Safer mental health services:
They also need to be sound and supportive
The Norwich perspective
Recent controversy in the Norwich Evening News (http://www.en24.co.uk/) follows publication of the 2004 Annual Report of the Director of Public Health in Norwich - "The Health of Norwich". One of the mental health programme outcome measures in this report is to reduce the higher than expected rates of self-harm and suicide in Norwich. Figures for admissions for (attempted) suicide and of undetermined intent are given for Norwich PCT health visitor areas, but no comparison is made with national figures, so it is difficult to see where the justification comes from for the self-harm objective. For most years from 1993 to 2002 deaths from suicide and undetermined injury for all ages in Norwich have been above the national and East of England rates, although they are small absolute numbers (on average 15.5 deaths per year in Norwich over this period). No measure of statistical significance is given in the report - and in fact because of the small numbers it is not significant compared to the rest of England (p=0.3). The east of England average is below the national average.
Suicide figures by local authorities (boundaries as at April 2004) are available from 1993-2004. Figures vary across the nation. For example, regional centres, coastal and countryside areas and industrial hinterlands are above the national average. Cities such as Liverpool and Nottingham have even higher figures. Norwich City, if the small figures are reliable, is on a par with one of the highest rates nationally in central London. However, not too much should be made of this finding because of the lack of statistical significance - it could just have been a chance variation over these years.
Despite this required caution, Ian Gibson, one of the Norwich MPs has called for an independent public inquiry into deaths at the local Hellesdon psychiatric hospital (story in Norwich Evening News). This is despite the rate of suicides at Hellesdon hospital being one per year, the same rate as the Norwich Evening News quotes for Suffolk mental health units (see letter from chair of Norfolk and Waveveney Mental Health Partnership NHS Trust). It is true that average suicide figures for Ipswich, which are probably the best Suffolk comparison with Norwich, are closer to the national average, but the figures over the period in question fluctuate widely from year to year. It is important to emphasise that average.figures, such as those for Ipswich, may be subject to considerable random yearly variation for some not necessarily obvious reason.
No interventions have reliably been shown to prevent suicide or deliberate self harm (Geddes, 1999; Appleby et al, 1999). Nonetheless, Norfolk and Waveney Mental Health NHS Partnership NHS Trust have developed an action plan with relatives of patient who have taken their own lives (National Audit Office, 2005). The Trust Board has stressed privacy and dignity of patients at all times. The Trust has claimed it has seen a reduction in inpatient suicides as a result of the action plan, although it has not produced any evidence to support this claim apart from pointing out that there were no inpatient suicides between January 2004 and May 2005. As pointed out above, there are considerable dangers in making claims based on suicide figures, which are small in absolute numbers.
This local issue has occurred in the context of the reform of the Mental Health Act 1983 (see http://www.critpsynet.freeuk.com/reform.htm. UK mental health policy has been driven over recent years by concerns about public safety (see my UK mental health policy website). I have previously published correspondence I had with the National Director of Mental Health, Professor Louis Appleby (Letter from Professor Appleby, Reply to Professor Appleby, Reply from Professor Appleby, Further reply to Professor Appleby). The mental health czar refused to debate with me whether community treatment orders, which are proposed in the reform of the Mental Heath Act, may increase rather than decrease suicide and homicide by mentally disordered people.
Norfolk's Stephen Fry thinks Norwich is a fine city of culture http://www.norwich2008.com/news/fry.htm. He felt suicidal when he walked out of the West End show Cell Mates in February 1995, and will talk candidly about his experiences of living with manic-depression in a programme on BBC2 in May 2006 (interview with Stephen Fry).
Appleby L, Shaw J, Amos T et al. (1999) Safer Services, Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. London: Stationery Office