Self-inflicted. Deliberate. Death-intentioned. A critical policy analysis of UK suicide prevention policies 2009-2019

Purpose With encouragement from the World Health Organisation, national suicide prevention policies have come to be regarded as an essential component of the global effort to reduce suicide. However, despite their global significance, the construction, conceptualisation and proposed provisions offered in suicide prevention policies have, to date, been under researched; this study aims to address this gap. Design/methodology/approach we critically analysed eight contemporary UK suicide prevention policy documents in use in all four nations of the UK between 2009 and 2019, using Bacchi and Goodwin’s post-structural critical policy analysis. Findings The authors argue that across this sample of suicide prevention policies, suicide is constructed as self-inflicted, deliberate and death-intentioned. Consequently, these supposedly neutral definitions of suicide have some significant and problematic effects, often individualising, pathologising and depoliticising suicide in ways that dislocate suicides from the emotional worlds in which they occur. Accordingly, although suicide prevention policies have the potential to think beyond the boundaries of clinical practice, and consider suicide prevention more holistically, the policies in this sample take a relatively narrow focus, often reducing suicide to a single momentary act and centring death prevention at the expense of considering ways to make individual lives more liveable. Originality/value UK suicide prevention policies have not been subject to critical analysis; to the best of the authors’ knowledge, this study represents the first attempt to examine the way in which suicide is constructed in UK suicide prevention policy documents.

Suicide as a medical education curricular topic: a documentary analysis of Brazilian federal medical schools

Purpose Physicians worldwide need to be able to identify and assess suicide risk or behavior in their consults. The proper training of medical staff is an important form of suicide prevention, especially because 80% of the patients who died by suicide were in contact with a health-care service in the year of their death. The purpose of this study is to verify if some of the most important Brazilian medical schools includes discussions regarding suicide in their curricula, and describe them. Design/methodology/approach The study performed a documentary analysis of all Brazilian federal higher education institutions. The analysis involved selecting the institutions that approached the topic of suicide in their curricula, and sorting it by keywords. The curricula that contained such keywords were then entirely read, analyzed and all components found were described regarding course period, workload and approach. Findings Within the 68 analyzed institutions, 19 (28%) included suicide in their curricula with a total of 31 components approaching suicide among them. Those components belonged to different stages of the course and had different workloads and approaches. A total of seven different approaches were identified: Clinical (54.8%); Emergency (16.1%); Medical Psychology (9.7%); Ethics (6.5%); Social (6.5%); Occupational (3.2%) and Forensic (3.2%). Originality/value To the best of the authors’ knowledge, the study is the first to address medical education regarding suicide in a large number of Brazilian institutions. It is also one of the few studies worldwide to quantify suicide discussion on a large number of institutions using documentary analysis.

Correlates of disclosure of non-suicidal self-injury amongst Australian university students

Purpose Non-suicidal self-injury (NSSI) is associated with psychological disorders and suicidal thoughts and behaviours; disclosure of NSSI can serve as a catalyst for help-seeking and self-advocacy amongst people who have self-injured. This study aims to identify the socio-demographic, NSSI-related, socio-cognitive and socio-emotional correlates of NSSI disclosure. Given elevated rates of NSSI amongst university students, this study aimed to investigate these factors amongst this population. Design/methodology/approach Australian university students (n = 573) completed online surveys; 80.2% had previously disclosed self-injury. Findings NSSI disclosure was associated with having a mental illness diagnosis, intrapersonal NSSI functions, specifically marking distress and anti-dissociation, having physical scars from NSSI, greater perceived impact of NSSI, less expectation that NSSI would result in communication and greater social support from friends and significant others. Originality/value Expanding on previous works in the area, this study incorporated cognitions about NSSI. The ways in which individuals think about the noticeability and impact of their NSSI, and the potential to gain support, are associated with the decision to disclose self-injury. Addressing the way individuals with lived experience consolidate these considerations could facilitate their agency in whether to disclose their NSSI and highlight considerations for health-care professionals working with clients who have lived experience of NSSI.

Dying at work. Work-related suicide – how does the UK regulatory context measure up?

Purpose The purpose of this paper is to examine how work-related suicides are monitored, investigated and regulated in the UK, examining a small selection of cases and drawing on international comparison with other countries. Effective data collection and regulation are the cornerstone of suicide prevention, and this paper aims to consider whether the UK’s current regulatory framework provides an effective basis for preventing work-related suicides. Design/methodology/approach This study draws on qualitative sociological methods and is based on an in-depth analysis of 12 suicide cases occurring between 2015 and 2020. In each case, work-related causal factors had been previously identified by at least one official source (police enquiry, coroner or employer’s investigation). This study analysed multiple sources of documentation and undertook interviews with individuals close to each suicide case. The aim of this study was to consider the organisational response of three stakeholder organisations to the suicides: the Health and Safety Executive (HSE), the coroner and the employer. Findings The study points to serious shortcomings in the UK’s regulatory response to work-related suicides. Suicides are currently not recorded, investigated or regulated. Whereas the fracture of an arm or leg in the workplace needs to be reported to the HSE for further investigation, a suicide occurring in the workplace or that is work-related does not need to be reported to any public agency. Employers are not required to investigate an employee suicide or make any changes to workplace policies and practices in the aftermath of a suicide. The work-related factors that may have caused one suicide may, therefore, continue to pose health and safety risks to other employees. Originality/value Whereas some recent studies have examined work-related suicides within specific occupations in the UK, to the best of the authors’ knowledge, this is the first study to analyse the UK’s regulatory framework for work-related suicides. The study on which the paper is based produced a set of recommendations that were targeted at key stakeholder organisations.

Self-harm and suicidal content online, harmful or helpful? A systematic review of the recent evidence

Purpose There are calls for greater regulation of online content related to self-harm and suicide, particularly that which is user-generated. However, the online space is a source of support and advice, including an important sharing of experiences. This study aims to explore what it is about such online content, and how people interact with it, that may confer harm or offer benefit. Design/methodology/approach The authors undertook a systematic review of the published evidence, using customised searches up to February 2021 in seven databases. The authors included empirical research on the internet or online use and self-harm or suicide content that had been indexed since 2015. The authors undertook a theoretically driven narrative synthesis. Findings From 4,493 unique records, 87 met our inclusion criteria. The literature is rapidly expanding and not all the evidence is high quality, with very few longitudinal or intervention studies so little evidence to understand possible causal links. Very little content online is classifiable as explicitly harmful or definitively helpful, with responses varying by the individual and immediate context. The authors present a framework that seeks to represent the interplay in online use between the person, the medium, the content and the outcome. Originality/value This review highlights that content should not be considered separately to the person accessing it, so online safety means thinking about all users. Blanket removal or unthinking regulation may be more harmful than helpful. A focus on safe browsing is important and tools that limit time and diversify content would support this.

Rapid response pathway united to reduce self-harm (RUSH): a case study of a pilot pathway for children and young people

Purpose In response to elevated local self-harm and suicide rates, and the lack of a dedicated pathway for children and young people (CYP) who self-harm, a rapid response pathway united to reduce self-harm (RUSH) was developed and implemented within Norwich (Norfolk, England). This public health case study aims to describe the pathway model and share its outcomes, learnings, and reflections over the pilot year. Design/methodology/approach RUSH was a community-based pilot pathway aiming to support CYP, 11–18 years old, engaging in or at risk of engaging in repeated self-harm and subsequently at risk of repeated attendance at local emergency departments. From May 2020 to April 2021, RUSH supported 61 CYP using funding from NHS England and Improvement. Findings This case study shares the pathway’s outcomes, through a mixed-method evaluation. Results indicate statistically significant reductions in self-harm frequency (p = 0.01) and anxiety and depression symptomatology (p < 0.001); a statistically significant increase in progress towards goals (p < 0.001); and a general downward trend in re-attendance at local emergency departments following RUSH. Findings also illustrate high service user satisfaction. Framework analysis of focus group data highlights positive experiences with hope for recommissioning from a staff perspective. Originality/value This study will be valuable for services looking to develop and implement a similar service provision, in response to the need to tackle self-harm rates as a broader approach to suicide prevention. In light of the NHS long-term plan (2019), it also serves as an example of how to develop and use a strategic co-production group, and work collaboratively with the voluntary, community and social enterprise sectors.

“You cannot pour from an empty cup!”: child well-being service providers’ and policymakers’ professional supervision, coping and well-being during COVID-19

Purpose This paper aims to present findings from 440 responses regarding the experiences of supervision, coping and well-being of 83 service providers and policymakers from eight countries working to support children’s well-being during the COVID-19 pandemic. Design/methodology/approach A smartphone survey hosted on a custom-built app was used. The data were analysed using qualitative content analysis. The data were gathered in the last quarter of 2020. Findings While most respondents described the supervision they received as “useful” – both personally and professionally – and reported several characteristics of effective supervision practices, concerns about not receiving optimal support were also voiced. Respondents shared a range of stress management and other self-care practices they used but also revealed their difficulties optimally managing the stresses and anxieties during the COVID-19 pandemic. As a result, some respondents shared they were feeling helpless, unmotivated and unproductive. Yet, overall, responses were imbued with messages about hope, perseverance and self-compassion. Originality/value Using a bespoke smartphone app, rich and intimate insights were generated in real time from a wide range of professionals across high- and low- and middle-income countries – indicating the need to better support their well-being and service delivery.

Structural indicators of suicide: an exploration of state-level risk factors among Black and White people in the United States, 2015–2019

Purpose Death by suicide among Black people in the USA have increased by 35.6% within the past decade. Among youth under the age of 24 years old, death by suicide among Black youth have risen substantially. Researchers have found that structural inequities (e.g. educational attainment) and state-specific variables (e.g. minimum wage, incarceration rates) may increase risk for suicide among Black people compared to White people in the USA. Given the limited understanding of how such factors systematically affect Black and White communities differently, this paper aims to examine these relationships across US states using publicly available data from 2015 to 2019. Design/methodology/approach Data were aggregated from various national sources including the National Center for Education Statistics, the Department of Labor, the FBI’s Crime in the US Reports and the Census Bureau. Four generalized estimating equations (GEE) models were used to examine the impact of state-level variables on suicide rates: Black adults suicide rate, Black youth (24 years and younger) suicide rate, White adult suicide rate and White youth suicide rate. Each model includes state-level hate group rates, minimum wage, violent crime rates, gross vacancy rates, and race-specific state-level poverty rates, incarceration rates and graduation rates. Findings Across all GEE models, suicide rates rose between 2015–2019 (ß = 1.11 – 2.78; ß = 0.91 – 1.82; ß = 0.52 – 3.09; ß = 0.16 – 1.53). For the Black adult suicide rate, state rates increased as the proportion of Black incarceration rose (ß = 1.14) but fell as the gross housing vacancy rates increased (ß = −1.52). Among Black youth, state suicide rates rose as Black incarcerations increased (ß = 0.93). For the adult White suicide rate, state rates increased as White incarceration (ß = 1.05) and percent uninsured increased (ß = 1.83), but fell as White graduation rates increased (ß = −2.36). Finally, among White youth, state suicide rates increased as the White incarceration rate rose (ß = 0.55) and as the violent crime rate rose (ß = 0.55) but decreased as state minimum wages (ß = −0.61), White poverty rates (ß = −0.40) and graduation rates increased (ß = −0.97). Originality/value This work underscores how structural factors are associated with suicide rates, and how such factors differentially impact White and Black communities.

The impact of mental health information overload on community education programs to enhance mental health-care seeking

Purpose Education programs seek to increase the public’s mental health literacy so they are better able to, among other things, help others engage in care when in need. This task may be diminished when such programs overwhelm participants with too much information. In addition, participants might arrive to the program with information overload related to the covered health topic. Information overload about health topics has been shown to influence attitudes and behavioral intentions. The overall purpose of the current study was to examine the relationship between mental health information overload, topic interest, and care seeking recommendations. Design/methodology/approach The current study tested a path suggesting high mental health information overload diminishes interest in learning about mental health, which in turn reduces recommendations to others to seek appropriate help when in need. Participants completed online measures of mental health information overload, topic interest and recommendations for care seeking. The data set analyzed represents valid responses from 221 participants. Structural equation modeling was completed to confirm the path model hypothesized for this study. Findings Structural equation modeling showed satisfactory fit and significant betas for the hypothesized path. Originality/value This study adds to the emerging literature on the impact of health information overload and is the first to the best of the authors’ knowledge to measure mental health information overload. Program developers should consider information overload in the ongoing development of public mental health education programs.