Tuesday, 5 July 2011

Suicide, murder and alcohol: Minister Poots fails to address issue in new report

The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Northern Ireland was published by the University of Manchester in June, focussing on evidence of deaths by murder or suicide by people with mental illness in the British Isles, and Northern Ireland in particular.  It makes tragic reading, draws a clear link between alcohol and the deaths, and highlights (again) the need for government to heed the recommendations in their overall alcohol strategy. 


NI Health Minister Edwin Poots

As NI Minister for Health Edwin Poots describes it in his introduction,
"Covering a nine year period from January 2000 to December 2008 during which there were 1,865 suicides and probable suicides in Northern Ireland, (and 15% of homicides committed by people who have been in contact with mental health services) the report presents detailed data that looks behind the headline statistics. By presenting a better understanding of these deaths, the report will assist in fine tuning policy and practice for the care of people within mental health services and help to prevent deaths".
The report analyses data from mental health and criminal justice bodies and provides further evidence of the strong link between alcohol misuse and mental illness, strong evidence of a link between alcohol and homicide, and conclusive evidence of a link between alcohol use and suicide in particular.  Of those who killed an acquaintance in NI, for example, 67% had a history of mental illness, but 91% were alcohol abusers and 97% had a history of alcohol and/or drug dependence.  Amongst those receiving treatment for mental illness, alcohol misuse in particular was a common feature of patient suicides featuring in 60% of cases, and had become more common over the nine year period of the report.

The report gives clear recommendations.  Chief amongst them are the need for 'reducing alcohol misuse and dependence' which 'should be seen as a key step towards reducing the risk of suicide and homicide, requiring a broad public health approach including health education and alcohol pricing. Mental health services should ensure that they have full availability of services for alcohol and drug misuse, including dual diagnosis services'.

All very straight forward, but let down by the simple fact that Minister Poots' own introduction fails to mention the word alcohol at all, despite the 91% co-incidence between alcohol and homicide in the report. The reports author Professor Louis Appleby, interviewed by the BBC on 29th June said: "Of all the patients who died by suicide, 60% were thought to be misusing alcohol by their doctors. About half of these were alcohol dependent."  Dr Uzma Huda, Vice Chair of the Royal College of Psychiatrists in Northern Ireland, calling for a minimum pricing for alcohol, said: "We can no longer afford to ignore the growing trend linking alcohol and suicide, particularly in young people."  Yet on UTV the Minister discussed the report and focussed only on 'deprivation', which the report itself found to be co-related with suicide but only amongst young males in data from 2005.  Correspondingly Poots again neglected to mention the greater problem of alcohol at all .

Commenting on the issue David Keating of the Mental Health Nurses Association makes the same point, writing that:
"Edwin Poots has responded by confirming that funding for suicide prevention will be safeguarded.   This is a welcome reassurance but what is the position regarding alcohol services?  Currently, the Health and Social Care Board are consulting on Tier 4 in-patient addiction units. The indications from consultations are a closure of units or wards with only three in-patient residential facilities as the preferred option, covering all of Northern Ireland.  This will affect the addiction wards in Downshire, Holywell, St Luke’s, and the Tyrone and Fermanagh hospitals but also have implication for Cuan Mhuire in Newry, Carlisle House, Belfast, and Northlands in Derry".
This lack of joined up thinking is echoed by Order Grand Secretary Drew Nelson interviewd on BBC news yesterday (4th July).  Mr Nelson said he felt social policy regarding the regulation of the sale of alcohol in Northern Ireland had been a "massive failure over the last 20 years". "There are far more people obtaining their alcohol from supermarkets and the problem there is when it comes to consumption, there is no regulation," he added. "I hear stories in towns of taxis going to off-licences and getting alcohol and delivering it to teenagers and there must be older people going into the off-licences and getting it for them so this is a problem for society." Mr Nelson said the drinking problem was "absolutely massive", but the order wanted to play its part in tackling it.

The conclusion is simple, as David Keating writes.  '"The health minister in June 2010 estimated that alcohol abuse costs £240 million in health and social care alone, in Northern Ireland annually (population 1.2 million).  If the minister wants to reduce the rate of suicide, he must demonstrate commitment to develop alcohol services, both community and residential, and not close in-patient units''.


Government alcohol strategy takes off

Its not a lack of evidence or advice that is lacking, it is a lack of political will.

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