In 2017, Norman Lamb was the Liberal Democrat MP for North Norfolk when he concluded the third Zero Suicide International Summit in Sydney (full text of his speech to follow).
Two years earlier when he was Minister of State for Care and Support in the United Kingdom Government, Lamb sparked a national dialogue of Zero Suicide at levels previously unimagined, including the BBC, Telegraph and Guardian and healthcare leadership throughout the NHS Trusts.
2015 Prime Minister Campaign
With general elections in May, the race was in the homestretch in England. January 18 was to be a day of dueling mental health initiatives, with Labour allocating more funds to child services.
UK Deputy Prime Minister Nick Clegg appeared on a BBC talk show to provide the Liberal Democrats counter, and promised to sign up the National Health Service (NHS) for a country-wide “Zero Suicide” campaign. He referenced pilot programs in organizations in Merseyside, the east of England, and the southwest that have employed the Henry Ford Health System model “where suicides were sharply reduced from 89 per 100,000 in 2001 to as low as zero among the patient population over the decade” (Guardian, “Lib Dems announce campaign for NHS to set ‘zero suicide’ goal”).
Clegg called for charities, voluntary organizations, and the NHS in “every part of England” to join in the effort to eliminate suicides. He encouraged a no-blame approach, mirroring the “just culture” espoused by Dr. Ed Coffey, the pioneer behind the success at Henry Ford. “[Zero Suicide] is doing more in every area of our society to ensure that people don’t get to that point where they believe taking their own life is their only option,” said the Deputy Prime Minister.
Several pilot programs that had already embarked on the mission were mentioned, including:
- Project Zero in southwest England. This program includes individuals with lived experience in its steering committee and partners behavioral health and social service organizations with local emergency services to identify and support individuals at risk, including utilization of Jeffrey Brenner’s “hot spotting” techniques.
- Mersey Care. An NHS trust in Liverpool, this program has established a goal to eliminate suicides in its area by April 2018, with training for staff in the skills to support those at risk, such as safety planning. They have also engaged a tiger team for monitoring individuals at highest risk.
- Stop Suicide Campaign. This program in Eastern England’s Cambridgeshire and Peterborough is providing ASIST (Applied Suicide Intervention Skills Training), and using social media and community events with public pledges.
Two days later, Lamb wrote about breaking the taboo on the last stigma, mental health and suicide. “We want to see this sort of approach [Zero Suicide] taken across the country.” (Read the Letter.)
After these events, the dialogue exploded and it was rich.
The BBC featured an article, “New strategy to cut suicides ‘achievable’, says Clegg.” The Guardian reported “Zero suicides is an admirable aim but it requires all-out change.” It also addressed the disparity between male and female suicide rates (read here). Allied non-profit organizations like the Samaritans and Contact NI weighed in with support. Professional associations immediately took notice, with NursingTimes.net addressing “‘Zero suicide’s goal risks blame culture if applied ‘clumsily.’” The Telegraph argued the first step in the ambitious plan would be to reject euthanasia and “assisted dying.”
In an article on the suicide deaths of adults detained while in psychiatric inpatient, jail or prison, the BBC reported the Department of Health for England was calling on every part of the NHS to commit to a new “zero suicide” ambition, again referencing the “perfect depression care” program at Henry Ford.
While the Liberal Democrats were ultimately defeated in the 2015 election, this extended conversation laid the groundwork for the Zero Suicide Alliance, that would be launched two years later.
2017 Sydney Summit
Full text of speech provided by MP Norman Lamb and used with permission
I wanted to start by thanking the contributors at this summit. I have enormous admiration for the work that you are all doing. You are the pioneers at the cutting edge, confronting skeptics and challenging orthodoxy.
I wanted to explain why this is of interest to me not only professionally but on a very personal level.
First, our oldest son, Archie, was diagnosed at the age of 16 with obsessive-compulsive disorder. We have experienced the failures of the NHS, waiting too long for treatment. Archie has been through very difficult times with a punishing condition but there is a real injustice because when we were confronted by a long delay before we could get treatment started, we did what any family in these circumstances would do if they were able to – we paid for treatment for Archie. But I do not want to live in a country where people with resources can get access to treatment and others are left waiting. That is a real injustice.
So I am on a mission to pursue the cause of equality for those who suffer from mental ill-health. Equality in terms of access to treatment on a timely basis – just as others enjoy.
Then, two years ago in the summer of 2015, my older sister, Catherine, took her own life.
She had been an inpatient for ten weeks. I was struck by what David Jobes said: “we put people in hospital where there is not suicide specific care.”
Catherine was in a unit with others with psychosis and with personality disorder. All of those in the unit were complex cases but was this a therapeutic environment in which to recover? There also seemed to be little involvement of family in decisions about Catherine’s treatment.
I was struck by what David Covington said about the small proportion of people in the United States who get suicide specific treatment – and yet we know that this can have a significant impact on reducing the death toll from suicide. This is surely intolerable and unconscionable.
So this is important to me personally. But more broadly, we have to challenge injustice.
In my family’s case I have no interest in retribution. I only have an interest in learning from experience and in trying to reduce the risk of others ending up taking their own life.
My introduction to the concept of Zero Suicide came from Joe Rafferty, Chief Executive of Mersey Care Mental Health Trust in the Liverpool area. He told me about Ed Coffey’s work in Detroit. I was fascinated by this and found the case for a more audacious approach to suicide reduction to be very compelling.
I managed to persuade the Deputy Prime Minister at the time, Nick Clegg, to join with me in launching a national challenge to NHS organisations to commit to a Zero Suicide Ambition.
We were supported at that time by Professor Louis Appleby. I remember his profound comment: in all of his professional life studying individual suicides, it was always the case that something could have been done differently which might have saved that person’s life.
We now have three pioneering areas in England are – Mersey Care, East of England and the South-West. It is good to see Ellen Wilkinson from South-West England here in Sydney.
In 2015 I left the Government following the general election but was then asked to chair the Commission on Mental Health in the West Midlands. This has culminated in an agreed action plan. It had been informed by my visit to meet Gary Belkin who had crafted the “Thrive NYC” strategy in New York. I had also visited Philadelphia. We are now starting to develop a global network of cities, all of which are taking citywide action on public mental health.
One action included in the West Midlands plan is a commitment to a Zero Suicide Ambition. We have also established a working group to look at how to embed mental health in primary care and I was struck by the compelling case put by Virna Little in terms of the action they have taken in her primary care centres in Harlem in Manhattan. In essence, it seemed to me that this was good preventive care, identifying risk at a much earlier stage and taking action to support that individual to recover.
This was very much in line with the approach taken in Detroit. They called the approach: “perfect depression care”, screening people in primary care – particularly those with chronic conditions – identifying those who may be at risk of suicidal ideation. Ensuring that those people get fast access to support for their psychological challenges is highly attractive.
In the West Midlands I believe that we have a real opportunity to combine the core Zero Suicide approach with health providers with a wider public mental health approach as described so effectively by Professor Paul Yip in his presentation. He talked about an umbrella over a community protecting them from risk. If we are to have an impact on the overall suicide rate then we have to combine work in our health providers with a wider public mental health approach to achieve better prevention.
We also have to look at the Criminal Justice System. Mike Doyle talked about the dreadful death toll in our prison system in England where there have been one hundred and nineteen suicides over the last twelve months. The same principles of expecting organisations to be audacious in committing to seeking to save every life must surely apply. Another action is that we will introduce a much greater use of what are known as “mental health treatment requirements” in three courts in the West Midlands. This is a sentencing option which seeks to address the underlying cause of offending behaviour where someone has a clear mental health condition.
We are at the very start of a journey in the West Midlands and I do not know what progress we will make but we have a big opportunity.
Reflections on the Summit
I thought that Chris Doyle’s, from Lendlease, presentation was very impressive. It reminded me also of the sign at the London construction site which said: “all harm is preventable – target zero”.
That culture is what we seek to apply to the mental health system. Lendlease have been incredibly successful by being audacious and by being clear that the death toll on construction sites was intolerable – and then introducing specific clear action to make the commitment a reality.
So long as we are clear on what we mean by Zero Suicide – that every life is precious and so long as we remember Louis Appleby’s experience that in every case something might have been done differently to save that person’s life then it seems to me that the concept of Zero Suicide is absolutely right. I was struck by Becky’s comment that: “we focus on zero every day”.
As we learned from Chris Doyle, there has to be a challenge to culture – a statement of ambition. This is necessary – but not enough.
The task is to marry the challenging audacious ambition with:
- Robust science
- Smart use of technology – just as Virna Little has done in primary care in Harlem
- Training of staff and embedding quality improvement methodology in everything that we do
There has to be an open learning culture.
Any one of these on their own will fail.
In the UK we have a very good, evidence based national strategy – but it is having little impact on the numbers of those who take their own lives because the culture in too many organisations is not being challenged. Organisations are not giving sufficient priority to ending this awful death toll.
So our mission is to:
- Promote the full package – THE AMBITION and THE SCIENCE and THE MECHANISMS TO ACHIEVE CHANGE
- Secondly, how do we move from pioneers around the world to making this mainstream?
There is a moral imperative that we do make this mainstream. We need evidence of impact of this approach and the lives that can be saved.
We need champions who will go out and proselytize for this approach around the world.
I will do what I can in the UK and beyond.
As Jan Mokkenstorm said: “we must not limit this to harm reduction. It must be about promoting well-being, happiness and giving people a good life.”
Twitter: @NormanLamb