On 19 January, Nick Clegg called for a ‘zero suicides’ target among people suffering from mental illnesses. Almost 4,700 people committed suicide in UK in 2013, at least 90% of whom were thought to be struggling with mental health issues, particularly depressive or substance abuse disorders.
The results of a programme in Detroit US have inspired the Deputy Prime Minister to call for something similar to be rolled out across the UK.
The progamme in question was created by the Behavioural Health Services division of Henry Ford Health System in 2001. Since that time they have seen a steady reduction in suicide rates amongst those in their care, from an initial rate of 89 per 100,000. For the past two and a half years, the rate has been zero, compared with an expected national average of 230 per 100,000.
Whilst Mr Clegg was making his appeal, the House of Lords continued to debate Lord Falconer’s Assisted Dying Bill. Amongst other amendments, their Lordships voted down the proposal to rename the Bill ‘Assisted Suicide’. Doubtless they wished to preserve the ‘softer’ label in the best interests of the public (though apparently no such sensitivities exist north of the border with their Assisted Suicide (Scotland) Bill). Euphemisms aside, it is difficult to argue that what is being advocated is not, essentially, suicide.
The Falconer Bill is modelled on Oregon’s assisted suicide legislation. What has become clear is that the overwhelming majority of those seeking assisted suicide in Oregon are not suffering with a terminal illness but want to end their lives because of feelings of worthlessness and hopelessness. Control of physical pain and suffering don’t rank in the top five reasons given. Instead, 93% cite ‘loss of autonomy’ and 89% ‘loss of enjoyment of life’ as key reasons. In one Oregon study, 26% of those seeking assisted suicide met the criteria for depression. In Washington State, where a similar law exists, 61% of people opting for assisted suicide in 2013 gave the fear of being a burden to family, relatives and caregivers as a principal reason. In another study, of those with terminal illness who initially considered euthanasia or assisted suicide, half subsequently changed their minds.
So, in the same week we have UK politicians appealing for a zero tolerance attitude to suicide among the mentally ill and seeking to legalise assistance for suicide for the terminally ill. The irony is that, as the figures above and here demonstrate, those with terminal illness who seek assisted suicide do so primarily for mental health reasons. Those who support suicide for terminally-ill people but not for those who, for often very similar reasons, cannot face the prospect of continuing their lives must make sense of their position.
Assisted suicide is commonly argued for on the basis of autonomy, so why would we not respect the autonomous wishes of those who simply don’t want to go on living but who are not terminally ill? Doubtless many of the 4,700 suicides that Mr Clegg was referring to were beset by the same unbearable feelings of hopelessness described by those seeking assisted suicide in Oregon. How will offering assistance for suicide to one category (those with terminal illness) help to reduce the rate of suicide amongst others?
If Oregon’s statistics were extrapolated to UK, it would equate to over 1200 people annually receiving assistance to end their own lives. What this means is that passing the Falconer Bill would effectively lead to a 13-fold increase in the number of terminally-ill people who presently commit suicide (92, based on a 2011 survey of UK Primary Care Trust suicide audits). Even more seriously, it would send the message that the way to cope with life’s insurmountable problems is to opt out. It would lend institutional support to the notion that the way to combat despair, depression and an apparently hopeless future is…precisely not to combat it, but to yield to it and take the easy option.
The way in which suicide is publicly portrayed has an effect on suicide rates. The WHO international guidelines on suicide portrayal refer to over 50 published studies, systematic reviews of which have consistently drawn the same conclusion, that media reporting of suicide can lead to imitative suicidal behaviours, sometimes known as the Werther effect. By the same token, media stories about how people coped positively with suicidal feelings actually lead to a decrease in levels of suicide in the general population. The legalising of assisted suicide would send the wrong message to the public and likely produce its own form of contagion.
Nick Clegg is no doubt well-intentioned in pursuing a ‘zero suicides’ target. But if we want to see the downturn in suicide rates he is calling for then, like him, we must reject the Falconer Bill as a necessary first step.