Suicide: the current data The role of work and employment in suicidal death Prof. Craig Jackson

1. Suicide: the current data The role of work and employment in suicidal death Prof. Craig Jackson Professor of Workplace Health Psychology Birmingham City University

2. Worldwide attitudes . . . Suicidal death just another outcome

3. Our own attitudes . . .

4. Worldwide Epidemiology 1 million suicide deaths / year 10-20 million attempts / year 50% of first time attempts fail 23X more likely to die from suicide if tried previously

5. Emerging issues Copycat Suicides Norway press ban Reduced copycat suicides Over-reporting Emotive, simplistic, gender-biased Social Networking Smaller world, greater individual influences

6. UK Adult Suicidal death: age-standardised rates

7. Mostly a White Male Problem

8. Over-simplified theories • Following are all common to suicide & attempts (Beautrais, 2001): • current mood disorder • previous suicide attempts • prior outpatient psychiatric treatment* • admission to psychiatric hospital within the previous year • low income • absence of educational qualifications • recent stressful events (legal, work-related life events) • never married* • No more advanced than Durkheim (1897)

9. Recession & Suicide Recession can be linked with rises in suicide - Japan 1997 WHO suicide data Suicide increases in UK, Canada & USA since 2007 EU rose by 6.5% by 2009Canada rose by 4.5% by 2009 USA rose by 4.8% by 2009 Reeves, McKee & Stuckler (2014)

10. Recession & Suicide 10,000 additional suicides per year in western countries “Marked differences” in suicide rates across countries affected by the same recession Therefore in theory, increased suicides during an economic crisis are 'avoidable'. Biggest risk factors for suicide are in recessions: 1. job loss 2. home repossession 3. debt Reeves, McKee & Stuckler (2014)

11. A Complex End-Stage Behaviour • Death becomes preferable to life

12. Suicide case: WPC Paula Tomlinson • Armed response officer, aged 37 • One of first female snipers in UK • 90-strong team (88 males) • Hanged at home 2004 • 2003 Dismissed from firearms duties • Complained: • Colleagues viewing porn video on a residential course • Felt victimised in macho culture of firearms unit • Fell out with a number of influential male colleagues • Sefton Coroner Christopher Sumner: “Paula Tomlinson killed herself at a time that she was suffering from stress, a contributory factor of which was work related.”

13. Suicide Data • Flawed at source e.g. coronal decisions; occupational classifications • Contradictory • Often Counterintuitive / Sometimes Intuitive • Changes continuously • Varies across cultures e.g. UK & US Farmers; UK rates vs US rates • Changes by each large-scale review of the data • Relationship twixt Suicide and Occupation is complex

14. Some Consistencies in Suicide Data #1 • Males represent 75% of suicide completions • Methods differ between sexes • Low pay & low job security increases suicide risk • Controlling for income and employment levels reduces risk in different jobs (Agerbo et al 2007) • Higher risk people may choose certain occupations • Elevated suicide risk in publicans (Kelly & Bunting 1998) • Knowledge of suicide methods increases risk • Access to lethal means increases suicide risk

15. Some Consistencies in Suicide Data #2 • Males 45-65 are at greatest risk of suicide • Divorcees are at greater risk • Living in a socially poorer areas is a risk factor • Suicide declining now (after 2007-2013 rise for males) • Prurient reporting of suicides increases suicide numbers • e.g. Norwegian press restraint • Single biggest killer of under 50s

16. Hanging Most common method in UK Majority in homes / gardens Minority in prisons & psychiatric hospitals Rope / cord most common ligature 47% did not achieve full suspension Oxford study (2009)

17. Firearms Shotguns used in 75% cases of firearm suicides Minority had contact with psychiatric services Small percentage had a history of previous self harm Sports & Work were main reasons for gun ownership Oxford study (2009)

18. Coproxamol More than 40% of individuals were aged 55+ years Almost half had a history of self harm Alcohol used in more than half the overdoses: alcohol use = fewer tablets needed Coproxamol was less often prescribed for younger than older cases Death occurred in most cases before the individual could reach hospital. Oxford study (2009)

19. Other poisonings Pesticides, herbicides, drain cleaners, other prescription meds 25% who died from overdose reached hospital alive Paramedics assisted in nearly 75% of cases Half the cases had a history of self harm Oxford study (2009)

20. Contradictions in Suicide Data - Sex • Samaritans (2012)

21. Compiled by the Psychiatric Foundation of Northern California, based on 213 suicide reports kept by Marin county coroner’s office from 1995 to 2005. The Golden Gate Bridge • 55.4% • of jumpers were never married • 39% • of jumpers were under psychiatric care • 81.8% • of male jumpers were white; • 11.3% Asian; 4.4% Black; 2.5% Latino • 84.9% • of female jumpers were white; • 3.8% Asian; 3.8% Black; 3.8% Latino; 3.8% Mixed races • 75% • of jumpers were male • 25% • of jumpers were female

24. France Telecom Case Privatised in 1998 40,000 jobs lost since 1998 186,000 employees 45% of those outside France 4.3% fall in profits in 1Q of 2009 182 million customers in 5 continents

25. France Telecom Internationale' 45% of customers outside France 182 million customers in 5 continents

26. France Telecom Suicides • 30 staff committed suicide 2008-2009 • 23 staff committed suicide 2010 • French suicide rate: • 26.4 per 100,000 male pop • 9.2 per 100,000 female pop • 17.8 per 100,000 all pop

27. France Telecom Staff Situation Uncertainty New working conditions Modernisation Internal job transfers - Japanese problem Cultural & organisational changes needed

28. France Telecom Cases 9thSept: 49 yr old male employee stabbed himself in meeting – told he would be undergoing internal job transfer 11th Sep: 32 yr old female employee leapt to death from office window 14th Sep: 53 yr old senior manager overdosed 1st Oct: 51yr old male employee jumped from road bridge – note blamed work “atmosphere”

29. France Telecom's 2 Point Defence “There were 28 suicides in the company in 2000, so 23 suicides over 17 months is actually an improvement and not evidence of an epidemic” “Most suicides caused by personal problems not professional ones”

30. France Telecom "Solution" Oct 2009 Deputy CEO Louis-Pierre Wenes resigned CEO Didier Lombard – vowed to end the “Spiral of death” Phone helpline Counselling Suspending job transfers French Labour Minister, Xavier Darcos wants: 2,500 biggest companies to plan “anti-stress” strategies Planned with Unions Govt has 27% stake in FT Health & Happiness now on “National Agenda” in France

31. Proportion of suicides by method and sex Vets Farmers Dentists Pharmacists Doctors Nurses Cops Lethal means Isolation Privacy Absence of help “Suicide Window”

32. Suicide Space • Access to lethal means • Opportunity for solitude • Only resort available (perceived) • Lack of support (perceived) • Location away from assistance • Vengeance / Protest / Masculinity • Death preferable to life

33. Job Specific Factors in Suicide • Vets and Farmers • Functional use of euthanasia • Facilitate a “Good death” • Long working hours • Rural isolation • Client dependence • Social isolation • Not adapting to change / flux • Attitudes to suicide and (non) help-seeing behaviour • This may serve to make suicide seem like a plausible solution to problems • Jobs with “Gallows Humour” – uniformed services

34. Job Specific Factors in Suicide • Oil & Gas Upstream • Long working hours • Isolation / Social isolation • Periods away from home • Support system removed • Medication deficits • Geo dependence • Difficulty adapting / culture shock • Gallows / Dark humour • Expectation to be hardy • Pre-existing psychiatric problems • Attitudes to suicide and (non) help-seeing behaviour • May make suicide seem like a plausible solution to problems

35. Behavioural Yellow Flags in Suicide • Observable in 75% of decedents in few weeks before death • Previous suicide attempts • History of suicide in family • Begin “tidying up” affairs • Foreshortening • Person acting completely out of character • Symptoms of depression • Hopelessness about the future • Periods of difficulty and change – holiday periods, prior to disciplinary hearings

36. Workplace Aftermath of Suicide Traumatic for surviving staff Even if not Workplace Suicide Guilt over what could have been done Some workers experience depression and consider suicide more Grief counselling offered for those who want it (post-vention) Let individual worker decide about post-vention The need for Workplaces to Develop (i) Suicide Prevention and (ii) Aftermath Policies

37. Male suicides by occupation group (England 2011-2015) 10,688 male suicidal deaths with known occupation (ONS, 2017) 81% of the 13,232 suicides with known occupations

38. Male suicides by low-skill elementary jobs (England 2011-2015) 10,688 male suicidal deaths with known occupation (ONS, 2017) 81% of the 13,232 suicides with known occupations

39. Female suicides by occupation group (England 2011-2015) 2,544 female suicidal deaths with known occupation (ONS, 2017) 19% of the 13,232 suicides with known occupations

40. Current Suicide-Occupation Position in England

44. A Crisis of Meaninglessness • Is it about mental health? • More treatment • More “talking about it” • More openness • Do workers have meaningful lives & work? • Relationships • Purpose • Meaning • Worthwhile • Valued • Family + Religion + Politics + Society all declining

45. If Suicide becomes the norm • Suicide “tourism” • Human rights • Failure to prosecute 120 Dignitasaccomplices on return to UK • Law will change probably (Lord Carlisle & Baroness Finlay) • What will happen to a generation of Dignitas workers? • The Vet effect (Melanby 2005)

46. References Etzersdorfer, E., L. Vijayakumar, W. Schöny, A. Grausgruber and G. Sonneck (1998). Attitudes towards suicide among medical students: comparison between Madras (India) and Vienna (Austria). Social Psychiatry and Psychiatric Epidemiology. 33. 3. 104-110. Gibb, B. E., M. S. Andover and S. R. Beach (2006). Suicidal ideation and attitudes toward suicide. Suicide & Life-Threatening Behavior. 36. 1. 12-8. Hawton, K and van Heeringen, K (eds). (2000). The International Handbook of Suicide and Attempted Suicide.Chichester, Wiley. Jackson CA. (2008) Work-Related Suicide. Management of Health Risks. 126: 2-8. Karasek, R. and T. Theorell (1990). Healthy work: stress, productivity, and the reconstruction of working life. New York, Basic Books.

47. References Karasek, R. A. (1979). Job demands, job decision latitude and mental strain: implications for job design. Administrative Science Quarterley. 24. 285-308. Mellanby, R. J. (2005). Incidence of suicide in the veterinary profession in England and Wales. Veterinary Record. 157. 14. 415-7. Reeves A, McKee M, Stuckler D.(2014) Economic suicides in the Great Recession in Europe and North America. The British Journal of Psychiatry. 205(3) 246-247. Sawyer, D. and J. Sobal (1987). Public Attitudes Toward Suicide Demographic and Ideological Correlates. The Public Opinion Quarterly. 51. 1. 92-101. Siegrist, J. (1996). Adverse health effects of high-effort/low-reward conditions. Journal of Occupational Health Psychology. 1. 27-41. Stack, S. (2001). Occupation and Suicide. Social Science Quarterly (Blackwell Publishing Limited) 82. 2. 384.

48. References Stansfeld, S., R. Fuhrer, M. Shipley and M. Marmot (2002). Psychological distress as a risk factor for coronary heart disease in the Whitehall II Study. International Journal of Epidemiology 31. 248-255. Stansfeld, S. A., R. Fuhrer, J. Head, J. Ferrie and M. Shipley (1997). Work and psychiatric disorder in the Whitehall II Study. Journal of Psychosomatic Research. 43. 1. 73-81. Vilhjalmsson, R., E. Sveinbjarnardottir and G. Kristjansdottir (1998). Factors associated with suicide ideation in adults. Social Psychiatry and Psychiatric Epidemiology. 33. 3. 97-103. Wasserman D, Wasserman C. Oxford Textbook of Suicidology and Suicide Prevention (2009). OUP. Oxford.