A social approach to suicide

The World Mental Health Day 2019 theme is suicide prevention. 

BASW CEO Ruth Allen reflects on the state of mental health and social policies in the UK related to this theme – and argues for the pressing need to shift to social and relationship-based approaches and a social justice paradigm in policy and professional practice.  

She calls for  a new manifesto for social work in mental health and encourages engagement with the Movement for Social Approaches in Mental Health (MSAMH). A recent webinar on MSAMH is free to access here.

Suicide is perhaps the most tragic occurrence related to mental distress.  It is a global problem as well as a major issue for us in the UK. As World Mental Health Day highlights the importance of understanding suicide and what may be done to prevent it, I hope that all who have experienced suicidal thoughts, and everyone affected by suicide, feel supported.

So many people across the world wish you well and send you love today, every day and for the future.

Suicide is rising in the UK. Numbers of suicides generally fell between 1981 and 2007. But since then, they have been increasing and are now at their highest since 2002. There was a rise of 11.8% in 2018 including a 19-year high in rate of deaths among young people aged 10 to 24.  Men are most at risk. Increases in suicides of young people at Universities have been particularly shocking.

There are as many individual stories behind a person taking their own life as there are suicides. Not all suicides come with warning signs and not all are related to mental distress.  Suicide also occurs across all classes and income brackets. But there are social and circumstantial factors and disadvantages which increase the likelihood of despair, suicide and mental health problems generally.  

Factors known to create suicidal thoughts and despair have been worsening since the economic crisis of 2008 and the subsequent long years of austerity. These include reduced employment and housing security and harsher social and welfare policies.  Poorer, more unequal and divided societies have poorer mental (and physical) health overall. In these times of austerity, the poorest, most excluded and those experiencing multiple disadvantage (such as racism and disablism) have been hit hardest. . See the excellent overview in Equality and Human Rights Commission report 2018 for more details.

In May 2019, Philip Alston, UN Special Rapporteur on Extreme Poverty, reported on his investigation into the situation across the UK and concluded  "The bottom line is that much of the glue that has held British society together since the Second World War has been deliberately removed and replaced with a harsh and uncaring ethos." He directly cited the impact of growing extreme poverty on hopelessness and suicidality. 

As life has got tougher for so many, mental health has been increasingly the zeitgeist. It has had mainstream political attention across all parties and countries of the UK.  From MPs braving the Commons bearpit to tell their personal stories, to highest level statements of commitment from those in power and in opposition. Mental health is discussed in the press and public discourse more positively and in less stigmatising ways. 

Recent commitments to more investment in mental health services – only partially reversing previous swingeing cuts – shows some political acknowledgment that many services are on their knees - or are screening out too many people in order to stay standing. 

Remember - ‘parity of esteem’ between physical and mental health has been enshrined in law since the Health and Social Care Act 2012. 

The commitments of the NHS Long Term Plan (LTP) and other recent announcements show some loosening of the purse strings on NHS spending in mental health. The LTP promises changes to mental health services, including a rise in investment in mental health outstripping the rises in other parts of healthcare.  Remember - ‘parity of esteem’ between physical and mental health has been enshrined in law since the Health and Social Care Act 2012. 

However, committing such resources without addressing the social determinants behind rising demands and needs is, as the saying goes, like sticking your finger in the dam that that continues to fill and will one day burst its banks.

Personal resilience? Yes – in a fairer society

Recent policy approaches to mental health and investment have been accompanied by encouragement for all of us to understand our own mental health better. We are encouraged to take more individual action to protect and improve our personal resilience. We are encouraged to talk to more to colleagues, friends and family more openly, and to seek help.

Looking after our own mental health is necessary and we can all learn to do it better.  But running parallel policies that make life much more mentally and materially harsh and unequal for very large sections of society while majoring on the importance of personal responsibility for inner resilience and self-care, is perverse.

Yet it makes complete sense in our current dominant political and policy system which is overwhelmingly focused on individual responsibility even where a person is literally blocked from exercising agency. Where timely access to primary care is impossible because of cuts, waiting lists or other barriers. Where a person does not have enough money for food let alone travel to a self-help support group. Where the power of solidarity and common identity between people experiencing the same types of barrier and discrimination has been undermined by service paradigms that focus intensively on the individual rather than their social identity and experiences.

The LTP and recently published Community Mental Health Framework for adults and older adults 

recognise the importance of communities, relationships, civil society activities, informal support, non-clinical help, housing and employment. The Framework includes community link worker, navigator and ‘social prescriber’ roles, to help people make community connections and use non-medical support such as social and activity groups.

These may well help. But such models of support can only really make a difference to mental health outcomes and sustainably improve people’s lives if:

• wider policies are reformed to reduce poverty including in-work poverty
• people using services have access to social justice, rights-based advocacy and self-advocacy support
• personalised, strengths based, rights-empowering social work and social care is available particularly for people facing complex social and health barriers and those most excluded and/or at risk
• investment and the power valency in services moves from clinical professional services, pharmacology and biomedical dominance in decision making towards social and psycho-social support, tackling the social disadvantages undermining good mental health, and opportunities for relationship-based support where it is needed.

A manifesto for social work in mental health?

Social work is vital in mental health services. We provide essential rights and legal knowledge and have responsibility to protect people’s rights under mental health legislation through AMHP, ASW and MHO roles across the UK.  The role of social workers in these activities is crucial. But our involvement in these roles as a profession is not enough if we want mental health support to be improved and become more socially focused, just and rights based.

Social work has been significantly affected by cuts to social care and health services and by austerity-driven increase in demands. This has impacted the numbers of social workers available to do rising amounts of work, our working conditions and stressors, and our ability to offer meaningful help including social support options and resolution to social problems. More people using services are in significant poverty and have more intractable problems of daily living. This has implications for the complexity of social work tasks and the emotional impact of our work.

Important implications for social work practice and guidance are contained in BASW’s recent Anti-Poverty Practice Guide. 

This is as relevant for mental health social workers as for any other practitioners. It helps individual practitioners to bring into their practice an understanding of the nature of poverty, of place, communities, sociological and economic factors, equality and human rights legislation and other contextual factors, integrating this with their understanding of the uniqueness of each individual – their personhood, their past, present and future, their culture, their distinctive challenges and strengths, their wishes and desires. The guidance focuses on the quality of human relationships at the heart of social work helping – and how this in itself is an act against poverty which can be so stigmatising, ‘othering’ and excluding.

Social workers in mental health needs to take on board guidance such as that in the BASW anti-poverty publication. And we need to think and plan together positively as a profession about what we want for the future.  We need, if you will, a ‘manifesto’ for social work in mental health.

This is not written yet, and I want to encourage engagement across the profession to determine what should be within it.  For me, it should include a commitment by social workers to engage in empowering themselves, people using services, carers and families to speak out about the need for a paradigm shift in  mental health services towards more socially-focused, relationship- and rights-based support, and a radical overhaul of the wider welfare, social and economic policies that are driving up mental distress and putting more people at risk and in despair.

Watch the webinar on the Movement for Social Approaches in Mental Health (MSAMH), get in touch and get involved.