What do we know?

Suicide on UK roads in context

Subtitle

Ann JohnProfessor of Public Health and PsychiatryChair of the NAG to WG on Suicide and self harm prevention

Whistle stop tour

Key facts and issues

Global and national suicide rates

Methods used-in relation to RTIs

An example from Wales

Suicide – key facts

Approximately 800 000 people die by suicide every year globally

For every suicide there are many more people who attempt suicide-1: 20

A prior suicide attempt is the single most important risk factor for suicide

in the general population.

Suicide is the second leading cause of death among 15–29-year-olds.

Ingestion of pesticide, hanging and firearms are among the most

common methods of suicide globally.

1.4% of all deaths worldwide, 17th leading cause of death in 2015.

Suicide –key issues

Potentially preventable

Ambivalence, response to a crisis, impulsive, planned

Only ¼ are known to MH services in the year before they die

Inequalities- Men lower socio-economic backgrounds, living in deprived areas, 10x more likely to take their own lives than those living in affluent areas

0

5

10

15

20

25

30

35

40

2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12

EASR

per

100

,000

Least deprived Most deprived

Suicides, European age-standardised rate (EASR) per 100,000, by least and most

deprived fifth (WIMD 2011), males aged 15+, Wales, 2003-2012Produced by Public Health Wales Observatory, using ADDE & MYE (ONS), WIMD (WG)

95% confidence interval

Many different risk factors interacting in complex ways

Risk Factors for Suicide(non-exhaustive)INDIVIDUAL

Sex - male

Low socio-economic status

Restricted educational achievement

Previous suicide attempt or self harm

Mental disorder (including those unrecognised or untreated)

Bullying- victim/ perpetrator

Alcohol or substance misuse

Family history of suicide

History of trauma or abuse

Sense of isolation

Personality traits-hopelessness, low self esteem, external locus of control,

aggression, introversion

Restricted help seeking

SITUATIONAL

Job and financial losses

Stressful life events (including divorce/ separation)

Relational or social losses or discord

Easy access to lethal means

Clusters of suicide that have an element of contagion

Family history of suicidal behaviour (modelling or

inheritance)

Parental psychopathology- depression, substance

misuse, anti social behaviour, non-intact homes

SOCIO-CULTERAL

Exposure to suicidal behaviours

Stigma associated with poor help seeking behaviour

Barriers to accessing healthcare, particularly mental health and

substance misuse treatment

Suicide by adolescent peer

Media coverage of a suicide

No single organisation, everybodys’ business

National strategies to co-ordinate action, PH, collaborative

Quality of suicide data

60/172 WHO Member states have good-quality death registration data

Legality, stigma, under reporting

Coroners court ‘beyond a reasonable doubt

Probable, possible

-Suicide, deaths of undetermined intent (open)

-Narrative verdicts as accidental death

-Accidental hanging and poisonings, single vehicular accidents, unknown cause

X81.0 intentional SH jumping or lying in front of a motor vehicle

X82 intentional SH by crashing a motor vehicle

Suicide excluded from road traffic data, Stats 19, validated DfT figures

‘clear evidence injury was self-inflicted, that the deceased intended to kill

himself. If there is any doubt about the intentions of the deceased either an

accidental or open verdict’

Age standardised suicide rates

UK:1981-2014

1932–33 increase due to recession

1939–45 decrease due to WWII

1950–63 increase (post war,

austerity)

1963–74 decrease

1975–90 increase

1991 – decrease2009-upturn

2016 registrations

15.7 29.1 31.6 19.4 17.44.8 10.0 9.3 4.8 5.3

England Scotland† Northern Ireland Wales UK*

Males Females

Suicides, European age-standardised rates (EASR) per 100,000, males and females

aged 15+, UK Nations, 2009-2011 Produced by Public Health Wales Observatory, using data from ONS, GROS & NISRA

95% confidence interval

*UK is derived from the sum of England, Scotland, Northern Ireland and Wales and does not include deaths of non-residents †Denominator used to calculate 2011 rate is based on 2010 MYEs as Scottish MYEs have not been revised to reflect Census 2011 populations

Males, females and age

2nd leading cause of death 10-29 year olds

Lethality

Proportion of suicide by method and

sex, Great Britain, registered in 2016

Jumping from a high

place

Jumping or lying in

front of a moving

object

Hanging

Isolated rural lay-bys,

- car exhaust

Rural lanes

Single vehicle

collisions

Do we know more? 2% of single vehicle RTAs are suicidal behaviours (Pompilli 2012)

2.8% fatal RTAs suicides, Scottish study (1792 road fatalities ONS bulletin)

Under reporting, as accidents, ambivalence, risk taking behaviour and suicide spectrum, impulsivity

Males, 25-34 years

Risk factors- previous attempts, mental disorder, alcohol

Little known re determinants of choice of method- ease of access, acceptability, occupation

Roads- Financial benefits, reduction of stigma

Community survey 14.8% who reported planning a suicide thought of having an RTA ( Murray and De Leo 2007)

Lethality

1/3 left a note: hardly any in RT- ? Impulsive, alcohol

Proximity to psychiatric hospitals

Single car, single occupant collision, head on collision single occupant heavy goods lorry, pedestrian accidents

Interventions to prevent suicides on roads

-4 ways

RESTRICT ACCESS TO THE SITE AND THE MEANS OF SUICIDE

① Closing all or part of the site ✔

② Installing physical barriers to prevent jumping or access ✔

③ Introduce other deterrents- boundary markings or lighting

④ Alcohol interlocks?

⑤ Intelligent speed adaptation

⑥ Car bonnet design, air bags

Interventions to prevent suicides on

roads-4 ways Increase opportunity and capacity for human intervention

① Improve surveillance- CCTV, staffing, foot patrols

② Suicide awareness staff, community ✔ (gatekeeper)

③ Car braking, lights, speed etc for pedestrian injuries

Increase opportunities for help seeking

① Samaritans signs (✓) / phones (✔)

② Signpost to staffed sanctuary

Change public image of site

① Appropriate media reporting

② Think about memorials

Other considerations RTAs and ED staff

Single vehicle single occupant accidents, PM, psychological

autopsies, inquests

Staff

Data collection- need more

Who? How? Where? When?

Real time surveillance

Attempts

ONS method and place of death

Since Stats 19 does not record suicide as a cause of death difficult for the highways agency to do national analysis or strategic prevention

Incident logs

In Wales

Elfyn Williams

Sarah Stone

Phil Chick

Ann John

Diolch yn fawr – Thank you

It’s a team and collaborative effort……………

TeamLloyd, Dennis, John, Tan, Delpozobanos, McGregor, Marchant, Brown, Kandalama, Andrews, Okolie, Daniels, Loxton, Basu, Wood, Glenndinig, Lacey, Thomas, Thomas, Lee.

ActivitiesLloyd- Samaritans Cymru BoardJohn- Chair National Advisory Group to WG on S&SH Prevention, APCO UK Suicide Prevention, HQIP Advisory Board NCISH, MHRN SSH RDG England, WISPLoxton- CASIP

UK and international collaborationsOxford (Hawton), Bristol (Gunnell), Cardiff (Scourfield, Jones, Owens, Walters,Kemp), Leeds (Owens), Manchester (Kapur) Scotland (Platt), Ireland (Arensman), Australia (Beautrais, Pirkis), Canada (Hatcher,

Lesage)

National Confidential Enquiry into Patient Outcomes and DeathsSwansea University Human and Health Sciences (SWISH)Farr InstituteNCPHWR-Lyons, Fone, Roberts, Brophy

National Centre for Mental HealthPRIME- paramedics, Snooks, Rees

Public Health Wales 3rd sector- Samaritans, Papyrus, Cruse, Hafal, Casip