This essay is going to explore the contemporary issue of suicide in adult males. I will be using epidemiology to justify this; epidemiology is the study of the determinants and distribution of population diseases. It is the key quantitative discipline that supports public health, this is often defined as the efforts taken to prevent disease and promote health by society (Cambridge University, 2010). Within this essay, the Joint Strategic Needs Assessment (JSNA) and the Clinical Commissioning Process (CCG’s) will be used to gain an understanding of whether suicide prevention campaigns are advantageous or disadvantageous in reducing suicide rates. This assignment will discuss and debate policies that are local, national and international levels to give a greater insight of how much of a public health issue suicide really is. The essay will include a public health campaign. There are many campaigns set up to reduce the number of adult males committing suicide but this essay will focus on one campaign only. The effectiveness of disease prevention, health protection and prevention methods of this campaign will be discussed and evaluated. This assignment will use public health framework to explore the effectiveness of the chosen campaign. The framework is used to appraise the effectiveness of the vision they have to ensure they maintain and enhance health. National policies will be looked into to see how the chosen campaign reflects these and within the World Health Organisation’s (WHO) health 2020 framework.
Public health manages the services and the activities that are in place to improve the standard of health in the overall population (Collins Dictionary). Suicide in adult males is a large public health issue, the statistics evidence this. According to the Office for National Statistics, males are continuing to account for three-quarters of deaths that are caused by suicide in the United Kingdom. The definition of suicide is when a person takes their own life intentionally (Collins Dictionary). The world health organisation states that people commit suicide in many different ways, an estimated 20% of global suicides are due to self-poisoning using pesticides, these mostly occur in rural agricultural areas of countries that have a high density of the population on low or medium incomes. Suicide is a public health issue as the rise in numbers is becoming critical. It has been known for many years that inequality and gender issues have led to suicide, this is particularly prevalent in middle-aged men (aged 45-49) in communities that are disadvantaged. Despite being aware of this there is still no comprehensive, cross-departmental government workplan that gives clear actions of how to reach the two-thirds of people who die by suicide, and who are not in touch with any mental health services (Samaritans, 2018).
As the statistics show more males than females commit suicide, The Samaritans looked at six main trends that may lead to suicide one of the trends is relationship breakdowns are more likely to lead men rather than women to suicide. Another trend is personality traits that can react with contributing factors that may lead a male to suicide, these factors are unemployment, deprivation, social disconnection. There are also triggers such as losing a job. Masculinity is another trend as men are more likely to turn to drugs and alcohol than women are to deal with their problems (The Samaritans, 2019). A main reason as to why more males commit suicide is men are less willing to talk about their feelings, they won’t express or show suicidal feelings. Therefore, they suffer alone (The British Psychological society, 2018). Suicide is an increased risk with people that have been diagnosed with a mental health problem as there may be an increase in suicidal thoughts or behaviours. A behaviour could be self-harming, the majority of people that self-harm do not wish to die the risk or attempting or completing suicide is increased (Mental Health Foundation, 2019). Although there are many methods of committing suicide, 4.4% of suicides take place on the railway. In 2018/19 279 fatalities on the UK railways were suicides or suspected suicides (Network Rail, 2019).
Dahlgren and Whitehead's model of health determinants describes an approach to health that is social ecological. This is done by linking an individual with the environment and also the disease. The individual is placed in the centre and the influences then change the structure to suite each individual. Layer one is the ways of living such as whether an individual is unemployed, this can either promote or damage health. Layer two is social and community influences that can be had on an individual, these again can promote or damage health. The final layer includes an individual’s lifestyle factors such as; access to services and facilities and their housing situation (Dahlgren and Whitehead, 1991). By modifying this framework to an individual it can be used to see the link between the health inequalities and suicide. The definition of health is a state of complete social, mental and physical well-being. Health refers to not only the absence of disease but physical and mental weakness too (WHO, 2019).
Public health is about protecting people from threats to their health and keeping them healthy. Public health activities can sometimes help individuals or other times the activities are aimed at helping larger groups of people such as ethnic groups, certain age groups and countries. The National Health Service (NHS) has three main domains, these are protecting people’s health from things like environmental threats. The second domain is health improvement by helping people stop drug using for example. The third domain is by ensuring that England’s public health services are the most efficient, effective and accessible equally (NHS, 2019).
Public health England exists because it was established on 1st April, 2013 to protect and improve the health and well-being of the nation, it also reduces the number of inequalities in health. This was done by bringing together public health specialists from more than seventy organisations and putting them all into one public health service. Public Health England is responsible for making the public healthier and reducing the number of health differences between different groups. This is done by promoting healthier lifestyles, giving advice to the government and supporting local government, the NHS and actions from the public. Public health England is there to protect the public from health hazards, prepare for any public health emergencies and to respond to them. By collecting information such as research, collecting and analysing data Public health England are able to improve their understanding of public health and can therefore come up with answers to any public health problems. Public Health England works alongside national and international professionals to help provide the government, NHS and the public with evidence-based support which is scientific and professional. Public health England is currently supporting the cross-governmental strategy that is in place for suicide prevention by creating resources for healthcare professionals and local authorities. This is to help them to understand and be able to prevent suicides in their areas. Public Health England work hand in hand with the National Suicide Prevention Alliance (NSPA), this is an England wide coalition which is committed to reducing the number of suicides in the country and improving help for those affected by suicide in any way (Public Health England, 2019).
Public Health England has a framework of outcomes, this is a vision aimed on the health of the public. The framework has two main outcomes, the first one is increasing health expectancy and the second is reduce differences between communities and people with different backgrounds (Public Health England, 2019). The government has a public health strategy, this is called Healthy Lives Healthy People. The White Paper outlines the government’s commitment to protecting the public from any health threats that are serious, it is also in place to help people live for longer, healthier and have more fulfilling lives. Health of the poorest and fastest will also be improving (HM Government, 2010). In November 2008 Professor Sir Michael Marmot was asked to chair a review that was independent and would propose the best evidence-based strategies for reducing the number of health inequalities in England 210. Marmot produced a strategy called Fair Society Healthy Lives’. Within this strategy Marmot states that life expectancy has gaps of up to 7 years between the richest and the poorest communities (Marmot, M, 2010). The local governments and communities have agreed to address issues to help prevent these avoidable inequalities to improve the heath of the overall population (Public Health England, 2019).
In 2012 the health and social care 2012 act was put into place and introduced the first ever legal duties regarding health inequalities. Health bodies including Public Health England, The Department of Health, Clinical Commissioning Groups (CCG’s) and NHS England were given specific duties, these require the bodies to consciously consider reducing health inequalities within the people of England. The act also made changes for local authorities on public health functions (Health and (social Care Act, 2012). The healthy people, healthy lives and the our health and well-being today policies are two policies that pull together and contribute to The Health and Social care Act, 2012). Both of these policies recognise that a person’s health isn’t just the presence of disease or illness but how well an individual actually is. The policies take the input from the public to be able to understand potential threats to health and identify ways to identify approaches that provide health services that will meet the needs of the public (Department of health, (2010).
Clinical Commissioning Group’s were put in place as part of the Health and social care act 2012. The CCG’s replaced primary care trusts on 1st April 2013. Groups of general practices (GP’s) come together to form CCG’s and they commission the best services for the population and their patients. CCG’s purchases services from their local community from any provider of service that meets the standards of the NHS and costs. Examples of these are NHS hospitals, voluntary organisations or private sector providers. This is done to provide better care for patients that is designed with knowledge of the local services and has been commissioned to the response of their needs. CCGs are responsible for about 60% of the NHS budget, a wide range of services are commissioned by CCGs these include mental health services, emergency care and community care (NHS, 2019).
The Joint Strategic Needs Assessment (JNSA) states that 1-12% of all suicides take place intentionally by collision with a train and that 94% of attempts have resulted in death (JSNA, 5.1.3). There is evidence to say that some prevention methods will work on railways for example, suicide pits and restricting access to the track by using sliding door (JSNA, 5.1.4). Other prevention and protection methods have been put in place by railways, one of these is Gatekeeper training, this teaches specific groups of people to be able to recognise people that may be high-risk of suicide and then refer them for treatment. This can be aimed at family members, community members as well as professionals in health and social care. This method has already been identified as a successful prevention method for suicide. Small Talk Saves lives trains the public to become gatekeepers so therefore the campaign is advantaged by the JNSA.
In 2016 there were more male suicides than there were female suicides, this is backed up by WHO data. The data shows that the international Male:Female ratio of age-standardized suicide rates was 1.8 per 100,000 people (WHO, 2017). In the United Kingdom there was a recorded 15.5 male suicides per 100,000 people in 2017, 24.8 deaths per 100,000 were males aged between 45 to 49 (Office for national statistics, 2017). In 2018 these figures increased even more. This is why the Small Talk Saves Lives bystander campaign was initiated. This campaign was set up by the rail industry which is working in partnership with The Samaritans and The British transport police. The campaign was first launched in November 2017, to date there has been no other campaign like this (Network rail, 2017). Small Talk Saves lives was put in place to empower the public to help prevent suicide on the railway’s and in other environments. Suicidal thoughts can be interrupted by a simple observation or question, they are usually temporary. This means that suicide is preventable. Small Talk Saves lives aims to give bystanders the skills to recognise a person when they are vulnerable and at risk of suicide and give them the confidence to approach them. It is a reminder to those who know how to start a conversation that they can be confident enough to approach and help a person in need (The Samaritans, 2019).