National Suicide Prevention

Strategy for England

Annual Report on
Progress 2008
Contents
Foreword 2
Chapter One: Progress in 2008 3
Implementation – progress in year six 4
Where we are now 5
In-patient suicides and those in contact 5
with mental health services (Goal 1.1)
Young men/people (Goal 1.3 and 2.5) 6
Self inflicted deaths in prison (Goal 1.4) 7
Older adults (Goal 2.7) 8
Methods of suicide and access to means (Goal 3) 8
Media reporting of suicide (Goal 4.1) 9
The internet (Goal 4.2) 9
Coroner reform (All Goals) 10
Key issues for 2009 11
Conclusion 11
Chapter Two: Statistical information 12
Suicide numbers and rates 12
The suicide prevention target 13
Current position 13
Contact details 20

1
 Foreword
This is the sixth annual report of progress since the national
suicide prevention strategy for England was launched in 2002.
The National Mental Health Development Unit (NMHDU),
replacing the National Institute for Mental Health in England, is
responsible for implementation of the strategy in partnership
with a range of agencies and organisations committed to
supporting delivery of the strategy’s goals and objectives.

The latest published statistics show a further and very welcome fall in the overall
rate of suicide amongst the general population. The most recent figures have fallen
to the lowest recorded in this country, although even this may not be enough to
hit the 2010 target. There has also been a further reduction in suicides among
young men, in mental health in-patient units and in prisons.
We cannot afford to be complacent however. Previously, periods of high
unemployment or severe economic problems have had an adverse effect on the
mental health of the population and have been associated with higher rates of
suicide. Primary care trusts and other front line agencies are aware of this situation
and are in a position to identify and support vulnerable individuals who are at risk.
This report highlights some of the work that we are doing nationally to support
these agencies as well as what was achieved in 2008.

Professor Louis Appleby

National Director for Mental Health

2
 Chapter One
Progress in 2008
The national suicide prevention strategy in England was launched
in 2002 with the aim of supporting the target to reduce the death
rate from suicide and undetermined injury by at least a fifth by
the year 2010. The Public Service Agreement reached between
the Department of Health, Treasury and No 10 to reduce the
mortality rate from suicide and undetermined injury by at least
20% by 2010 reflects the Government commitment to improving
access to mental health services. This important national target
originally set out in Our Healthier Nation has been retained in the
National Standards Local Action health and social care standards
and planning framework for 2005/06 – 2007/08 and in the
2008/2009 and 2009/10 NHS Operating frameworks.

The likelihood of a person committing suicide depends on several factors. These

include physically disabling or painful illnesses and mental illness; alcohol and drug
misuse; and level of support. Stressful life events such as the loss of a job,
imprisonment, a death or divorce can also play a part. For many people, it is the
combination of factors which is important, rather than any single factor.
There is no single approach to suicide prevention. That is why we have developed
a broad strategic approach which involves health and social care agencies,
Government departments, and the voluntary and private sector organisations.

3
Implementation – progress in year six
Implementation of the strategy has been taken forward in 2008 by the National
Institute for Mental Health in England (NIMHE) as part of the Well-being and
Inclusion work stream and in collaboration with a wide range of organisations and
individuals. It is an evolving strategy which develops in light of progress made and
emerging evidence. We now have:
the overall rate of suicide amongst the general population at the lowest
rate on record
a further encouraging fall in suicide rates amongst young men
a further fall in the number of suicides amongst mental health in-patients
2008 saw the lowest number of self-inflicted deaths in prisons since 1995.
This means that the 20% reduction originally set within the national strategy
was again met.
We have also continued to make progress involving a number of specific initiatives.
These include:

Goal 1 To reduce risk in key high-risk groups

Publication in March 2008 of Refocusing the Care Programme Approach by the
Department of Health – a policy and positive practice guide for trusts and
commissioners to align more closely with risk management.
The National Patient Safety Agency are currently undertaking an update of the
Suicide Prevention Toolkit published originally in 2003.
Implementation of the revised Prison Service Order 2700, (suicide prevention
and self-harm management), was completed in April 2008. This ensures that
care and support is provided to all prisoners to reduce the likelihood of suicide
or self-harm.
The National Offender Management Service (NOMS) commenced a review of
the Assessment, Care in Custody and Teamwork system in July 2008, as part of
a Continuous Improvement Plan. The review will complete in 2009.

Goal 2 To promote mental well being in the wider population

Publication of the systematic review Mental disorders, suicide, and deliberate
self-harm in lesbian, gay and bisexual people in February 2008. The strategy
now includes LGB people as a specific group who have special needs under
goal two of the strategy (Goal 2.8).

Goal 4 To improve media reporting of suicidal behaviour in

the media
Shift, the Department of Health funded campaign to tackle the stigma and
discrimination associated with mental illness, has published a guide for

4
 journalists on how sensitive reporting can help tackle the stigma of mental
illness (February 2008). The handbook, What’s the Story?: Reporting Mental
Health and Suicide, gives practical advice to the media on covering suicide,
mental illness and violent crime by psychiatric patients. This handbook
highlights the international evidence that careless reporting of suicide may
trigger copycat suicides and provides advice to journalists to encourage more
sensitive and responsible coverage.
On 27 March 2008 Safer Children in a Digital World, the report of the Byron
Review1, was published. The review made a number of recommendations
about harmful or inappropriate material, including sites which exist to promote
suicide, which will set the framework for future action.
In addition, the Social Networking Good Practice guidance2, published by the
Home Secretary’s Task Force for Child Protection on the Internet on 4 April
2008, refers to the issue of suicide. The guidance recognises that young people
will talk about this, and other difficult issues, and advises Social Networking
Sites to provide links to support services such as Childline and the Samaritans.
(The NSPCC and the Samaritans were involved on the project team).

Where we are now

The target is to reduce the death rate from a baseline of 9.2 deaths per 100,000
population in 1995/6/7 to 7.3 deaths per 100,000 population in 2009/10/11.*
The three-year average rate rose in the period immediately following the setting
of the baseline. However, the rate has since fallen and the latest available figures
for the period 2005/6/7 show it is now 13.9% below the baseline.
Following a period in which the rate of decline slowed, the data for 2005/6/7
show signs that the rate of decline may once again be increasing – this trend
needs to continue if we are to meet the target. For more detailed analysis of the
statistical data, see Chapter 2.
* this target was revised from 7.4 following a change in the methodology used by the Office
of National Statistics to record the cause of death.

In-patient suicides and those in contact with

mental health services (Goal 1.1)
Having a severe mental illness is a known risk factor for suicide. Because a
significant number of suicides occur during a period of in-patient care or shortly
after discharge, managing risk effectively and ensuring good continuity of mental
health care are essential.

1 www.dcsf.gov.uk/byronreview/
2 police.homeoffice.gov.uk/publications/operational-policing/social-networking-guidance/

5
Staff continue to carry out regular audits of wards and ward areas to identify and
minimise opportunities for hanging or other means by which patients could harm
themselves. Many services have adopted thorough audits of ward areas to identify
potential ligatures and ligature points that could be used and all services have
removed non-collapsible bed and shower rails, replacing them with collapsible
fittings recommended by the CMO report Organisation with a Memory.
Managing risk effectively and ensuring good continuity of mental health care is
essential and has contributed to reducing suicides within this high-risk group.
Avoidable Deaths, a report by the National Confidential Inquiry into Suicide and
Homicide by People with a Mental Illness published in December 2006, highlighted
continued concerns about the number of in-patients dying by suicide whilst off the
ward without permission. Working with the CSIP Acute In-patient Care Programme
a practical workbook has been developed to help staff reduce the number of
patients who go missing from mental health wards and who place themselves or
others at risk. The guide (published in March 2009) is intended for staff such as
nurses and managers responsible for the care of people in mental health in-patient
settings. It offers practical support to staff in mental health in-patient settings and
includes a range of good practice examples from around the country.
The latest available data shows that the numbers of in-patient suicides in England
have fallen from 216 in 1997 to 136 (projected) in 2006 (see Chapter 2 for the
latest statistical data on in-patient suicides).

Young men/people (Goal 1.3 and 2.5)

There has continued to be an encouraging and sustained fall in the rate of suicide
amongst young men under the age of 35. However, the death rate from suicide
amongst this high-risk group is still high in comparison with the general
population. That is why it is still important for services to develop more effective
approaches to engage with young men.
In December 2007, Department of Health (DH) and Department for Children, Schools
and Families (DCSF) Ministers commissioned an independent CAMHS review to:
identify how mainstream and universal services could play a more effective role
in promoting the emotional well-being and mental health of children, young
people and their families
identify practical solutions to current barriers in the delivery of integrated care
pathways at a service delivery and strategic level
develop priority actions for national, regional and local stakeholders in
delivering the proposed vision of emotional health and well-being.
The CAMHS Review published its final report in November 2008 (available at
www.dcsf.gov.uk/CAMHSreview/). The report’s vision is that the 20
recommendations made will enable a number of important changes to take place

6
over the next three to five years, to improve children and young people’s mental
health and psychological wellbeing:
Everybody will recognise the part they can play in helping children grow up,
have a good understanding of what mental health and psychological well-
being is and how they can promote resilience in children and young people,
and know where to go if they need more information and help.
Children’s services will work effectively together to provide well integrated child
and family-centred services to improve mental health and psychological well-
being. As part of this:
• universal services will play a pivotal role in promotion, prevention and early
intervention
• specialist services will deliver support that is easy to access, readily available
and based on the best evidence.
Staff across these services will have a clear understanding of their roles and
responsibilities and those of others, and will have an appropriate range of skills
and competencies.
The suicide rate amongst teenagers continues to fall and is below the general
population rates. However, events in the Bridgend area highlight that young
people are the most vulnerable and the risk is greater when they have a feeling of
identification, whether with celebrities or other young people. It is important to
continue to support improvements in young people’s emotional well-being as
outlined above (see page 9 under the section on the internet).

Self inflicted deaths in prisons (Goal 1.4)

After the rise in 2007, the number of apparent self-inflicted deaths fell to 61 in
2008. The 61 deaths in 2008 represent a 34% decrease on 2007. The main areas
of decrease were in the numbers of self-inflicted deaths of foreign nationals (down
15); those with life sentences (down 12); females (down 7) and the prisoners of
black and minority ethnicity (down 10 and 22 respectively). Analyses of the 2007
foreign national prisoner deaths revealed there was nothing unusual about the
deaths with regards to foreign nationality needs. This subset showed a similar mix
of risk factors to the general group who take their lives.
During 2008, the Government announced its intention to implement the
recommendations of the Fulton Review on the Forum for Preventing Deaths
in Custody. This replaced the Forum and the Ministerial Roundtable with the
Ministerial Council on Deaths in Custody. A Justice Minister will chair the
Council, which also includes Ministers and senior officials from the Department
of Health and the Home Office, who will consider how to prevent deaths in all
forms of custody. An Independent Advisory Panel consisting of experts in the
area of preventing deaths in custody has also been created.

7
 Older adults (Goal 2.7)
The suicide prevention strategy under Goal 2 (to promote mental well-being in the
wider population) focuses on a number of groups within society for who additional
specific measures should be taken. These are not the groups at high risk of suicide,
defined in goal one. They are, however, vulnerable groups of people and the
strategy identified older adults as one of these groups. The recent Age Concern
campaign report Down but not out: older people and depression – launched in
August 2008 set out a plan to:
encourage older people with depression to seek help
ensure older people with depression are correctly diagnosed
ensure older people with depression get the treatment they need.
In order to raise awareness and reduce the risk of suicide amongst older adults the
Equalities in Mental Health programme within the NMHDU is developing a pod
cast aimed at GPs and other practice staff to help them identify those at risk.

Methods of suicide & access to means (Goal 3)

Research has indicated that the likelihood of committing suicide will depend to
some extent on the ease of access to, and knowledge of, effective means. One
reason is that suicidal behaviour is sometimes impulsive, so that if a lethal method
is not immediately available a suicidal act can be prevented (see Chapter 2 for
the latest statistical data on deaths from suicide and undetermined injury by
method and gender).
We have already taken some important measures to reduce the means of
suicide, which include removing potential ligature points in in-patient psychiatric
units and regular environmental audits of wards. The phased withdrawal of the
prescription only painkiller coproxamol – its licence was revoked in December
2007 – will, we hope, lead to a reduction in deliberate or accidental drug
overdose deaths.
Continuing to promote and use the guidance issued in 2006 on action to be
taken at specific suicide hotspot is key to support local agencies in identifying
and taking action to improve safety and deter acts of suicide at these locations.
NOMS continues to review the specifications for safer cells, such as specially
designed furniture and fixtures which are manufactured and installed to make the
attachment of ligatures very difficult and access to window bars prevented via
specialist approved window design. Current projects include the development of
a chair to complement the safer cell design.

8
 Media reporting of suicide (Goal 4.1)
There is already compelling evidence, from research conducted in the United
Kingdom and elsewhere, that the reporting and portrayal of suicide in the media
can lead to copycat suicides, especially amongst young people or those already at
risk. That is why the national suicide prevention strategy for England made a
commitment to improve the reporting of suicide and suicidal behaviour in the
media as one of its six goals. In 2006 the Press Complaints Commission (PCC)
acknowledged this evidence by adding a sub-clause in the Editors’ Code of Practice
to discourage the reporting in the media of excessive detail of suicide methods.
In January 2009 the PCC made its first ruling against national newspapers in
relation to the ‘copycat suicide’ clause. In this landmark decision, the PCC found
against seven newspapers. There had been only one previous judgement against a
media outlet, a regional newspaper, under clause 5, which prohibits the publication
of excessive detail about the method used in order to reduce the risk of copycat
suicides. In this latest case, the newspapers had gone further than simply referring
to the method used to take his own life, which would not have been a breach. The
newspapers had described in detail how the person took his own life.
There has been much debate in the aftermath to the Bridgend suicides about media
coverage and interest in such events. In February 2008, Shift published a guide for
journalists on how sensitive reporting can help tackle the stigma of mental illness.
The handbook, What’s the Story?: Reporting Mental Health and Suicide, gives
practical advice to the media on covering suicide, mental illness and violent crime
by psychiatric patients. In addition, both the International Association for Suicide
Prevention in partnership with the World Health Organisation and the Samaritans
updated their own resource or guidelines for media professionals. In March 2009,
the PCC’s Editors’ Code of Practice was further amended in the aftermath of the
series of deaths of young people in and around Bridgend, South Wales. This guidance
reiterates the need to avoid “excessive detail” stresses the risks of glorification of
suicide and cautions about republication of photographs of previous individuals who
have taken their lives. As well as encouraging the use of helpline numbers, it cautions
against the use of photographs without relatives’ consent. We hope that all these new
measures and the resources published in 2008 will provide an opportunity to encourage
sensitive media reporting of suicide and continued engagement with media outlets.

The internet (Goal 4.2)

The Government shares the concerns expressed about internet sites that may
encourage people to take their own lives. As part of the Suicide Prevention Strategy, we
have explored a number of measures to protect the most vulnerable people, including:
Raising awareness of the potential harmful implications of such websites
and chat rooms; and

9
 Encouraging search engine providers to ensure that search results give greater
prominence to more responsible sites, such as the Samaritans and Child Line,
offering help and support to people in overcoming suicidal feelings.
On 27 March 2008 Safer Children in a Digital World, the report of the Byron
Review, was published. Primarily, it recommended that a UK Council on Child
Internet Safety, chaired by the Home Office and DCSF and reporting to the Prime
Minister, be established. The cross-government Byron Review Action Plan
published on 24 June 20083 set out how the Government intends to implement all
the recommendations within the Byron Review. The UK Council on Child Internet
Safety4 was launched formally on 29 September.
The Byron report identified websites promoting suicide as an area where there is
some confusion about the application of the law to online activity. Accordingly, the
report recommended that consideration should be given to whether the law in this
area could usefully be clarified; and that the UK Council should explore
appropriate, properly resourced enforcement responses. It also recommended that
sites which exist to promote suicide in a way that contravenes UK law should be
taken down once the relevant internet service providers have been notified of their
existence and the fact that they are illegal has been confirmed.
Following a review of the Suicide Act 1961, the Ministry of Justice (MoJ) announced
in September 20085 that the law on assisting suicide was to be simplified to
increase public understanding of the law in this area and reassure people that it
applies as much to actions on the internet as it does to actions off-line. The new
provisions are included in the Coroners and Justice Bill6 which is currently before
Parliament. They do not change the scope of the current law but they will make it
easier for individual internet users and internet-based businesses, such as Internet
Service Providers (ISPs), to understand the sort of behaviour that the law prohibits.

Coroner reform (All Goals)

In the Queen’s Speech on 3 December 2008, plans were announced for a
Coroners and Justice Bill. In addition to the amendments to the Suicide Act (see
above) the bill will also set out plans for reform of the coroner system which have
been evolving over the last two to three years. The Coroners and Justice Bill was
published on 14 January 2009. On the same day the Ministry of Justice published
a revised version of the Draft Charter for Bereaved People who come into contact
with the coroner system, and a response to a consultation on media reporting of
coroners’ inquests. The Bill has completed its passage through the House of
Commons and is now progressing through the House of Lords. The Bill proposes to:
introduce a national coroner service for England and Wales, headed by
a new Chief Coroner

3 www.dfes.gov.uk/byronreview/actionplan/index.shtml
4 www.dcsf.gov.uk/ukccis/
5 www.justice.gov.uk/news/announcement170908a.htm
6 services.parliament.uk/bills/2008-09/coronersandjustice.html

10
 improve the experience of those bereaved people coming into contact with the
coroner system, giving them rights of appeal against coroners’ decisions and
setting out the general standards of service they can expect to receive
reduce delays and improve the quality and outcomes of investigations and
inquests through improved powers and guidance for coroners, and the
publication of statistics and reports to prevent deaths.

Key issues for 2009

The recent report Foresight Mental Capital and Well-being: Making the most
of ourselves in the 21st Century highlighted the link between mental ill-health
and social factors, especially debt – particularly important during the current
economic circumstances. Previously periods of high unemployment or severe
economic problems have had an adverse effect on mental health and have
been associated with high suicide rates. A notice has been placed in the
Department of Health Bulletin for NHS Trust Chief Executives highlighting the
effect that the current economic conditions might have on the well-being of
vulnerable individuals and asking that they work with frontline agencies to
identify and support such individuals. In addition, in response to the current
economic circumstances the Department of Health have brought forward the
roll out of Improving Access to Psychological Therapies (IAPT).
To ensure effective promotion and dissemination of the bereavement pack –
Help is at Hand – we are undertaking a full and comprehensive evaluation of
this resource. In addition, we are very keen to ensure that this pack is readily
available to those that need it and at a time when they need it. We need to do
more to promote the availability of the pack to those who come into contact
with those who are bereaved by suicide or other traumatic sudden death. This
will include health and other practioners, emergency care staff, GPs, the police
and coroners officers. We also need to encourage those who are in contact
with those bereaved to distribute the pack to those who may need it – such as
people working in coroners’ courts, the health service (examples above),
prisons, and funeral parlours.
It remains a clear priority to work with the media to highlight the need for journalists
and editors to report suicide responsibly and for our stakeholders to respond to
careless or insensitive reporting (see also page 9 under media reporting of suicide).

Conclusion
The strategy is an evolving document and continues to develop over time in the
light of progress made, adapting our approach where necessary. The strategy will
continue to be a key programme of activity delivered by the NMHDU and will be
subject to regular annual review and evaluation.

11
 Chapter Two
Statistical information
Official suicides are those in which the coroner or official
recorder has decided that there is clear evidence that the injury
was self-inflicted and the deceased intended to take their own
life. Open verdicts or undetermined injuries are those where
there may be doubt about the deceased’s intentions. Research
studies show that most open verdicts are in fact suicides. For
the purposes of measuring overall suicides in England, official
suicides and open verdicts are combined.

Details are collected when deaths are certified or registered. Most deaths are certified
by a medical practitioner; however, suspected suicides must be certified after a
coroner’s inquest. Statistics on the cause of death are collected by the Office for
National Statistics and are passed to the Department of Health on an annual basis.

Suicide numbers and rates

The number of suicide deaths refers to the actual number of people who have died
by suicide or injury (and poisoning) of undetermined intent.
The rate of suicide refers to the frequency with which suicide occurs relative to the
number of people in a defined population. This age-standardised rate takes
account of changes in the size and age structure of the population to provide a
comparable trend across time and across different areas.

12
The suicide prevention target
The target is to reduce the death rate from suicide and injury (and poisoning) of
undetermined intent by at least a fifth by the year 2010, starting from a baseline of
1995/6/7. The target is measured using three-year pooled rates. Three-year rolling
averages are generally used for monitoring purposes, in preference to single year
rates, in order to produce a smoothed trend from the data and to avoid drawing
undue attention to year-on-year fluctuations instead of the underlying trend.

Current Position
The target is to reduce the death rate from a baseline rate of 9.2 deaths per
100,000 population in 1995/6/7 to 7.3* deaths per 100,000 population in
2009/10/11. Figure 1 shows the latest available data (for the 3 years 2005/6/7)
showing a rate of 7.9 deaths per 100,000 population – a reduction of 13.9 per
cent from the baseline.
* this target was revised from 7.4 following a change in the methodology used by the Office of
National Statistics to record the cause of death

Figure 1: Mental Health Target

Death rates from intentional self-harm and injury of undetermined intent excluding
‘verdict pending’ in England 1993-2007 and target for the year 2010 all persons

Death rate per 100,000 Progress since baseline:

12
A fall of 13.9%

10 Target:
20% minimum
reduction from
8
1995-97
baseline rate

0
1993/4/5 1995/6/7 1995/6/7 1999/2000/1 2001/2/3 2003/4/5 2005/6/7 2007/8/9 2009/10/11
3 year average

Rates are calculated using the European Standard Population to take account of differences in age structure.
Source: ONS (ICD9 E950-E959 plus E980-E989 excluding E988.8 (inquest adjourned) ICD10 X60-X84, Y10-Y34 excl Y33.9 (verdict pending)

13
The three-year average rate rose in the period immediately following the setting
of the baseline. However, the rate has since fallen and is now 13.9 per cent below
the baseline.
Following a period in which the fall in the suicide rate slowed, the data for
2005/6/7 show signs it may once again be accelerating. If the fall from the
baseline to 2007 is projected through to 2010, the target is narrowly missed. An
alternative projection, starting in 1998/9/2000 when the rate peaked, hits the
target. Although the recent fall is welcome, suicide rates have tended to rise during
periods of high unemployment or economic uncertainty. We are therefore entering
a time when vigilance by front-line services will be needed.
Although the recent decline in rates is welcome news, there is compelling
evidence that suicide rates may rise during periods of rising unemployment or
economic uncertainty.
The suicide rate for the year 2007, the most recent available, was the lowest
recorded. The European Age Standardised Rate (EASR) was 7.5 per 100,000
population, following falls in the last 3 years (see figure 2).

Figure 2: Suicide mortality – trend in single year rate

Death rates from intentional self-harm and injury of undetermined intent excluding
‘verdict pending’ in England 1996-2007, all persons

Death rate per 100,000

10

9.5

8.5

7.5

0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Rates are calculated using population estimates based on 2001 census. Rates calculated using the European Standard Population to take
account of differences in age structure. 1996 to 1998 and 2000 have been coded using ICD9, 1999 and 2001 onwards are coded using ICD10.
Source: ONS (ICD9 E950-E959 plus E980-E989 excluding E988.8 (inquest adjourned) ICD10 X60-X84, Y10-Y34 excl Y33.9 (verdict pending)

The majority of suicides continue to occur in young adult males (figure 3 on the
next page) – that is those under 50 years. In relation to women of the same age,
younger men are more likely to take their own lives. The peak difference is the 30-
39 age group where there are more than four male suicides to each female.

14
The average ratio between men and women of all ages is more than three male suicides
to each female. Once people pass 50 years of age, the ratio gradually reduces, to around
2.1 male suicides to each female suicide in the 70-79 and 80 and over age groups.

Figure 3: Age pyramid

Death from intentional self-harm and injury of undetermined intent excluding
‘verdict pending’ by ten year age band and sex, England 2007

Deaths
800

700

600

500

400

300

200

100

0
under 10 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80 and over
Age groups

Women Man
Source: ONS mortality rate

Figure 4 (below) shows the death rate per 100,000 population by age and gender.

Figure 4: Age pyramid

Death rates from intentional self-harm and injury of undetermined intent excluding
‘verdict pending’ by ten year age band and sex, England 2007
Age standardised death rate per 100,000 population
20

18

16

14

12

10

0
under 10 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80 and over
Age groups

Women Man
Source: ONS mortality rate

15
The difference between number of deaths and death rates shows up mostly in the
80+ age group as the numbers are relatively small, but so is the population, so the
rate per 100,000 population is relatively large, particularly for men.
In the last thirty years of the 20th century, suicide rates had fallen in older men and
women but risen in young men. We are now seeing evidence of a sustained fall in
suicide among young men in recent years, although the rate remains high in
comparison to the general population. The suicide rate for men aged 35-49 rose
gradually over the years 1970 to 1991 but in recent years, this rate has levelled off
(see figure 5). This age group had the highest death rates of all 15-year age bands
in 2005-07.

Figure 5: Trend in suicide rate for men aged 25-34 and 35-49
Death rates from intentional self-harm and injury of undetermined intent, England

Age standardised death rate per 100,000 population

30

25
Males 35-49

20

Males 25-34
15

10

All persons all ages

5

0
1970 1975 1980 1985 1990 1995 2000 2005
Three-year average rate, plotted against middle year of average (1969-2007)

Rates are calculated using population estimates based on 2001 census. Rates calculated using the European Standard Population to take
account of differences in age structure. Years to 1998 and 2000 have been coded using ICD9, 1999 and 2001 onwards are coded using ICD10.
Source: ONS (ICD9 E950-E959 plus E980-E989 excluding E988.8 (inquest adjourned) ICD10 X60-X84, Y10-Y34 excl Y33.9 (verdict pending)

The latest data, covering calendar year 2006, show that the number of in-patients
taking their own life in England has fallen from 216 in 1997 to 136 (projected) in
2006 (see figure 6).

16
 Figure 6: In-patient suicidesa
Persons (questionnaire) England 1997-2006

Number of deaths

250
Projected
Observed
200

150

100

50

0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Year

a Projected figures are shown to provide the most accurate number of cases expected for a given time period.
Projected figures may vary annually according to changes in the baseline data.
b Data for 2006 are 89% complete.
Source: National confidential inquiry into suicide and homicide by people with mental illness, latest available data used.

Suicides by people in contact with mental health services in the year prior to death
show a decrease to 1,122 (projected) in 2006 from a peak of 1,320 in 2004. The
projected figure is calculated from the proportion of questionnaires that have been
returned on the number of cases identified in 2006 to date. The projected figure
for 2006 is an estimate based upon the current 89% questionnaire response rate
and will change as the questionnaire returns improve (see figure 7).

Figure 7: Suicides by people in contact with mental health services

(in 12 months prior to death)a
England 1997-2006

Mental health care suicides

1400
Projected
1200 Observed

1000

800

600

400

200

0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Year

a Projected figures are shown to provide the most accurate number of cases expected for a given time period.
Projected figures may vary annually according to changes in the baseline data.
b Data for 2006 are 89% complete.
Source: National confidential inquiry into suicide and homicide by people with mental illness, latest available data used.

17
Figure 8 shows the number of self-inflicted deaths in English prisons for the years
1997 to 2008. The figure for 2008, showing a fall of 28 from the previous year, is
the lowest number of self-inflicted deaths in prisons since 1995.

Figure 8: Self-inflicted death in prison

England (calendar year)

Number of deaths

100

90

80

70

60

50

40

30

20

10

0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Year

Historic figures are subject to minor changes when inquest verdicts differ from initial classification.
Source: HM Prison Service.

NOMS statistics are based on deaths categorised as ‘self-inflicted deaths’ This

differs from the definition of ‘suicide’ quoted in the introduction. They do not only
count the number of deaths that receive a ‘suicide’ or ‘open’ verdict at inquest, but
any death where it appears that the person may have acted specifically to take
his/her own life. The classification used for apparent suicides is therefore much
more inclusive than the definition used in community suicide statistics.

Figure 9: Deaths from suicide and undeterminded injury by method and sex
England 2007

Males Females
total deaths 3055 total deaths 956
Key

Hanging, strangling and suffocation

Drug-related poisioning

Other poisioning including motor gas

Jumping/falling before a moving object

Drowing

Jumping/falling from a high place

Sharp object

Firearms and explosives

Smoke fire and fumes

Other

Source: Office for National Statistics (ONS)

18
Among the general population, hanging and suffocation is still by far the most
common method of suicide for men, accounting for more than half of all male
suicide deaths. Drug-related and other poisoning are the next most common
methods used. Among women, drug related poisoning is still the most common
method of suicide, accounting for 36% of all female suicide deaths, but hanging
and suffocation now account for over a third of all female suicides and is the
second most common method used (see figure 9). Jumping/lying/falling before a
moving object and other poisoning including motor gas took a slightly larger share
of the total in 2007 than in 2006.

Figure 10 shows the latest 3-year average rates of suicide by English Strategic
Health Authority and by gender.

Figure 10: Geographic distribution of suicide, 2005-2007

Death rates from intentional self-harm and injury of undetermined intent in England
Strategic health authority (average of three years 2005-2007)

Suicide 2005-2007
Males Females
Rate per 100,000 population
by SHA
HIGHEST RATES
Significantly
13.25 and over 4.50 and over
above average

Around average
11.00 to 13.24 3.25 to 4.49
for England

Significantly
Under 11.00 Under 3.25
below average
LOWEST RATES

A significant difference is where the 95% confidence interval of a SHA rate lies wholly outside the 95% confidence interval for England.

Source: NCHOD using ONS data (ICD10x60-X84, Y10-Y34 excl Y33.9 (verdict pending))

19
 Contact details
National Mental Health Development Unit National Team
Room 8E44 Quarry House, Quarry Hill, Leeds, LS2 7UE

Keith Foster, Programme Lead for Suicide Prevention:

keith.foster@dh.gsi.gov.uk or keith.foster@nmhdu.org.uk

Donna Terry, Suicide Prevention Programme Support Manager:

donna.terry@dh.gsi.gov.uk or donna.terry@nmhdu.org.uk

20
This is the sixth annual report
of progress since the national
suicide prevention strategy
for England was launched
in 2002. The National
Mental Health Development
Unit (NMHDU), replacing
the National Institute for
Mental Health in England,
is responsible for
implementation of the
strategy in partnership
with a range of agencies
and organisations
committed to supporting
delivery of the strategy’s
goals and objectives.

National Mental Health

Development Unit
Room 8E44 Quarry House
Quarry Hill, Leeds, LS2 7UE
t: 0113 254 6914
f: 0113 254 5596
www.nmhdu.org.uk
The National Mental Health Development
Unit (NMHDU) is the agency charged
with supporting the implementation of
mental health policy in England by the
Department of Health in collaboration
with the NHS, Local Authorities and other
major stakeholders.