Suicide and Self-Harm

This topic area covers statistics and information relating to suicide and self-harm in Hull including local strategic need and service provision. Other information relating to Mental Ill Health can be found within Vulnerable Groups, and information relating to Mental Health and Emotional Wellbeing can be found within Health Factors under Adults and under Children and Young People.

This page contains information from the Office for Health Improvement & Disparities’ Fingertips. Information is taken ‘live’ from the site so uses the latest available data from Fingertips and displays it on this page. As a result, some comments on this page may relate to an earlier period of time until this page is next updated (see review dates at the end of this page).

The Office for National Statistics ‘back-date’ their recent estimates of the resident population once more accurate Census data becomes available. Their revised estimates are due to be released in November 2023. In the meantime, the Office for Health Improvement & Disparities have removed their trend data which relied on resident population estimates from Fingertips (affecting hospital admissions due to self-harm), and it will be added back in sometime after November 2023 (no date has been given). Some of the statements on our website pages have been retained with the comments relating to the trend data when it was shown on Fingertips even though the trend data is not shown, and the actual values will change (in most cases slightly) once the calculations are redone using the new backdated population estimates.

Headlines

• There were 450 emergency hospital admissions for intentional self-harm in 2021/22 in Hull which was similar to England (164.4 versus 163.9 admissions per 100,000 population).
• Suicide is the biggest killer of men under the age of 45 in the UK. Every suicide has a huge impact on the person’s family, friends, local community and work colleagues.
• There were 90 deaths from suicide and undetermined intent which were registered over the three year period 2019-21 in Hull (71 men and 19 women).
• The mortality rate from suicide and undetermined injury is statistically significantly higher in Hull compared to England, and around 27% higher than England (31% higher for men and 8% higher for women).
• There is considerable year-on-year variability, but the mortality rate has been steadily increasing in Hull in recent years since 2013-15. For deaths registered during 2013-15 the mortality rate was 12.2 per 100,000 population and increased to 14.8 per 100,000 population for 2017-19. The rate decreased to 13.5 per 100,000 population for 2018-20 and further decreased to 13.2 per 100,000 population for 2019-21.
• Reviews of local Coroner’s records have found 131 cases of suicide registered over the four years 2016-2019 for Hull residents, with a gender split of 79% male: 21% female. The most at risk age group in Hull is 35-49 years (37% of all cases), followed by 20-34 years (31% of cases) and then 50-64 years (20%).
• Isolation and worklessness are common features – 77% of Hull cases were single, divorced, separated or widowed; 50% lived alone and 58% were retired or not employed at the time of death.
• Suicide is complex and there are many contributing factors. However, the key risk factors found in the Hull cases are mental health problems, previous suicide attempts and/or self-harm, substance use, relationship/family problems, alcohol use, poor physical health, work problems, debt/financial problems, criminal justice issues and housing issues.
• Suicide is preventable and it is everybody’s business to be aware of risk factors and how to offer support to those at risk.

The Population Affected – Why Is It Important?

The Office of National Statistics released the most up to date data on suicides in England and Wales on 6 September 2022. In 2021, there were 5,583 suicides registered in England and Wales, equivalent to an age-standardised mortality rate of 10.7 deaths per 100,000 people; while this was statistically significantly higher than the 2020 rate of 10.0 deaths per 100,000 people, it was consistent with the pre-coronavirus (COVID-19) pandemic rates in 2019 and 2018.

The fall in the suicide rate in 2020 was likely to have been driven by a decrease in male suicides at the start of the coronavirus pandemic, and delays in death registrations because of the pandemic.

The latest figures include deaths that occurred in 2020 and were subsequently registered in 2021 owing to disruption to coroners’ inquests; this provides evidence that the suicide rate did not increase because of the coronavirus pandemic.

Around three-quarters of suicides were males (4,129 deaths; 74.0%), consistent with long-term trends, and equivalent to 16.0 deaths per 100,000, the rate for females was 5.5 deaths per 100,000.

Among females, the age-specific suicide rate was highest in those aged 45 to 49 years (7.8 deaths per 100,000), while among males it was highest in those aged 50 to 54 years (22.7 deaths per 100,000).

Females aged 24 years or under have seen the largest increase in the suicide rate since our time series began in 1981.

The impact of suicide on the person’s family, friends, local community and work colleagues is huge. It is estimated that each suicide further impacts up to 135 other people such as family, friends and colleagues. Losing someone through suicide can cause reactions and emotions that are different to those felt after death from illness, accident or natural causes. ‘The grieving process is characterised by questioning and a search for an explanation. Suicide is still a stigmatised topic, which can reinforce feelings of shame and stigma in the bereaved, and make the person feel worse and more isolated’, says Prof Keith Hawton from the Centre for Suicide Research, Oxford. In addition there is an increased risk of suicide, depression and admission to psychiatric care among those bereaved by suicide.

However suicide is a preventable rather than an inevitable event. Effective and evidence-based interventions can be implemented at population, sub-population and individual levels to prevent suicide and suicide attempts. 

Suicide prevention is everybody’s business.

A suicidal person may not ask for help, but that doesn’t mean that help isn’t wanted. Most people who take their own lives don’t want to die – they just want to stop hurting. Suicide prevention starts with recognising the warning signs and taking them seriously.

Sudden unexplained deaths are investigated to establish the cause of death, and in England this is undertaken by a coroner through in inquest. Sometimes it is difficult to establish whether the cause death was suicide as sometimes it is not clear if there was intent or whether the death was due to an accident. In England in 2018, the criteria to determine if the death was suicide was lowered from “beyond reasonable doubt” to “the balance of probabilities”. However, there can be differences between coroner verdicts, and as there is still stigma associated with suicide deaths it is possible that some deaths are not classified as suicides particularly if there are religious taboos around suicide or the death involved a child. As a consequence, deaths from ‘undetermined intent’ are included within the definition of suicide deaths.

Deaths occurring in England not requiring a coroner’s involvement need to be registered within five days, but there will be delays in registering a death for suicides as an inquest is necessary, and it can be several months before a suicide or deaths from ‘undetermined intent’ is registered. As a result, national suicide statistics are reported based on the year of the death registration rather than the year of the death.

The Hull Picture

Self-Harm

The Office for Health Improvement & Disparities’ Fingertips provides information relating to hospital admissions for intentional self-harm, and shows that the directly age standardised admission rate per 100,000 population is statistically similar in Hull compared to England for 2021/22 for all ages (emergency admissions), but lower among those aged 10-24 years (all admissions).

The rate is given as the number of admissions per 100,000 population and patients can be included more than once within the financial year if they are admitted for self-harm on more than one occasion during the year (admitted as an emergency for all ages).

The emergency admission rate for self-harm in Hull has fallen between 2013/14 and 2020/21 for all ages at a relatively consistent rate of decrease. In the year 2020/21, there were 570 emergency admissions for self-harm among Hull residents and in 2021/22 there were 450. Whilst Hull’s rate has been statistically significantly higher than England, in 2021/22 following continued decreases, the rate is now statistically similar to that in England.

For those aged 10-24 years, but there is considerable year-on-year variability in the admission rate for self-harm. For 2020/21, there were a total of 185 hospital admissions for intentional self-harm in Hull among young people aged 10-24 years and in 2021/22 there were 155 admissions.

The rate of admission for self-harm among people of all ages relates to emergency admission whereas the rate among young people aged 10-24 years relates to all types of admission not just emergency admissions, so the definitions are not the same. If the number of non-emergency admissions are small, then this would suggest that around one-third of admissions for self-harm are among those aged 10-24 years.

Suicides and Undetermined Injury

The Office for Health Improvement & Disparities’ Fingertips presents information on the directly age standardised mortality rate from suicide (10+ years) and undetermined intent (15+ years) among those aged 10+ years. Rates are given as deaths registered within the specified years per 100,000 population standardised to the European Standard Population.

For deaths registered over the three years 2019-21, the mortality rate from suicide and undetermined intent in Hull was significantly higher than England with the rate being around 27% higher in Hull compared to England for both men and women. The mortality rate for men was almost four times higher among Hull men compared to Hull women (20.9 versus 5.6 per 100,00 population).

For men and women combined, the mortality rate from suicide and undetermined intent in Hull has ranged from 11.3 per 100,000 population to 14.8 per 100,000 population for deaths registered between 2001-03 and 2019-21. There had been a steady increase in the rate between 2013-15 and 2017-19 in Hull, but the rate in Hull has fallen the last two years. Since 2013-15, the rates across England and the Yorkshire and Humber region have also increased although the rate for both remained the same between 2018-20 and 2019-21.

Over the three year period 2019-21, there were 90 deaths that were registered which were classified as suicides or deaths from undetermined intent among Hull residents (71 males and 19 females).

As three-quarters of deaths from suicide and undetermined intent are among men, the trends over time in men followed a similar pattern to the trend noted for men and women combined, although there was a slight increase in the rate in Hull between 2018-20 and 2019-21.

The trend for women also followed a similar pattern, although the rate was in 2017-19 was the highest it had been in Hull since 2004-06, but increased quite sharply over the two years prior to that. The latest rate (for 2019-21) at 5.6 per 100,000 women is among the lowest it has been in the last six years and among the lowest it has been since 2001-03 (with only four years having lower rates).

Local Suicide Audits

There are ongoing audits of local suicide deaths with the intention of learning lessons and reducing future risk. Recent annual reviews of suicide deaths among Hull residents from the Hull and East Riding Coroner’s data, have shown the following findings:

• From 2016 to 2019, 131 suicides were registered by the Coroner for Hull residents. Numbers have been reducing for the last 3 years but have increased again in 2019.
• The gender split was 79% : 21% (103/28) male / female (national gender split 75% : 25%, so Hull men, relative to females, are slightly more at risk than nationally).
• There was a wide age range 14-96 years; the most at risk age group is 35-49 years (37% of all cases), followed by 20-34 years (31% of cases) and then 50-64 years (20%) with 9% of cases aged over 65 years.  
• A total of 15 suicide cases in people 25 years and under were registered between 2016 and 2019.
• Hanging (59%) at home is the most common method, exactly consistent with the national picture. This continues to pose a great challenge to suicide reduction measures.
• For deaths occurring since 2015, the Humber Bridge falls account for 7% of cases. It is 13% if all registered deaths since 2016 are counted which includes historic cases where the actual deaths occurred as far back as 1982.
• The residence of cases shows a  greater concentration in the west of city and an association with greater deprivation.
• Isolation and worklessness are common features – 77% of cases were single, divorced, separated or widowed; 50% lived alone and 58% were retired or not employed at the time of death.

The key risk factors seen in the 91 cases analysed for 2017-19 were:  

• 80% mental health problems, of which 32% were in touch with secondary care mental health services;
• 39% had had previous suicide attempts and/or self-harm;
• 30% had substance treatment needs;
• 28% had relationship/family problems;
• 16% had alcohol treatment needs;
• 16% had poor physical health;
• 15% had work problems;
• 13% had debt/financial problems;
• 12% had criminal justice issues; and
• 5% had housing issues.

Eight in ten of the 91 cases had at least two of these key risk factors.

Strategic Need and Service Provision

Suicide prevention involves a multi-factorial approach as the causes and reasons why people consider taking their own lives are complex. There is an increased risk with male gender, deprivation and poverty, and among those living with mental health problems in particular depression, anxiety and post traumatic stress disorder (PTSD). Unemployment, debt, problems with relationships, drug and alcohol use, child abuse, and a wide range of other factors can have an influence, as is shown in the graph of risk factors below.

There is a requirement for all local authorities to develop and implement a local suicide prevention plan which should include provision for bereaved families (postvention support).

In March 2020 the Hull Mental Health Task and Finish Partnership Group refreshed the multi-agency Emotional Wellbeing and Suicide Prevention Action Plan (EWSPAP) and its associated annual delivery plans. The EWSPAP is structured around 4 domains:

1. Children, Young People and Families.
2. Workplace and Employability.
3. Communities and Citizens.
4. Suicide Prevention.

With 4 cross-cutting themes to capture key activity:

1. Data, Intelligence and Evidence.
2. System Change and Service Development.
3. Communications, Marketing and Media.
4. Training and Workforce Development.

Under the suicide prevention domain in year 1, there are plans to:

• Consult on and roll out a programme of training across organisations and the wider community, including phase two of the Talk Suicide campaign.
• Coordinate a  campaign with Substance Treatment Service clients as a high risk group.
• Have discussions with local print and online media on sensitive approaches in reporting of suicide.
• Pilot and evaluate a Postvention service to support those bereaved by suicide.
• Pilot and evaluate processes for gathering and using real-time data.
• Undertake qualitative research to inform the approach to support people who have self-harmed, understand current provision and benchmark against best practice.

Progress against the EWSPAP and associated annual delivery plans will be regularly reported to the Hull Health and Wellbeing Board.

In 2020, a Real Time Surveillance was introduced in Hull to inform timely follow-up and suicide prevention activities. Before the commencement of the Real Time Surveillance in Hull, we relied on waiting for the coroner’s conclusions and annual suicide audits to drive suicide prevention work, however, there is an emerging argument for shifting effort to collating case information via the Real Time Surveillance processes.

Resources

The Office for Health Improvement & Disparities’ Fingertips: https://fingertips.phe.org.uk

Hull Annual Suicide Reviews

Cerel J, Brown M, Maple M, Singleton M, Van De Venne J, Moore M and Flahert C (2018). How many people are exposed to suicide? Not six. Suicide and Life-Threatening Behaviour. doi:10.1111/sltb.12450. https://pubmed.ncbi.nlm.nih.gov/29512876/

Hull Emotional Wellbeing and Suicide Prevention Action Plan 2020

Online suicide prevention training (Zero Suicide Alliance)

The Journey to Suicide Statistics (Samaritans Video)

https://youtu.be/ycaDkhTCZB0

Updates

This page was last updated / checked on 26 September 2023.

This page is due to be updated / checked in February 2024.