Suicide is the second most common cause of death among young men, after accidents. Government and voluntary initiatives are working to cut rates, but sensationalised coverage needs to be reined in, finds Mark Gould
Internet death cults, suicide clusters, copycat deaths; it is difficult to consider the tragedy of suicide without getting caught up in a flurry of emotive language. Recently the media itself has become part of the suicide story.
This is almost a sinister variant of Heisenberg's uncertainty theory, which, put simply, states that in trying to observe sub-atomic particles, the act of measurement changes that which is being measured: the more coverage the issue gets, the more young people it seems are inclined to kill themselves.
Seventeen teenagers have committed suicide in the area of Bridgend in Mid Glamorgan since January 2007. But the high rate of suicide in the area had been noted some time before these tragedies. Last July Philip Walters, the coroner for South Wales, went public with his concerns over high suicide rates in young men in the region.
A review of suicides for Bridgend local health board in January by the Welsh National Public Health Service revealed statistically significant rates of suicide among young men aged 15-24 in Denbighshire, Neath/Port Talbot and Bridgend. The highest levels appeared in Bridgend and Neath/Port Talbot, with an average of three cases of suicide among males of this age per year every year from 1996-2006.
The review concludes that while the three areas show higher rates than the Welsh average, the pattern is not evident when "all-age" is considered.
There have been other suicide "clusters". In 2004 there was a 28 per cent increase in deaths by suicide in Northern Ireland to 213, far higher than those recorded at the height of the Troubles. The Maryhill area in the East End of Glasgow accounted for 20 per cent of all Scottish suicides for over two decades until 2001. And since 2005 there have been 17 suicides among young men in the Turkish and Kurdish immigrant community in and around north London. Two of them, who were close friends, hanged themselves within a matter of weeks in the same churchyard.
While every death is a tragedy, these figures must be considered in context of an almost 10 per cent decrease in UK suicides in the 10 years to 2005.
In February the NHS in England and Wales recorded the lowest young male suicide rate in 30 years. Data from the Office for National Statistics revealed that for men aged 15-24, the overall suicide rate dropped from 16.6 per 100,000 people in 1990 to 8.5 per 100,000 in 2005. Among 25-34 year old men, overall suicide rates declined from 22.2 per 100,000 in 1990 to 15.7 per 100,000 in 2005. However, suicide remains the second most common cause of death among young men, after accidents.
Higher levels of suicide often correspond to areas of deprivation and high unemployment. In the case of the young Kurdish male suicides, many were asylum seekers whose right to remain in the UK was uncertain or who had recently been refused leave to remain. And one common factor with many of the young people affected in the cases outlined is that they had not appeared on the radar of NHS services.
Responses from various governments have included devising a national suicide prevention strategy focusing on training, early intervention, easier access and community support. In Scotland the Choose Life initiative introduced in 2002 with a target of a 20 per cent cut in suicides by 2013 has already recorded a 13 per cent reduction, down from a peak of 17.6 deaths per 100,000.
Wales is set to rush out a similar plan, which will draw on Choose Life and build mental health national service frameworks and mental health promotion work in suicide prevention pilots.
In February, Welsh Assembly health minister Edwina Hart said: "The recent sad deaths from suicide in young people in South Wales has highlighted the need to pull together the significant amounts of suicide prevention policy and initiatives in place into a single action plan.
"I have also agreed that there will be some early pilot projects in suicide prevention work in those areas with the highest suicide rates. Key partners, including the Samaritans, will play an important role in ensuring the plan provides national strategic direction, is developed quickly - by the spring - and is focused on action to reduce risks and prevent suicide."
High rates of suicide in Northern Ireland led to direct action by the community, while in Scotland the Choose Life initiative also stresses local empowerment.
The Bridgend area is thought to almost certainly be named as one of the suicide prevention pilots. Bridgend's Samaritans branch is already working with local people, police, health and other statutory and voluntary partners to raise awareness of services. And mental health charity Mind Cymru is calling for all schools to have at least one teacher or school nurse to have suicide awareness training.
Samaritans volunteers have been out on the streets in Bridgend recently. "We were out on Saturday night from 7pm-2am, talking to people coming out of pubs and clubs. We have also got a poster campaign in the area targeting a young audience and we are going into schools in the local area during personal, social and health education classes," says a spokeswoman.
The Samaritans agree there is no simple explanation for the Bridgend phenomenon, but say a Welsh national suicide prevention strategy will help cut deaths.
Some of the more sensational media reports have linked the deaths with "internet suicide cults". While there is no direct evidence to support this idea, the Samaritans is also in talks with social networking site Bebo and with AOL and Google. "When people write, 'I want to kill myself' on Google, we want to make sure that they don't get connected to suicide chatrooms," explains the spokeswoman.
The Welsh Assembly has also produced tight reporting guidelines for local and national media. "There is good evidence from across the world that media reporting needs to be responsible in order not to increase rates and encourage 'copycat' suicides," says Edwina Hart.
The guidelines state that young people are at a greater risk of being influenced by media coverage of suicides, so reports of suicide should be "discreet and sensitive, should avoid sensationalising the issue and avoid explicit details of method".
Ann Parry, chief executive of Papyrus, a charity that works to reduce young suicides, welcomes a national suicide plan for Wales, but stresses it must be backed up with resources and not rushed in as a knee-jerk response to media headlines.
She is certain media coverage has been the catalyst for more deaths. "The coroner first drew attention to the higher than usual deaths by suicide in Bridgend over 12 months ago and Madeleine Moon [MP for Bridgend] also mentioned it in May last year, but the media didn't pick it up until January. Then you had the death of a young attractive girl and there was a frenzy to report the details. And that created hysteria. The reporting has become part of the phenomenon."
Papyrus wants the government to ban access to websites offering information on suicide and self-harm - a move Ms Parry stresses is not a swipe at the voluntary euthanasia movement.
"The internet has changed the way children interact. I don't think we have seen the full extent of the downside of the internet yet in relation to suicide. We are concerned about young people taking their own lives who, with the right interventions, could have overcome their suicidal feelings. So many people who have survived a suicide attempt tell us: 'Thank God it didn't happen'," she says.
Ms Parry set up Papyrus and its telephone 'Hopeline' after her son committed suicide. She felt there were very few appropriate services available. She says that wider access to talking therapies such as through the English Department of Health's improving access to psychological therapies programme is vital, but that it must be presented to young people in the right way.
"We need places where kids and young men can go without feeling like they are accessing mental health services with all the stigma that is attached to that, but where they can talk to someone with experience who they can relate to."
Positively 42nd Street
Just behind the Arndale shopping centre in central Manchester, 42nd Street has been talking to young people for nearly 30 years. The service opened in 1980 as a community-based response to rising levels of suicide which by the 1990s saw Manchester record the highest rates of young male suicide in western Europe. Its community mental health manager Maryam Arbabi doubts whether a network of cognitive behavioural therapy clinics will be the appropriate panacea to reduce suicide.
"CBT works for some people, but I think you need to look at the whole person in each case. They may have really deep-rooted problems that a few sessions of therapy won't be able to help, so I would be a bit cautious about seeing it as a solution in itself," she says.
42nd Street offers a drop-in centre, helpline and counselling, in addition to therapies including CBT and group work and individual support, including specific support for black, gay and bisexual youngsters. It sees around 500 new clients a year.
"This is a very open access service. Clients don't have to have a specific problem, they can just be feeling a bit down, a little stressed. As a first meeting, we can arrange to meet on neutral ground; it's about ensuring that young people feel they are in a safe, non-judgemental environment. We have a young person's panel when we recruit and young people are involved in putting together our AGM. We also have creative projects, drama and arts - it's not just talking."
Ms Arbabi says that while the model is far from perfect, she feels the service has established some useful ways of engaging with young people in a way that they feel comfortable with, unlike conventional NHS settings. "It's about going out, offering services in the community, in schools. And it's about word of mouth: young people tell their friends to come and check it out."
Suicide trends 1995-2005
England from 9.2 per 100,000 people to 8.5 per 100,000
Scotland from 16 per 100,000 people to 14.6 per 100,000
Wales from 13 per 100,000 people to 11 per 100,000
Northern Ireland from 11.2 per 100,000 people to 9.6 per 100,000
Community-based support in Londonderry
Foyle Search and Rescue was set up 15 years ago by a group of friends as a community response to rising levels of suicide in and around Londonderry in Northern Ireland. The city stands on the Foyle, one of the deepest and fastest-flowing rivers in Europe. It is crossed by two bridges that have been become synonymous with suicide.
The organisation was started by two local men, Harry Boyle and Billy Garnett, who were searching for a friend believed drowned in the river. As they searched, they came across a young woman contemplating suicide and realised a dedicated team of volunteers might cut the death toll.
Now its team of volunteers is on call 24 hours a day and provides shore patrols of the river and surrounding waterways from 9pm-3am on Thursday, Friday and Saturday nights - the peak periods for suicide attempts.
Taxi drivers in the area have also set up their own community suicide prevention initiative, Taxi Watch. Drivers are trained in counselling skills to help identify people at risk of attempting suicide and where possible, talk them out of it. They are also issued with "rescue kits" that can be stored easily in the taxis and used if the driver comes across an incident. The kits contain first aid equipment, as well as a "throw line" that can be used to pull people to shore. Derry's sub-aqua club trained the drivers to use the equipment, as well as basic first aid.
Between its formation in 1993 and January of this year, Foyle Search and Rescue has stepped in to prevent 1,141 potential suicides, recovered 52 bodies and rescued 90 people from the water. Before the advent of Foyle Search and Rescue, there were around 25-30 deaths in the river a year. Last year there were just six, but even this is double the average of preceding years.
Volunteer Stephen Twells says suicides and attempted suicides are on the rise. Last year alone, the service stopped 103 people from jumping in the river - almost three times the number in 2006. "Of that, 80 were male and the average age is getting younger. We had two 15-year-olds last year," says Mr Twells.
In 2004, 213 people took their lives in Northern Ireland - up by 60 on the previous year and considerably higher than suicide rates during the worst years of the Troubles. Studies carried out by Ulster University have suggested that the soaring rates may be a direct result of the disintegration of social bonds formed when people are confronted with civil unrest. But Mr Twells says the post-Troubles theory does not explain why people aged 15 with no experience of the conflict are trying to kill themselves.
Northern Ireland 's national suicide strategy was published in October. It acknowledged that the peace dividend might have a flipside and stressed the importance of grass-roots initiatives like Foyle Search and Rescue and other groups for the bereaved.
Find out more
Choose Life: A National Strategy and Action Plan to Prevent Suicide in Scotland, Scottish government, 2002
Improving Access to Psychological Therapies, Department of Health, 2007
Foyle Search and Rescue, 028 7131 3800