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SANE, 1st Floor, Cityside House, 40 Alder Street, London E1 1EE
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Abstract |
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This is an audit of 10 359 calls made to the national mental health helpline SANELINE between January 1996 and June 1998 aiming at describing the profile of suicidal callers.
RESULTS
More calls were by, or about, women. The most common age group for suicidal callers was 25-34 years, while those under 25 were least likely to call the helpline. Fifty-five per cent of all calls related to people suffering from depression, and 31% were for people with psychosis. The majority of sufferers who were planning suicide or were in the act of suicide at the time of the call were in contact with services, and almost three-fifths of sufferers reported problems with services.
CLINICAL IMPLICATIONS
There is an urgent need for innovative interventions targeting males and those under 25 years of age.
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Introduction |
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TopAbstractIntroductionThe studyFindingsCommentAppendixReferences |
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Statistics published by the Office of Population Censuses and Surveys in England and Wales (OPCS) showed that, in 1996, there were 3455 registered deaths due to suicide (ICD-9 E950-959 (World Health Organization, 1978)), and that since 1993, there has been an overall decrease in deaths due to suicide (OPCS, 1997). This has, however, been accompanied by an increase in suicide rates among young men (15-44 years of age) (OPCS, 1997). Men outnumber women in committing suicide by a ratio of three to one. This has been the case since 1989.
Although the literature on the epidemiology of suicide is extensive, little information is available on the profile and needs of people who suffer from a psychiatric disorder and who have suicidal intentions.
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The study |
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TopAbstractIntroductionThe studyFindingsCommentAppendixReferences |
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Sample
Analyses were conducted on 10 359 calls made between January 1996 and June
1998. This corresponded to 15% of all calls logged on SANELINE database for
that period of time. To be included in the sample, sufferers must have
reported having or having had suicidal intention, and carer or professional
callers must also have said that the sufferers were suicidal.
In total, 75% of callers in the sample were sufferers (n=7804), 22% of carers (n=2226) and 3% of professionals (n=329) calling on behalf of sufferers. Volunteers spent 4143 hours in contact with these callers. The average length of call was 24 minutes, compared with 16 minutes, for non-suicidal callers.
Because information is entirely volunteered by callers, missing information on most of the areas covered in the CRS is expected. Therefore, missing cases were removed from the analysis on each variable, accounting for the reduction in the total number of cases in each individual analysis.
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Findings |
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TopAbstractIntroductionThe studyFindingsCommentAppendixReferences |
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Reason for calling the helpline
Sixty-two per cent (n=6395) called the helpline because they
wanted support, 21% (n=2251) because they felt distressed, and 17%
(n=1713) because they wanted information. The type of information
required related to: the availability of social support groups in local area
of residence (49%, n=833); inquiries about legal matters (18%,
n=308); general information on illness (17%, n=293); and
medication (12%, n=200). Other inquiries made up 4% of the calls.
Illness
Fifty-five per cent (n=5227) of all calls, where information on
illness was provided, related to people with depression and 31%
(n=2876) to people with psychosis. The rest (13%, n=604)
related to other illnesses (phobias, compulsive—obsessive disorder,
eating disorders, anxiety, etc.). The distribution by gender showed that for
psychosis, more calls related to males than females, whereas for depression,
more calls related to females than males (see
Table 1). For both illnesses,
however, there were no major differences by gender in age of callers with
suicidal ideation, though the lowest proportion of calls pertained to male
callers with psychosis in the 15-24 age group
(Table 2).
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As far as comorbidity is concerned, alcohol addiction was reported in 336 (3%), while street drug dependency was mentioned in 119 calls (1%). Dependency on both was reported in 32 calls (0.3%).
Treatment
Ninety per cent of callers with suicidal ideation (n=6651) were on
prescribed medication; 22% (n=1626) had hospitalisation episodes, and
18% (n=1330) had counselling/therapy. Electroconvulsive therapy was
reported in 173 calls. No mention of any type of treatment was made in 2969
calls (29% of sample). It is to be noted that this distribution was not
different to that of callers with no suicidal ideation.
Suicide status and use of services
Half of all callers (n=3015) gave no reasons why they contacted
SANELINE. A fifth (n=1204) said they were not aware of the
availability of services in their area of residence. Another fifth
(n=1213) said they used the services and found them not helpful, and
14% (n=936) said that they could not access the services when they
needed them (at weekends, out of office hours, etc.). Two per cent
(n=132) said that no services were offered to them. There were no
major differences by gender in suicidal callers' perceptions of services;
however, males were less likely than females to be aware of the availability
of services; the 3% difference was the largest between the two groups
(Table 1).
Half of the callers with suicidal ideation (n=5234) had attempted suicide in the past, almost a fifth (n=1619) were planning to commit suicide at the time of the call, and 5% (n=475) were in the act of suicide when calling the helpline. Most of those who were planning to commit suicide, or were in the act of committing suicide when they called the helpline, were in contact with services, that is, had seen a health professional (doctor or nurse) in the last month. This was also true of those who attempted suicide in the past (Table 3).
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Caller's story
Qualitative information about the callers was recorded on the back of the
CRSs. This information, when provided, gave insights on the problems that
callers were facing. Social issues and issues related to care and services
were often mentioned by callers. For example, some callers were not content
with the treatment or care they received. Some callers specifically criticised
their health providers. Some reported social problems such as stigma, social
network, social isolation and problems related to daily living. Examples of
cases are found in the Appendix.
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Comment |
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The data from this audit showed that the majority of sufferers in our sample were receiving care. A large proportion of them saw a health professional in the month preceding their SANELINE call. This is in line with a recent national clinical survey which reported that 24% of people who committed suicide had had contact with mental health services in the year before death (Appleby et al, 1999). These findings cast doubt on the effectiveness of the current system of care that may be failing to meet the health and social needs of its most vulnerable users. A considerable proportion of callers also reported problems relating to access to and availability of services when needed, thus emphasising the importance of identifying ways to mobilise effectively and efficiently existing National Health Service resources, and to improve awareness of and faster access to services.
The audit also showed that females were more likely to seek help than males. Females with suicidal ideation were at least twice as likely as males to call the helpline, and female carers were almost four times more likely to seek help on behalf of the person with suicidal ideation than their male counterparts. This may partly explain why more males than females eventually go ahead with the act of suicide. This gender difference could have serious implications on use of services and outcome of illness. Our analysis showed that males with suicidal ideation were less likely to be aware of the availability of services that could provide them with help. It would therefore seem that as yet strategies to increase male awareness of the need to seek help when feeling suicidal, and their awareness of the existing sources of help, have failed. Given that males are in general less easy to engage in mental health treatment (Hawton, 1997), innovative methods of targeting them are needed if we are to reduce the prevalence of suicide among this group. Another group that could be targeted is those under 25 years of age, a group less likely to call the helpline, and whose sources of help and support are unclear. It is advisable, however, for developers of any strategy targeting this group to take into account the current youth culture and to conduct interventions through a medium relevant to that culture.
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Appendix |
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TopAbstractIntroductionThe studyFindingsCommentAppendixReferences |
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Case 2
Mr T. has been suffering from severe depression for several years now. He
does not feel he wants to go on living. He said that hospital care was of no
help to him in the past. He called his community psychiatric nurse (CPN)
tonight and told him that he wanted to kill himself. He said that the CPN told
him that he had no time for a deep and meaningful conversation and hung up. Mr
T. felt very desperate and let down.
Case 3
Ms M. has been suffering from depression continuously for four-and-a-half
years now. She wanted to know whether people overcome this problem. She feels
she cannot open up to her husband for fear of losing him. She would like to
have hospital care but she is afraid of losing her dignity and of losing her
husband and friends.
Case 4
The caller is very concerned about her friend M. who suffers from
schizophrenia. He has been ill for 10 years now, and has been sectioned a few
times. Last month he took an overdose. The caller said she is aware that M.
lacks social and communication skills and this is making him worse because it
prevents him from seeking help. She said she needed help on what to do.
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Acknowledgments |
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References |
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TopAbstractIntroductionThe studyFindingsCommentAppendixReferences |
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DEPARTMENT OF HEALTH (1992a) The Health of a Nation: a Strategy for Health in England. London: HMSO.
DEPARTMENT OF HEALTH (1992b) The Health of a Nation: Specifications of National Indicators. London: HMSO.
DEPARTMENT OF HEALTH (1999) Saving Lives: Our Healthier Nation. Cm 4386. London: HMSO.
HAWTON, K., FAGG, J., SIMKIN, S., et al
(1997) Trends in deliberate self-harm in Oxford, 1985-1995.
Implications for clinical services and the prevention of suicide.
British Journal of Psychiatry,
171,
556-560.
OFFICE OF POPULATION CENSUSES AND SURVEYS (1997) Mortality Statistics in England and Wales. London: HMSO.
WORLD HEALTH ORGANIZATION (1978) Mental Disorders: Glossary and Guide to their Classification in Accordance with the Ninth Revision of the International Classification of Diseases (ICD-9). Geneva: WHO.
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| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| British Journal of Psychiatry | Advances in Psychiatric Treatment | All RCPsych Journals |
