Recent years have seen improved provision of suicide prevention support, yet in society – and arguably across most businesses – suicide remains a taboo word that few dare to mention. Marking World Suicide Prevention Day on Tuesday September 10, Nick Warburton explains that giving people who have suicidal thoughts permission to open-up is a critical first step towards helping individuals and saving lives.

Published last September, the Government’s Suicide prevention strategy for England: 2023 to 2028 pledges to reduce the nation’s suicide rate within two and a half years.

Although progress has been made since the previous strategy in 2012, the Government warns the suicide rate is not falling. Arguably, a significant reason for this is that suicide remains a taboo subject that many people avoid discussing.

“There are an awful lot of myths out there like, ‘If you mention the word suicide, you’ll plant the idea in a vulnerable person’s head’ and that’s not the case,” says Peter Holland, Media Manager at PAPYRUS, a specialist suicide prevention charity that offers free resources, educational training and a confidential helpline.
 
“We need to talk openly about suicide because that gives a vulnerable person a safe space in which to talk about what they are worried about.”

Dispelling myths

Another common myth is that only mentally ill individuals think about suicide and go on to take their lives.
 
In fact, an NHS digital survey from 2018 found that one-in-five people suffer from suicidal thoughts but the majority that feel suicidal don’t want to die; they just want the situation they are in or the way they’re feeling to stop.
 
“Many people have suicidal thoughts, but we don’t talk about suicide enough and because of the stigma it almost makes it embarrassing to tell someone that this is what you are thinking and what is going on for you. It then becomes almost impossible for people to seek help,” says Shannon Rivers, Head of Inclusion & Wellbeing Advisory at Business in the Community (BITC), which has developed Reducing the risk of suicide: a toolkit for employers.
 
Another myth that needs dispelling is that everyone that takes their own life has mental health problems at the time they die by suicide.
 
As a report published in 2022 by the Health and Safety Executive (HSE) Workplace Health Expert Committee (WHEC) notes: “suicide is usually the outcome of a complex interaction of socio-environmental, behavioural, and psychiatric factors”.

Pathway to suicide

The WHEC report outlines a model developed by Rory O’Connor, Professor of Health Psychology at Glasgow University, and colleagues, which outlines three phases in the transition from suicidal ideation to suicide attempt/suicide.
 
The first is the pre-motivational phase, which describes many different triggering events that can give rise to suicidal ideation and behaviour. These include a diverse range of life events like relationship break-ups through to work-related stressors such as bullying, job insecurity and high-pressure environments.
 
The second is the motivational phase and the factors that lead to the emergence of suicidal ideation.
 
One strand of O’Connor’s research looks at the relationship between entrapment, suicidal ideation and behaviour. He posits that entrapment – caused when a person’s “attempts to escape from defeating or humiliating circumstances are blocked” – is “central to the final pathway to suicide”.
 
This final phase is triggered when an individual has “exposure to suicide or suicidal behaviour” and “access to means”.
 
As the WHEC report notes, proportional mortality rates are high in certain occupations, notably farming, in part because they do have access to the means of suicide. 
 
For Andy and Lynda Eadon, whose son Len took his own life, an exodus of people working on farms in the past 50 years has meant individual farmers often work longer days, spending large periods of time on their own. There are also huge financial pressures to contend with.
 
“Unfortunately, when you get put in that situation, you can make rash, impulse decisions”, says Andy Eadon.
 
“I know with our son, he had a few things go wrong and something went wrong the morning that he took his life and it was a case of rather than come back and talk to us, he didn’t look around him and took his life.”

Construction focus

BITC’s ‘Reducing the risk of suicide: a toolkit for employers’ highlights the Mates in Mind programme, which was set up because the construction sector has a particular range of factors that are recognised as likely stressors, such as heavy workloads, long working hours, family separation and job insecurity. It’s also an industry dominated by men, who often find it hard to open-up about how they feel.
 
According to an article published in PBC Today in May this year, male construction workers in the UK are almost four times more likely to die by suicide than the national average, with around 700 people a year taking their lives in construction-related suicides.
 
“The construction industry can be very task-orientated; often shaped by the key deliverables around programme, quality and cost,” says Carl Wales, SHE Manager for Wates Smartspace at construction firm Wates Group. “It’s an environment where it can be easy to overlook its people.”
 
Wales is one of PAPYRUS’s volunteers who helps promote the charity and suicide prevention at Wates Group and within other organisations. He is one of many volunteers who support the charity through their lived experience of suicide, whether that is a family member, a friend or a work colleague.
 
After losing his son Rowen to suicide, aged 17, Wales began to share his personal experience and helps promote a “suicide safer community” by raising awareness of suicide risk, support, and training.
 
Sharing his lived experience to help break down the stigma, he promotes open conversation with the business, its customers and supply chain – “anyone that will listen”.
 
“[Vulnerable people] will send out what Applied Suicide Intervention Training (ASIST) calls invitations to talk,” he says.
 
“People may test the water, mentioning suicide jokingly, flippantly or in the third person, trying to understand, ‘Is this person safe to talk to?’ allowing them the option to withdraw from that conversation if they don’t feel safe. That’s why it’s important we ask, ‘Are you having thoughts of suicide?’ if somebody mentions suicide. It could be their invitation to talk.”

Spotting the signs

By helping colleagues to spot the signs, he says we can increase awareness and understanding, helping to identify those struggling. The more people that are trained, the greater the chance there is to catch people and signpost to professional services.
 
“[Suicide] is a way to escape the pain that people feel in that moment in time whether that is work-related, financial or relationships,” Wales argues.
 
“If we can connect with the right person at the right time, maybe we can reframe their thoughts, give them a more optimistic view, take away that negative or self-destructive thought-process, and let them see they are valued and important. A problem shared is a problem halved.
 
“That’s why peer-to-peer support is so important. We know how our colleagues present, so it’s about making sure the peers know enough to feel confident to ask, and, if necessary, signpost to professional support.”
 
Wales recognises, however, that some vulnerable colleagues don’t want to talk, so it’s important to make resources available and support visible. Projects have information leaflets available and contacts on the back of toilet doors so those individuals can privately access helplines.
 
PAPYRUS also employs professional suicide prevention advisers, who are available via a confidential hotline and can refer vulnerable individuals to emergency services if they think the person is at imminent risk of taking their life.
 
In the spirit of creating suicide safer communities, Wates Group also funds two-day ASIST training for members of the local community, supporting suicide prevention within the communities in which they work.
 
“It has always been about having access to resources,” Carl Wales says. “If resources are there, in your face, people can use them. If they are not there, they can’t.”

Employers’ responsibilities

Although there are many reasons why people die by suicide, work can be a significant contributor.
 
Interestingly, research from 2021 suggests that “employee suicides are still largely treated as an individual mental health problem that has no direct relevance for work or the workplace”.
 
According to the WHEC report, France, Japan and the United States all formally recognise a category of work-related suicide. However, this is not the case in the UK, which has “no systematic methods of collating employee suicides within an organisation or workplace”.
 
Despite the absence of a recording system, Mary Lawrence, Partner at Osborne Clarke LLP, points out that Great Britain’s Health and Safety at Work Act etc 1974 does include requirements under Section 2 to ensure the health and safety of employees so far as is reasonably practicable, and this extends to mental health.
 
“Under Section 2, there doesn’t have to be an actual incident or a diagnosis of anxiety and depression, it’s all about creating a risk,” she says.
 
“In theory, enforcement action could be taken where a workplace environment and behaviours are creating the risk of an issue occurring. We are a long way from that in the UK. At some point, there will be a high-profile suicide, potentially a cluster, within a business, which forces the HSE’s hand to investigate under Section 2.”
 
Lawrence says she advises clients to carry out organisational (rather than simply individual) mental health risk assessments, including the consideration of suicide risk and to consider factors and behaviours in a workplace which need to be examined and action plans to put in place.
 
She encourages businesses to consider resources including the HSE’s Stress Management standards, ISO45003 and specific resources like BITC’s toolkit to assist in doing so.
 
As Rivers explains, employers have a major role in mitigating suicide risk and adds that BITC advocates the use of wellbeing action plans, which includes skilling-up line managers so they can identify when employees are showing distress signals.
 
“There should be some education around increasing suicide awareness for everyone, but especially for line managers because they are the pinnacle piece in an organisation and have the most direct interaction with employees,” she says.
 
“[Wellbeing action plans] are a prevention tool that is collaborative and co-created with the individual in question. They can help line managers spot when something isn’t quite right with someone or they might need to check in a little bit more.”

Effective response

Rivers adds it is important that employers also put together a step-by-step plan to support those who have survived a suicide attempt. This includes setting out the support available, how much leave is taken and how it is recorded and the return-to-work process. BITC recommends a phased approach back to work where possible.
 
She also says employers should put together detailed plans if someone does take their own life. This should include the support available to staff who may have worked closely with that person as well as the bereaved family.
 
The impact on parents like Carl Wales and Andy and Lynda Eadon is beyond what most of us can imagine. As the latter points out, however, change is most needed in wider society.
 
“We’ve talked to lots of people who have lost loved ones to suicide and we know that these families are going to be scarred for the rest of their lives,” they said.
 
“For far too long suicide has been cast as a dirty word in British society and quickly swept under the carpet. Nothing will change until society gains the ability to open honest conversations about how people really feel and the impact of someone taking their life. We all need to gain the confidence to start a conversation regarding the subject of suicide and when we enter a conversation, it has the ability to save a life.
 
“Usually, if you ask anybody who they look after daily, they will say everyone and everything before they mention themselves. Respect is a mainstay of positive mental health. We all desire it and would hate to lose it, but we find it hard to give ourselves respect. Everyone needs to realise they have their own unique personality and given a chance can brighten up the darkest of rooms.
 
“If we all stop and look around at the people who have shaped our lives and care about us, we would realise that they cannot manage without you in their lives. Open and honest conversations about positive mental health can keep families and communities together.”

Practical, confidential suicide prevention help and advice

• PAPYRUS HOPELINE 247 – 0800 068 4141, text 88247 or email: [email protected]
• Samaritans 116 123
• Shout 85258 – 24/7 text line 

Nick Warburton is a highly experienced freelance journalist, editor and researcher. He is a former acting editor of IOSH magazine and a former editor of SHP magazine.