Preventing young suicides

Posted on February 15th, 2008 by theanatomiser

The recent spate of apparently unrelated suicides among young people in the Bridgend area of south Wales has generated much criticism of the media; the ‘media’ in its various guises, from newspapers to the internet, appearing to be the only way these tragedies could possibly be in any way linked. In the middle of these alarming figures (seventeen deaths in just over a year) comes a report in the British Medical Journal (download it here) describing how the suicide rate in young men has in fact fallen over the last decade compared to earlier years. In England and Wales in 2005, the numbers of suicides among young men was the lowest it has been since the 1970s. The article’s authors question how this trend has come about – are people really happier than they were ten or twenty years ago, thanks to social factors or more effective psychiatric care? Or has the suicide rate dropped for other more mundane reasons, such as the fact that catalytic converters make it now almost impossible to kill yourself with car exhaust? There is little new in any of these arguments.

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In 1903 just ten people in England killed themselves deliberately using domestic gas. In 1908 following the death of a bank clerk in Manchester, the local coroner asked journalists not to report details of the case lest the ‘epidemic’ of self-gassing spread even further. But despite his efforts, by 1928, and for the next few decades, self-poisoning with domestic gas was the favoured method of suicide throughout the land. After all, a lethal poison was being piped directly into peoples’ homes, and even fed into a conveniently head-accommodating box, the gas oven. Gas suicides peaked in the year 1958, when an astonishing 5,298 people (fifteen every day) gassed themselves to death in England and Wales. By 1963 when the poet Sylvia Plath famously sealed her doors with wet towels and lay down to die by her open oven door, North Sea gas had already been discovered, and the UK was near the start of its colossal decade-long conversion from old-fashioned, poisonous town gas (containing on average 15% of the lethal constituent carbon monoxide) to the new, cleaner, ‘natural’ gas. By the mid 1970s, sticking your head in the oven was no longer a guarantee of near-instant death. Those who wanted an easy exit from life had to find another route, and the suicide rate fell dramatically.
Common sense suggests that making it more difficult to carry out the act will always prevent at least some suicides, but the more determined will always find a way. Preventing suicide would therefore seem to require two things –reduction in mental illness (or at least ‘unhappiness’) along with public health legislation to make the environment a safer place to be (or at least one where death is more difficult to come by.) Unfortunately this approach has one large flaw.
Some three quarters of people who kill themselves have had no contact with psychiatric services in the year leading up to their death. While this fact is often used by politicians as a conveniently bite-sized weapon with which to attack their opponent’s management of the health service, in reality so few suicide victims get psychiatric help simply because so few have recognisable mental illness leading up to their death. Many, like the young people from Bridgend, are well-adjusted and seemingly happy; which can make the devastation for the bereaved even more acute, and makes creating a meaningful prevention strategy near-impossible.
Certainly some who kill themselves will have encountered some form of psychiatric intervention leading up to their deaths, cases which can probably be rightly termed ‘failures’ of psychiatric care, even though simply expressing suicidal ideation does not automatically qualify someone to be treated against their will (the myth that someone who actually says they are going to end their life rarely does so, should be dismissed once and for all.) But the ones who give no clue as to their intentions, if indeed they have any up until the last fatal moment; what can be done about them?
The attraction of young people toward a flirtation with death is explained by some with the glamourisation of death and suicide in ‘popular culture’. This perception can be traced from internet chat rooms right back to the romantic poets, but is hardly recognisable by anyone who works in the emergency services. Few things look less glamorous or more hideous than someone who has ended their life, and is about to have their bones picked over by a home office pathologist. The ‘cry for help’ theory is another way to rationalise otherwise inexplicable actions. But when victims have obviously gone to great lengths to make sure they are not discovered too soon, this theory too begins to leak water badly.
For a long time, the term ‘para-suicide’ was used to describe cases where people have cut themselves – usually around the wrist area – and presented to hospital, but who do not appear to have real suicidal intent. This term has now been replaced with the broader term of ‘deliberate self-harm’, or DSH. This includes the overdose patients who constitute such a large portion of the average A&E department workload; patients who in themselves cover an enormous spectrum of psychology, from the baffling regular overdosers whose weekend is incomplete without a handful of random tablets and a ‘999’ call, to the impulsive, instantly-regretted acts, to the planned and deliberate attempts at suicide by pharmacology. One especially harrowing aspect of the deaths in Wales is the choice of method, one which leaves little room for last minute changes of mind.
In the few cases of suicide in which I have been involved, the one common factor is the sense of devastation and bewilderment among those left behind. Amid the ‘normal’ bereavement emotions, trying to make sense of such a seemingly non-sensical decision by a loved one can easily come to take over a person’s life. To prevent such tragedies in the future, particularly in those who show no outward signs of emotional upset, is a huge challenge to all involved.

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