnancy, teenage health, chronic illnesses and many others.

DIPEx was voted by the Times as one of the top 3 patient health sites (2006), was in the Guardian’s top 10 health websites (2004) and was singled out in a recent study (Times article March 2007) as a favourite, trusted site for patients.

Link to site:

Independent Police Complaints Commission – Report on S136

September 10, 2008


Twice as many people are detained in unsuitable police custody for assessment under the Mental Health Act as those taken by the police to hospital for this purpose, according to research published by the Independent Police Complaints Commission (IPCC) today (10 September).

During a one year period (2005/06) over 11,500 people were detained in a police cell as a place of safety under section 136 of the Mental Health Act. In the same period 5,900 people were taken to and detained in a hospital.

The IPCC’s report, ‘Police Custody as a “Place of Safety”: a National Study Examining the Use of Section 136 of the Mental Health Act 1983’, examines the nature and extent of the use of police custody as a place of safety across England and Wales. It is the first time national data on the use of section 136 by all 43 police forces has been collated. The report makes a number of recommendations for the police and health services to improve practice and the experiences of the many thousands of people detained by the police under this power.

Under section 136, police officers can detain people, believed to have a mental disorder, who are in a public place and take them to a place of safety such as a hospital or police station for assessment.

Ian Bynoe, IPCC Commissioner with national responsibility for mental health, said: “Someone whose distress or strange behaviour causes the police concern needs rapid medical and social assessment in a safe environment. It is therefore intolerable that even though it has been Government policy since 1990 that a hospital is the preferred place of safety for such an assessment our research shows that twice as many people are detained in police custody as in a more fitting hospital environment.

“Police custody is an unsuitable environment for someone with mental illness and may make their condition worse, particularly if they are not dealt with quickly, appropriately and don’t receive the care they need. The continued use of cells not only diverts police resources from fighting crime, but criminalises behaviour which is not a crime. A police cell should only be used when absolutely necessary, for example when someone is violent, and not as a convenience.”

Key findings

  • An estimated 11,500 people were detained in police custody as a place of safety in 2005/06. This compares with about 5,900 people in a hospital environment that year.
  • The use of section 136 varies significantly between police forces. The average rate of detention across England and Wales was 55 detentions per 10,000 people in custody. Low rates of detention were reported by Cheshire and Merseyside Police (1 per 10,000 people in custody). High rates were reported by Sussex Police (277 per 10,000) and Devon and Cornwall (174 per 10,000).
  • Just under two thirds of people (61%) detained in police custody were male.
  • The average age of those detained was 36 years, but the ages ranged from 12 to 89 years. Four per cent of detainees were aged 17 or under. Four people were 12 years old.
  • Almost eight out of 10 (78%) of detainees were White; 4% were Black; 3% were Asian; 2% other ethnic origins and 14% were of unknown ethnicity. When compared to the general population the rate of detention for Black people was almost twice (1.7 times) as high than for White people.
  • The majority of people (78%) were detained in police custody for 12 hours or less. The average length of time spent in police custody was nine hours and 36 minutes. Ten individuals were detained for over the legal limit of 72 hours. Almost two thirds (65%) of section 136 detainees arrived in police custody outside of normal office hours (between 6 p.m. and 9 a.m.).

Differences across England and Wales

The IPCC’s research examined why the rates of the use of section 136 varied so much between police forces.

The strongest factor in explaining the differences in the rates of use of police custody is the availability of alternative places of safety. Alternative places of safety were more readily available and more commonly used in low rate and some medium rate forces, than higher rate areas.

A strong factor in some forces was suicidal behaviour associated with high local populations of transient and deprived populations, along with well known ‘suicide spots’ such as seaside cliffs in the police force area. These tended to be in areas where there was little or no alternative to police custody and so had the effect of pushing rates of detention up.

A number of people were being repeatedly detained and released under section 136. They were often felt to be more difficult to assess and care for due to the complexity of their problems, for example having a combination of mental disorder and substance abuse. In some areas outreach work was being conducted in order to reach these people and reduce the numbers of detentions in future.

Other examples of differing practice include officers in forces with lower rates of the use of section 136 finding it less bureaucratic to arrest for minor offences such as breach of the peace, compared to officers in higher rate forces where the reverse was true. This could account for some differences in the rates of detention.

Inconsistent and incomplete data recording by police forces means that information is not available on what happened to section 136 detainees after they were released from police custody. This makes it difficult to establish whether the power is being used appropriately.

Mr Bynoe said: “The strongest factor in explaining the differences in the rates of section 136 use by police is the availability of alternative places of safety. Our research found that alternative places of safety were more readily available and more commonly used in low rate forces.

“When senior police officers and senior staff within health and social care recognise this is a joint problem which requires a coordinated approach it becomes more likely that alternative places of safety will be developed.”


The IPCC report sets out 22 recommendations to improve practice in the future:


NHS commissioners should:

Recommendation 1: work with relevant organisations to develop alternative places of safety to police custody. Consideration should be given to using existing facilities, such as hospital emergency departments and psychiatric units where it may be possible to set aside a space that can be used as a place of safety. These facilities should adhere to the Royal College of Psychiatrists’ standards on places of safety (2008).

Recommendation 2: consider applying for Department of Health funding to set up purpose built facilities where necessary; taking into account how they will staff these facilities using their existing resources. This funding does not apply to Wales and health boards there will need to consider local funding arrangements.

Recommendation 3: consider what preventative outreach work might be conducted to help individuals who are detained under section 136 frequently. Such outreach work may help to prevent some section 136 detentions and ensure that at risk individuals receive appropriate care and treatment.

Recommendation 4: use specialists, such as community psychiatric nurses, to provide outreach services to police custody and arrange mental health assessments. Joint funding from both the police and primary care trust/NHS commissioner would increase staff availability outside normal working hours.

Police forces should:

Recommendation 5: consider ways to improve the co¬ordination and timeliness of mental health assessments. For example, where specialists such as community psychiatric nurses are not available to arrange assessments, agreements could be made for approved social workers to co-ordinate assessments.

Recommendation 6: raise any problems with lengthy delays in mental health assessments in hospital emergency departments with the relevant primary care trust/NHS commissioner to see if a solution can be agreed – for example, the implementation of target times.

Recommendation 7: ensure that officers on the street have adequate training to recognise symptoms of mental disorder, understand their powers under the Mental Health Act 1983, and know what their local arrangements are for places of safety.

Recommendation 8: agree with other agencies that officers can contact individuals with mental health expertise, such as approved social workers, to get advice on particular individuals.

Recommendation 9: ensure that custody officers and staff receive refresher training on mental health symptoms and section 136 processes so that detainees held in police custody

Recommendation 9: ensure that custody officers and staff receive refresher training on mental health symptoms and section 136 processes so that detainees held in police custody receive appropriate care and attention.

Police forces and NHS commissioners should jointly:

Recommendation 10: meet at a strategic level to review the current arrangements with regard to section 136 detentions in their area. This should include a review of the effectiveness of existing protocols and agreements, if they exist. Section 136 should be seen as a joint problem and joint solutions should be sought.

Recommendation 11: review their arrangements for detaining under section 136 people who are intoxicated and/or violent to ensure that they get the most appropriate care. It might be possible to provide a non-police facility where individuals can be safely detained and assessed with police officers present.

Recommendation 12: look for solutions that improve the availability and/or timely attendance of doctors approved under section 12 of the Mental Health Act 1983, where this is a problem. Forces should require their forensic medical examiner provider to ensure that sufficient forensic medical examiners are section 12 approved. This could be particularly helpful in increasing the availability of specialist doctors outside normal working hours.

Recommendation 13: accurately and consistently record section 136 detentions both in police custody and hospital environments. The records should include key demographic details such as age, gender and ethnicity, along with the length and outcome of the detention (for example, whether the individual was taken to hospital). We support the Royal College of Psychiatrists’ (2008) suggestion that one national recording form for England and Wales is introduced. Police forces should also work to ensure that offenders with mental disorders are captured on their systems in order to identify the true scale of the detention in police custody of people with mental disorders.

Police forces, NHS commissioners, ambulance services, and social services should jointly:

Recommendation 14: agree a policy on the transportation of section 136 detainees being admitted to hospital following an assessment (within the wider conveyance policy required under the Mental Health Code of Practice). This should include detainees being held in police custody and at alternative places of safety. Ambulances should generally be used for transportation, unless there is sufficient risk to ambulance staff due to the violence of the individual. In such cases it may be acceptable to use a police vehicle. It is imperative that the transportation of a detainee occurs as promptly as possible, so as not to prolong their detention in police custody. It is therefore important that appropriate and realistic target times for transportation are set, agreed and adhered to.

Recommendation 15: agree a policy on the transportation of section 136 detainees being released back into the community (when transportation is necessary). This should include detainees being held in police custody and at alternative places of safety. The policy should specify which organisations are responsibility for transportation in the different circumstances, and which is responsible for paying for the costs involved in using taxis.

Recommendation 16: monitor section 136 detentions by multi-agency groups at a local level to identify any problems. This should include monitoring of the new power to transfer between places of safety to see how it is being used in practice.

The Healthcare Commission, and its successor, the Care Quality Commission, should:

Recommendation 17: collate annual data on section 136 to improve data collection and increase understanding of the use of section 136. If a national form is adopted for recording all section 136 detentions in custody and alternative places of safety, as suggested by the Royal College of Psychiatrists (2008), this information should be collected locally. The information can then be provided to the Care Quality Commission for collation.

Recommendation 18: conduct analysis into the data gathered on section 136 detentions, such as the make up of the detainees, length of time they are detained and the outcome of section 136 detainees to see what happens to the individuals. This will help to determine whether this power is being appropriately used across police forces. The data should be presented annually and be made available to the public.

The police, social services and mental health trusts should:

Recommendation 19: provide joint training on section 136 and mental health. This will help to improve communication and understanding about the different roles and responsibilities between the various organisations.

Recommendation 20: clarify the current situation by providing joint training on information sharing and what can be shared legally about a section 136 detainee.

Further research should:

Recommendation 21: examine and seek to explain disproportionality in the ethnic make up of section 136 detainees.

Recommendation 22: explore the experiences and perceptions of section 136 service users’ experiences. This is an important gap in our knowledge and understanding the experiences of these individuals could help improve the detention process and the care that people receive.

Mr Bynoe added: “This is an important piece of research which has implications for the police, health and social care services. We have written to the chief xxecutives of all primary care and mental health trusts, as well as all chief constables of police forces in England and Wales to make them aware of the findings and recommendations and encourage them to act upon these.

“Over the next year IPCC Commissioners will monitor whether their forces and local health and social care authorities have developed new protocols on the use of section 136 in their area taking account of the new Mental Health Act and the revised Code of Practice limiting the use of police custody to exceptional situations.”

“The IPCC will now work with ACPO, the Royal College of Psychiatrists and the Sainsbury Centre for Mental Health to ensure that our work and recommendations are taken forward.”

* ‘Police Custody as a “Place of Safety”: Examining the Use of Section 136 of the Mental Health Act 1983′,
Maria Docking, Kerry Grace and Tom Bucke, IPCC, London ISBN 978-0-9556387-1-8.

The report can be found here or is available from the IPCC,

90 High Holborn, London WC1V 6BH.



For further information please contact:

Richard Offer, Head of Media
Tel: 020 7166 3214
Fax: 020 7166 3514
Mob 07710 381890
Journalists only out of hours: 07717 851 157


IPCC publishes major study on use of s136 Mental Health Act

World Suicide Prevention Day – 10th September

September 10, 2008

World Suicide Prevention Day – 10th September


2008 – Think Globally, Plan Nationally, Act Locally

(Click the link above to find World Suicide Prevention Day flyers in English, French, German, Italian, Spanish and Chinese, and to find a listing of activities from around the world.)

Think Globally – Extent of the Problem
Think Globally – Collaboration
Think Globally – Research
Plan Nationally – Strategy
Plan Nationally – Evaluation
Plan Nationally – Collaboration
Act Locally – Implementation of Programs
Act Locally – Community Initiatives
Act Locally – Advocacy
What You can do to Support World Suicide Prevention Day

World Suicide Prevention Day is held on September 10 each year as an initiative of the International Association for Suicide Prevention (IASP), and is co-sponsored by the World Health Organisation (WHO). The 2008 theme is “Think Globally. Plan Nationally. Act Locally.” This phrase, first used by the movement to save the environment, can equally well be applied to suicide prevention:

  • to develop global awareness of suicide as a major preventable cause of premature death,
  • to describe the political leadership and policy frameworks for suicide prevention provided by national suicide prevention strategies,
  • and to highlight the many practical prevention programmes that translate policy statements and research outcomes into activities at local, community levels.

This year’s theme “Think Globally. Plan Nationally. Act Locally”, is an opportunity for all sectors of the community: the public, charitable organizations, communities, researchers, clinicians, practitioners, politicians and policy makers, volunteers and those bereaved by suicide, to join with the IASP and WHO on World Suicide Prevention Day in focusing public attention on the unacceptable burden and costs of suicidal behaviours with diverse activities to promote understanding about suicide and highlight effective prevention activities.

Think Globally – Extent of the Problem

The WHO estimates that one million people die in the world each year by suicide. These figures represent an annual world mortality rate from suicide of 14.5 per 100 000 population. The reality is that every minute there are two more deaths by suicide.

In many developed countries suicide can be either the 2nd or 3rd leading cause of death among teenagers and young adults and is the 13th leading cause of death worldwide for people of all ages. In addition to those who die by suicide, many millions make non-fatal suicide attempts in the context of emotional distress and suffering for the people involved and their families.

There are substantial variations in suicide rates among different countries. However, one must be cautious in comparing suicide rates between countries since some countries report accurate suicide data and others fail to count a significant proportion of their suicides. Suicide rates, as reported to the WHO, are highest in Eastern European countries including Lithuania, Estonia, Belarus and the Russian Federation. These countries have suicide rates of the order of 45 to 75 per 100 000.

By contrast, reported suicide rates are lowest in the countries of Mediterranean Europe and the predominantly Catholic countries of Latin America (Colombia, Paraguay) and Asia (such as the Philippines) and in Muslim countries (such as Pakistan). These countries have suicide rates of less than 6 per 100 000. In the developed countries of North America, Europe and Australasia suicide rates tend to lie between these two extremes, ranging from 10-35 per 100 000.

Suicide data are not available from many countries in Africa and South America. In 2009 IASP will provide an opportunity for countries in South America to highlight the problem of suicide and to share knowledge in order to expand suicide prevention activities at its 25th International Congress in Montevideo, Uruguay.

Most suicides in the world occur in Asia, which is estimated to account for up to 60% of all suicides. Together, three countries – China India and Japan – because of their large populations, may account for up to 40% of all world suicides. However, because of the sheer size of their populations, some of these countries do not have complete national registration systems for deaths, including suicide, and may lack comprehensive medical verdict or coronial systems. Official mortality data which are reported to the WHO may be based on a sample of the population which is not necessarily representative. In addition, accurate suicide data may be difficult to establish if suicide remains stigmatized, criminalized or penalized.

A recent study attempted to overcome some of these problems to estimate suicide rates more accurately. This study was conducted in Tamil Nadu, India, and used trained lay interviewers to conduct ‘verbal autopsy’ interviews with family members for 39 000 deaths. Using this approach, the study found that suicide rates were 10 times those reported officially to the WHO. If these findings are applicable to other countries they suggest that global suicide deaths may, in fact, be much higher than the near one million previously estimated.

Monmouthshire Local Health Board

September 8, 2008

The following is a link to the website of the Monmouthshire Local Health Board – a variety of useful information and reports is available for you to read.