The rise in suicide
Suicide rates are now the highest they have been in England for 25 years.
Suicide rates are now the highest they have been in England for 25 years.
The Office for National Statistics (ONS) has released the latest report of quarterly suicide death registrations in England for Quarter 4 (October to December) of 2023. Unfortunately, it shows a 6% rise, which is the highest national rate of suicides since 1999. There were 1,439 suicides registered in Quarter 4, equivalent to 11.4 suicide deaths per 100,000 people. Overall there were 5,579 suicides registered in England, which is significantly higher than 2021 and 2020.
It’s difficult to attribute causes to individual suicides, as well as trends. While it is important to to be responsible and circumspect when speculating, this notable and recent upshift in suicide deaths should be analysed and monitored.
The ONS figures need to be interpreted with some caution because there is a delay in coronial inquests, meaning that only 39.3% of the deaths registered in 2023 had a date of death in the same year, and some of the deaths occurred in 2022 and 2021. Crucially, this means that we should be cautious about making conclusions for 2023 at the moment as there will still be a large number of suicides that occurred in 2023 which have not yet been registered.
So what might have caused the trend? Professor Louis Appleby who chairs the National Suicide Prevention Strategy Advisory Group has commented on the uptick in suicides on Twitter. He suggested that the likeliest cause is the economic downturn and cost of living crisis. Historically recessions cause suicide rates to increase. The North East, North West and East of England have seen the most significant increases in suicide, but the North East, Midlands and London are actually the three regions with the highest levels of poverty, so this theory does not necessarily tally up neatly. The significant jump in the North West specifically might indicate a change in the way deaths have been recorded. The economic effect Appleby proposes would also not easily explain that the increase for women was greatest in the over 60s.
Could there be another factor? Appleby has zoned in on the economy for obvious and sound reasons, but has so far ignored a key factor.
In April 2021, Professor Appleby was the Lead Author of the report ‘Suicide in England in the COVID-19 pandemic: Early observational data from real time surveillance’, analysing ’real time surveillance’ (RTS) of suspected suicides during the pandemic and lockdowns. Despite greater distress, the study did not find evidence of an increase in suicide rates. Ensuing ONS month by month data for 2020 and 2021 also showed no increase in suicides.
There was a vital caveat which needed to applied to this data which, although present within the ONS report, wasn’t given much weight by people who endorsed the findings: it was too early to be sure. Suicide is a verdict given by a coronial court, and does not operate in ‘real time’. Some courts were running almost a year behind on case load during the pandemic. This was not something to be ignored in favour of real time data — the coronial verdict is not simply a rubber stamping process. Analysis based on real time surveillance might have delivered a reassuring answer at the time to people who wanted to believe that the pandemic, lockdowns and other distressing NPIs didn’t ultimately lead to the most tragic consequences, but it was too soon to deliver a verdict.
Indeed, Appleby’s tweet thread on 12th April 2023, just over a year ago, was confident in its assumptions:
‘New @ONS data give us, for first time, national suicide rates month by month for Covid years 2020 & 2021, compared to earlier years. Graph shows no rise in these years overall, or any month, or any period of pandemic, including lockdown.
What can we learn from this?
It may tell us something about the protective power of social cohesion, of looking out for each other, of community, with its message of acceptance & concern.
If so, we need to hang on to it. It hasn’t looked in strong supply lately.
It may confirm something we saw after the 2008 recession, the life-saving impact of economic support - for people on benefits or in debt or fearing for their jobs & homes.
Particularly important as we head further into the cost of living crisis.
It reminds us to look at the evidence, no matter what the headlines claim.
Or the Twitter “likes”.
Or the academics who should know better.
Or the current attempt at revisionism in the media.'
In a National Confidential Inquiry into Suicide and Safety in Mental Health presentation, Appleby suggested a number of reasons why suicide had not increased. Despite the obvious anxiety about Covid-19, the tough lockdowns, economic ramifications and huge societal changes, he believed people were protected due to a combination of:
economic protections;
a supposed increase in social cohesion;
increased vigilance and support from family, friends and neighbours;
reduced access to certain methods of suicide;
a sense of short-term crisis.
These could well have prevented the rise in suicide at the time, but conclusions from previous analyses of other disasters warn that the rise in suicide does not occur during the disaster, but afterwards. The lack of rise in suicides was in keeping with disaster literature. A subsequent increase in suicide - as we see happening now - is also in keeping with disaster literature.
In the early psychological phases of disaster — ‘heroic’ and ‘honeymoon’ — you would not expect to see more suicides. They come afterwards. In the case of a ‘slow disaster’ like Covid-19, this could be some time afterwards.
At the time, Professor Lucy Easthope, the country’s leading authority on disaster and recovery, commented that the real time surveillance data was very useful, but that more attention should be given to the role of the coronial process as well as the underreporting of possible suicides which can be recorded as either an open verdict or crucially a narrative verdict which allows the coroner to expand on the additional factors that led to death. Ultimately, she concluded, real time death data could be unreliable.
She is now concerned now that ‘post-disaster conditions that may promote hopelessness are all increased, including economic instability, domestic violence, depression and alcohol use’ and that ‘we appear to have incubated a real sense of nihilism and hopelessness in younger people’.
It’s a frustrating stage of the Covid-19 saga. Warnings at the time were ignored and it is painful for experts such as Easthope to observe the impact on the public of chronic disaster and delayed support for physical and mental health, not to mention the toll on response workers who ‘tend to feel let down and morally injured by the state’.
‘It’s particularly important to consider long-term suicide when risk assessing economic policies,’ says Easthope. ‘Things like furlough schemes have positives but also come with substantial emotional negatives such as future redundancy, effects on self-worth, esteem and purpose. All disaster decisions come with negatives, there are no purely perfect answers. Discussion of the negatives was not welcomed and people like me were seen as pessimistic if we raised suicide as a result of Cabinet or Treasury decisions. It was very hard to get traction in 2020 and 2021 with these concerns.’
Whether suicide rates go up or go down, they are preventable and they are always too high. It’s a tragedy for suicide rates to be the highest in England for 25 years. If the pandemic and the never-before-used lockdowns turn out to be a factor in this devastating trend, we could well see the rates rise further.
According to the Samaritans one in five of us have experienced suicidal thoughts. If you’re going through a tough time, you don’t have to face it alone. Call Samaritans day or night on 116 123. Email jo@samaritans.org.
40 years ago, I made an attempt,which did not succeed-obviously-but having been troubled by recurrent bouts of depression since my teens, I can identify with any lost soul who loses all hope and takes the way out.
My view is that the lockdowns were a scandalous, ill conceived disaster,driven by a confluence of 'experts', dodgy modelling, profiteering on the part of various pharmaceutical concerns, opportunistic politicians, nudging and officious public figures seduced by power: the podium appearances,the dreadful adverts, the management by decree which superseded good governance made my blood boil.
Not all suicides can be attributed to the lockdown lunacy, but I'm convinced that many of those whose lives were ruined fell into unbearable despair.
In the early days -2020-I read of the loss of livelihoods, mounting indebtedness, marital breakdown and loss of access to essential public health services which led many sufferers to end it all.
Correlation is not causation but nonetheless, I think we can be sure that lockdowns contributed.
I know of 3 suicides which were all, without doubt, due to lockdown.