PAPYRUS Newsletter

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PAPYRUS

prevention of young suicide

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CEO Report

prevention of young suicide Welcome to the newsletter of the national charity PAPYRUS.

Spring 2013 no.49 Contact details PAPYRUS Prevention of Young Suicide 67 Bewsey Street Warrington Cheshire WA2 7JQ. Tel: 01925 572 444 Fax: 01925 240 502 email: admin@papyrus-uk.org web: www.papyrus-uk.org For support, practical advice and information concerning suicide prevention call the PAPYRUS helpline:

HOPELineUK 0800 068 41 41 Or text or email us:

SMS: 07786 209697 e-mail: pat@papyrus-uk.org Patrons: Rt Hon David Hanson MP, Rt Hon David Heathcoat-Amory, Simon Hughes MP. Honorary Advisor: Professor Mark Williams – University of Oxford.

This newsletter is available online at www.papyrus-uk.org/NL/49 Back copies of previous newsletters are also on the website.

Please note, the views expressed in this newsletter do not necessarily reflect those of the editorial team or of PAPYRUS as an organisation. Any information contained in this newsletter is intended for guidance only and is not a substitute for professional advice. No responsibility for loss occasioned as a result of any person acting or refraining from acting because of what is written in the newsletter can be accepted by the publisher, authors or the PAPYRUS Trustees.

Registered Charity Number 1070896.

A Company Limited By Guarantee Number 3555482.

COVER: Young people in Kent talk about young suicide prevention with PAPYRUS.

We are ALWAYS looking for people to get involved with PAPYRUS so if there's something you'd like to do to help, please contact PAPYRUS on admin@papyrus-uk.org or on 01925 572 444.

2 PAPYRUS SPRING 2013

Dear Members and friends Winter is ending and spring is in the air.

It has been a busy time here at PAPYRUS. Since our last newsletter we have been able to speak directly to the Minister for Health about our ongoing internet campaign as well as to the Chief Coroner about the Standard of Proof used by coroners to reach a suicide conclusion at inquest. We have also been inducting our new Area Representatives who will help us to reach out to local communities to raise awareness of PAPYRUS. Also, we have been preparing to give our website a makeover, bringing it more in line with social media and building on our engagement over the last few years with followers on Facebook, Twitter, LinkedIn and other communication channels. Our new look will mean that we can interact with you, our members, on issues that are relevant to you in the pursuit of our aims to reduce suicides among young people. Keep an eye out for the new site in the coming months.

Since the last edition, we have tried to

renew our contact with our members and supporters, to renew our commitment and to update our subscriptions lists. I hope you are able to continue to support us and, if you are a member of PAPYRUS, I trust that we continue to speak in your name when campaigning for change and influencing others to do their bit to prevent young suicide.

The recent ONS publication of UK suicide rates in 2011 suggests that there is no room for us to be complacent about the prevalence of young suicide in the UK. Further, it does not show the scale of suicidal behaviours that do not result in death. By working in schools, colleges and community organisations this year, we continue to share a message that young people deserve to be listened to and taken seriously, especially when they are having thoughts of suicide.

On our helpline, HOPELineUK, and through our text and email services we know that many young people across the UK are battling with suicidal thoughts and seeking help. For many parents,

Out&about ● The Suicide Prevention Team has continued to reach out into our communities to provide training and raising awareness in a variety of settings, including universities. We provided two one-day workshops at London South Bank University in suicide prevention, to help raise awareness amongst all staff groups. At Warwick University, we presented a workshop for students as part of their Mental Health Week and at Oxford University, as part of their Mind Your Head Campaign with Student Run Self Help (SRSH), we were invited as a guest speaker to students and university staff. We also held a stall at the Wellbeing Event at Edge Hill University, Ormskirk, which was well attended by staff and helped to raise the profile of the work of PAPYRUS. ● The team has also had contact with young people to raise awareness of suicide and emotional wellbeing in a number of schools and colleges, including Bromley College in Kent where a full day of workshops was delivered to a range of students. Another full day of workshops took place at Warrington Collegiate, including a series of follow-up sessions. Workshops

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delivered for young offenders in Accrington, were tailored to focus on their particular needs. ● We were pleased to accept an invitation by local radio station, Radio Warrington, to promote and speak about our work and the services we provide. We have worked with organisations including Lancashire CRUSE in Blackburn to deliver awareness of PAPYRUS to that charity’s volunteers, as well as how to effectively help someone who may be at risk of suicide. An invitation to speak at a meeting held by the University Mental Health Advisors Network (UMHAN) provided an excellent opportunity to raise awareness of our services, training packages and how these can be used to benefit students.

Our ASIST courses continue to grow from strength to strength. One workshop was held in conjunction with MIND Cymru to staff from MIND.

t

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Contents family members and friends who worry about vulnerable young people, there is an enduring sense of responsibility and concern.

We have produced two new short films since our last newsletter. Each lasts ‘give or take’ one minute. One, asks viewers to support us with a donation to help to save young lives. The other, Thinking of Ending It All?, promotes help-seeking and directs viewers to our helpline services. I hope you can help us to share these through social media and get more people to know about PAPYRUS. I look forward to seeing you at our annual Conference on 29 June 2013 in Manchester. Details are on our website.

Meantime, thank you for your ongoing interest in and support for PAPYRUS. It really does make the difference.

Warmest wishes GED FLYNN Chief Executive

N THE COMMUNITY

Some of our members have recently been trained as Area Reps (see website for details).

We also provided another workshop in Warrington. ● We continue to attend meetings at the Welsh Assembly Government Suicide Prevention Advisory Group, the All Party Parliamentary Group (Suicide Prevention) at Westminster, Call to Action meetings for Suicide Prevention and represent our members on the UK Government’s National Advisory Group on Suicide Prevention.

Antenatal depression: the risk

5

Suicide verdicts: pressing for change

6

Help for Dyslexic young

8

The impact of homelessness

9 10

Are veterans more at risk?

Looking after a suicidal person is tough

but

what about looking after yourself too?

It’s another day and you anxiously wait for your son to come downstairs from his room for breakfast, hoping he has made it through another night.

This morning has been one of many when you are worrying about keeping mornings since his suicide attempt three someone else safe, but if you can’t look weeks ago. During that time you’ve after your own mental health, you will managed to get him to the GP and he is begin to struggle helping others now waiting for some support from with theirs.

CAMHS. But whilst waiting for CAMHS Try to take time out when you know you’re wondering, what can I do for him? they are with a friend, or at a counselling What should I say? Should I be checking on appointment: somewhere you know they him 24/7? Should I let him out of the aren’t at risk. Use this time to distract house, and the ultimate question, what if yourself from the worries you have and my son attempts to take his life again, and remember what you used to have time for; this time… he dies? an old hobby, spending time with friends to Our HOPELineUK service not only takes catch up or watching your favourite soap on calls from young suicidal people, but also television. Always be aware of the things from parents, friends, family, colleagues and you do that you enjoy, that make you happy people supporting or concerned about a so you can allow yourself to switch off from young person they know. We know the your worries and take some time anxiety you go through, the distress, the for yourself. despair and the difficulty of how hard it can be to see a Your mental health is important too. loved one struggling with suicidal thoughts. We can If you ever feel so low that you experience suicidal thoughts, you help you identify the must seek support for yourself – HOPELineUK is here for you too practical and emotional and can advise you on where. support you can give your You can call HOPELineUK on 0800 068 4141, text us on 07786 loved one but we also 209 697 or email us at pat@papyrus-uk.org know that supporting a vulnerable person can Our team of dedicated suicide prevention professionals can largely impact on your advise, signpost or give you information for you and for any young emotional wellbeing as person you are concerned about. well.

We’re open Monday to Friday from 10am until 5pm and 7 until We strongly encourage 10pm and at weekends and on Bank Holidays from 2 until 5pm. you to take time out for Outside of these hours you can leave us a message and we will call yourself. We understand you back when we re-open. that this can be hard to do Do take time to look after yourself too.

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Living through antenatal depression Often, when hearing about pregnancy and depression, the reader thinks of postnatal depression, but despite being less well-known, antenatal depression – which occurs during a pregnancy – can have more detrimental effects on a mother’s mental health than postnatal depression which affects a mother after the birth.

When a woman finds out she is pregnant, the last emotions she would expect to feel are those of depression, anxiety or suicidiality, however antenatal depression is now affecting one in ten pregnant women.

Symptoms reported include: ● ● ● ● ● ●

No appetite/over eating Tired but unable to sleep Feeling lonely and isolated Lack of motivation and interest Obsessional thoughts and behaviours Excessive crying

enced ‘80% who experi n had io ss re p e d l ta a n te an ion’ postnatal depress

dependent on your support can make this even harder.

It is not uncommon for feelings of depression to develop into thoughts of suicide and/or self-harm.

mood. Often the confusion of not knowing why they feel so low, contributes to the secrecy of keeping low feelings to themselves.

The causes of ante-natal depression are different for everyone. They can include: ● ●

● ● ● ● ●

These symptoms are purely an example, as everyone is different and what one woman may experience as antenatal depression may be different to another. The main symptom to be aware of is feeling different within oneself: to notice if there are struggles with certain activities or situations that were no problem before, or lack of motivation, which had not occurred before. If you are struggling with your day-to-day routine where you wouldn’t have done so previously, then this is a change for you and one that you need to seek help with.

Causes of Antenatal depression Depression during pregnancy affects 20% of women, yet many women are reluctant to open up to others due to feeling pressured to maintain a happy and upbeat

Chemical or hormonal imbalance due to pregnancy Worries of losing the baby, possibly due to a history of miscarriage or stillbirth Worrying about a relationship, work or money A history of depression or anxiety-related problems Concerns over your body changing shape or weight Uncertainty around the future Unplanned or unexpected pregnancy

The most important thing is to recognise how you are feeling and to ask for help from those who can support you.

Antenatal and Postnatal Depression After the birth, a sudden drop in hormones, combined with looking after a new baby, can cause the depression to continue in the form of Postnatal Depression. A survey by NetMums and The Royal College of Midwives (RCM) identified that 80% of those who experienced antenatal depression went on to have postnatal depression. Facing a number of new challenges when depressed can make it difficult to focus, and having a small child

g ‘Depression durin pregnancy affects 20% of women’

Antenatal Depression and Suicide NetMums and RCM’s survey worryingly identified that mums felt their mental illness affected the relationship they had with their baby, and that depression appeared to have a positive correlation with the number of children the mothers went on to have.

Antenatal and prenatal depression are becoming more common. If you’re pregnant and feeling lower than usual, feeling less motivated to do the activities you enjoy or feeling different in general, try not to keep it to yourself. NetMums and RCM’s research showed 74% of those surveyed stated that it took a few weeks or more before realising there was an issue. Speaking to your midwife can often help.

If you have any doubts, speak to your midwife or GP for advice or contact the PAPYRUS helpline, HOPELineUK on 0800 068 4141.

The earlier depression can be identified, the sooner support can be provided.

Try not to keep troubles to yourself or struggle with on your own, help is available.

ognise ‘Important to rec ask how you feel and for help’ Resources: http://depression-in-pregnancy.org/ http://www.bbc.co.uk/news/health-20265786 http://www.guardian.co.uk/lifeandstyle/2008/jan/ 29/healthandwellbeing.mentalhealth PAPYRUS SPRING 2013 5

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Media Managing media at an Inquest Recent experience of some members prompts me to focus on media at inquests.

Journalists have the right to attend an inquest and press reports may appear. Whether they report on it or not is up to them.

Newspapers and magazines must abide by the Editor’s Code of Practice, which sets out guidance on suicide reporting and is monitored by the Press Complaints Commission.

Reports that are accurate and fair are unlikely to be actionable. However, interpretation of what the Editor’s Code rules as ‘excessive’ reporting can be far removed from what PAPYRUS believes is necessary to prevent suicides. We have in the past made representation to remove the word ‘excessive’ and continue to press our case.

The contents of suicide notes and personal letters are not usually read out at an inquest; unless the coroner decides it is important to do so, in which case they may be reported.

You can always request that the journalist does not include the content: that you feel it is an intrusion of grief.

Prior to an inquest it is a good idea to prepare a statement that can be given to a journalist, thus avoiding direct comment and aiding accuracy. A prepared statement also provides the opportunity to add a note that you request that suicide method should not be included in any report to avoid copycat occurrences. For the same reason the location of a suicide should be omitted to avoid ‘hot spots’. Do also ask that our helpline HOPELineUK telephone, text and email details are included as a source of help.

The rise in numbers of news agencies and freelance journalists looking for stories as a commercial business opportunity has seen increasing numbers attending inquests. They can be aggressively determined. One of our members opened the door to a speculative contract-bearing journalist the day following the inquest and received a further three within the week.

An agency journalist will apply pressure for a contractual ‘exclusive’ story, which can be despatched to worldwide media within minutes, with potential for the family involved to lose control. Photographs innocently supplied can end up under copyright of the agency.

Most journalists are sensitive and fair, but often under pressure ‘to get a good story’. If you are approached by a journalist – at any time – you should not feel under pressure. It is not a royal command.

PAPYRUS can help with media statements and concerns over media reporting.

Contact Rosemary Vaux on 020 8943 5343 or email pressoffice@papyrus-uk.org 6 PAPYRUS SPRING 2013

Standard of Stephen Habgood, PAPYRUS Chairman

PAPYRUS has launched a campaign to change the way in which Coroners reach a verdict in cases of suicide.

It is a requirement for the Coroner to deliver a verdict in determining the cause of death and in doing so all the verdicts have to be established to the test within the balance of probabilities, except for suicide and unlawful killing, which have to be proven beyond reasonable doubt.

PAPYRUS deems the current standard of proof (beyond reasonable doubt) to be no longer necessary; it reflects a time when suicide was an unlawful act in the same way that unlawful killing remains an unlawful act. We believe the balance of probability to be a fairer test and reflects the changes made in the Suicide Act of 1961 which decriminalised the act of suicide.

The requirement that the standard of proof should be beyond reasonable doubt is both unnecessary and unreasonable and perpetuates the stigma around suicide.

Whilst we acknowledge that, in some cases, parents and families desire a verdict other than suicide, PAPYRUS believes that the reluctance of some Coroners to name suicide as the cause of death, preferring to use narrative verdicts, helps to maintain stigma.

In addition, maintaining the high level of proof distorts the figures of those who have taken their own life and hides what we consider to be

Photo by Fabio de Paola.

‘We believe it to be unacceptable and unnecessary to continue to treat acts of suicide as unlawful’ a national scandal that so many, particularly young people, die each year by their own hand.

We have presented our views to the Chief Coroner and will be pressing for this change to be adopted in the revision of the Coroners and Justice Act 2009.

Background The Coroners’ system originated in medieval England and since the system was established a Coroner has been appointed to investigate and determine the cause of death for those who die within their jurisdiction.

One of our primary campaign aims at PAPYRUS is to reduce the stigma that still surrounds suicide, since we believe that addressing stigma will encourage more open discussion and enable those young people who are troubled to seek help and support from organisations such as ourselves.

PAPYRUS believes that Coroners

‘The requirement that the standard of proof should be beyond reasonable doubt is both unnecessary and unreasonable and perpetuates the stigma around suicide’

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proof are responsible for perpetuating stigma that surrounds suicide because of the standard they apply in cases of suspected suicide and their reluctance to deliver a suicide verdict, despite clear evidence when a person takes his or her own life.

Words count Despite changes in religious attitudes and the law, it can be seen that in reaching a verdict the Coroner applies the same test for suicide and unlawful killing, reflecting an age when suicide was unlawful.

We believe it to be unacceptable and unnecessary to continue to treat acts of suicide as unlawful.

Our members find the use of the term committed suicide to be unacceptable since is implies the person they have lost to suicide has committed an illegal act when in fact they were seriously ill with a diagnosed or undiagnosed mental illness, or were sufficiently troubled to decide to end their own life. (The preferred term is completed suicide.)

Accurate data is important in our understanding of the rate, method and causes, particularly of young deaths. The Office for National Statistics uses data from Coroners' Inquests. The application

by Coroners of such a high standard of proof and their reluctance or unwillingness to deliver a suicide verdict is also unhelpful in gathering accurate data around suicides. In addition, the growing preference for narrative verdicts can lead to under reporting of suicide, can reinforce stigma, and leave a family in denial. This is particularly the case for children under the age of 15 years. Therefore we believe the data to be seriously flawed.

The application of the civil standard will provide us with more accurate information around those who choose to take their own life and the statistics of those who complete suicide are likely to rise significantly, reflecting the true extent of suicide in our society.

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Concerns about acne medication Recent reports on the inquest into the death of the 16 year-old son of a PAPYRUS member have again highlighted the potential for psychiatric side-effects of isotretinoin treatment.

The coroner stated that “an acne drug may be linked to suicide” and that he would be writing to the MHRA requesting it to implement more rigorous guidelines on the use of isotretinoin with tighter psychiatric screening of patients.

The inquest was told that there was no scientifically proven link between the drug and suicide, and that isotretinoin patients reporting suicidal tendencies was rare at less than one in 10,000.

PAPYRUS has monitored research into this issue for several years.

In 2012 we read the results of a Swedish study which assessed the risk of attempted suicide before, during and after treatment with the drug. This concluded that an increased risk of attempted suicide was apparent up to six months after the end of treatment.

The researchers recommended close

CASE HISTORY

monitoring of patients for suicidal behaviour up to a year after treatment ended. They did, however, point out that the risk of attempted suicide may be rising before treatment, because of the acne, so an additional risk due to the isotretinoin treatment cannot be firmly established.

There had been similar publicity following the suicide of a 20 year-old man in 2007. At that time a spokesperson for the MHRA stated “the safety of isotretinoin remains under close scrutiny. Most recently, in 2005, an Expert Working Group met to consider all data relating to psychiatric reactions.”

The list of possible side-effects in the Patient Information Leaflet issued with isotretinoin preparations includes ‘rarely, mood changes (depression, aggressive behaviour, anxiety) and, very rarely, psychosis and suicidal ideation’.

Hopefully this latest report of another suicide will serve to encourage patients, parents and carers to report any concerns to their GP and will again highlight the need for increasing vigilance for up to 12 months after the end of treatment.

Worries about suicide and acne treatment PAPYRUS member Lorraine Hale, mother of 16 year old Robbie mentioned in the article above, firmly believes that side-effects of medication for acne were detrimental to the mental wellbeing of her son.

A popular teenager, Robbie took his own life in January 2011, having been prescribed with isotretinoin (Roaccutane) treatment for acne in April 2010.

“Robbie was a kind, gorgeous, confident, caring, funny and intelligent young man – a true gent,” said Lorraine. “He had not been embarrassed or teased about his acne but had sought treatment when it became uncomfortable on his back.”

“We had been advised of the side-effects when the medication was prescribed but I was not concerned because Robbie had such a happy, positive demeanour.”

After the medication he had anger issues that were totally out of character.

“His personality changed: not instantly but he started losing his confidence saying that all his mates were leaving him out. He became angry and really aggressive, arguing frequently with his sister. When I told his GP he was having anger issues, it was dismissed as hormonal.”

“Robbie’s suicide cannot be totally attributed to this drug, but I am in no doubt that it contributed to his despondency. At the Inquest into Robbie’s death the Coroner recorded an Open Verdict as he could not rule out the possibility that the drug contributed to Robbie’s death. I am confident that if Robbie had not taken the medication he would still be with me today. The Coroner has written to the MHRA to report his concerns re the risks associated with this drug and the monitoring of patients during and after taking this medication. They have 56 days to respond to the course of action they will take.”

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“Dyslexia – a challenge to learning, a challenge to life” Are young people with dyslexia at greater risk of suicide?

Everyday, school children are learning something new. They attend five to six different subjects a day, where they must adapt and accommodate new information. They face pressures to achieve, meet expectations of their teachers and parents, and in addition to this, they may have an undiagnosed learning disability, such as dyslexia. If dyslexia continues to go unnoticed, the young person may begin to doubt themselves academically, affecting their self-confidence and self-esteem. Their work may begin to deteriorate resulting in teachers or parents to suggest they “try harder”. Perhaps their classmates pick up on their latest low coursework/homework marks and tease or bully them about it.

A combination of the young person’s worries from society’s reaction may cause them to not want to attend school, resulting in detentions and further discipline. Gradually the young person could become miserable and may have thoughts of suicide.

What is Dyslexia?

Dyslexia is a common learning difficulty that mainly affects the skills involved when reading and spelling words. A common concern or myth for sufferers of dyslexia, is a feeling of low intelligence, when in fact, dyslexia is usually an unexpected difficulty affecting an intelligent child. It has also been known to affect numerical skills. Dyslexia is a spectrum disorder, that is to say its symptoms can range from mild to severe, which can explain why some sufferers are not diagnosed until adulthood, and others in their early school years.

How common is dyslexia?

It is estimated 4-8% of school children have some level of dyslexia.

How do I know if I have dyslexia?

Dyslexia is usually noticed by a teacher or a parent who may notice the signs in your class or homework. However if you think you may have dyslexia and it has not been mentioned previously, it’s important you ask your teacher if you can be assessed Symptoms of dyslexia include: ● Slow writing/reading speed – letters can appear to move around, blur and cross over each other. ● Problems recognising/understanding 8 PAPYRUS SPRING 2013

● ●

new words e.g. technical terms in science Problems with spelling Problems with expressing and structuring essays

What can I do to get help?

Despite there being no ‘cure’ for dyslexia, a range of educational programmes and interventions has been proven effective in improving reading and writing skills in many affected children. Around 95% of those respond well to these interventions and go on to make moderate to good progress with regards to their reading and writing. The remaining 5% may continue to find reading and writing difficult and require more intensive support and long-term assistance. Dyslexia is best treated as early as possible to support the child’s needs and requirements.

‘Research suggests that young people suffering from dyslexia are ten times as likely to have suicidal thoughts’ Dyslexia and suicide

Suicidal ideation can be recognised from behavioural changes such as: ● Changes in sleeping pattern ● Changes in appetite ● Becoming withdrawn or more sociable than before ● Substance misuse ● Loss of interest in usual activities ● Loss of energy Verbal indicators can also be noticed, and should always be clarified as to what the young person means, for example: ● I can’t go on ● It’s all getting too much ● I want everything to stop ● I just want to get away from everything ● I don’t see the point of anything anymore.

A young person’s view …

I have first-hand experience of the preconceptions and barriers facing someone managing undiagnosed dyslexia through much of their school career.

During my earlier school years, low grades and difficulties mastering basic literacy and numeracy skills were brushed off as ‘lack of effort’ or ‘ability’ by teaching staff. The absence of an early diagnosis also meant I was not provided with the necessary support and tuition required to overcome my specific learning needs and reach my academic milestones.

This lack of support combined with the usual institutional and peer pressure facing a young person in an educational setting, negatively impacted on my self-esteem and resulted in my gradual disengagement from secondary school.

Only with my eventual diagnosis at the age of nineteen, whilst attending university, was I fully able to understand the source of my difficulties and receive the necessary specialist support to enable me to reach my potential.

Research suggests that young people suffering from dyslexia are ten times as likely to have suicidal thoughts. The pressure to meet expectations of society, or keep up with their friends’ grades can cause great distress. Dyslexia is identified as being the most common childhood loss of self-esteem, which can lead to great misery and in some cases, suicidal thoughts.

Rutter and Maughan (2005) observed and assessed a group of children with dyslexia as they grew into adulthood and identified higher rates of anxiety than normal and reported episodes of low mood and suicidal thoughts. The earlier a diagnosis can be made, the better, to avoid the distress and loss of self confidence and self esteem. Those who suffer with dyslexia are often highly talented in everything other than reading and spelling. The support they receive throughout education can enable them to become successful in the arts, References: commerce or engineering and this http://www.nhs.uk/Conditions/Dyslexia/Pages/ encouragement of success from an Symptoms.aspx early age can help reduce loss of http://www.dyslexia.org.uk self-esteem, or avoid it Michael Rutter, M., and Maughan, B (2005).

(Dyslexia.org.uk).

Dyslexia: 1965–2005. Behavioural and Cognitive Psychotherapy, 33, 389-402.

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Homelessness and suicide A person is commonly defined as homeless if they do not have access to a permanent or secure form of accommodation. According to a recent study carried out by the housing support charity Shelter, experiences of homelessness and poor housing have been demonstrated to contribute to increased risk of suicide and suicidal behaviour.

The Shelter study further highlighted how the above link is particularly pronounced in relation to groups with additional care and support needs, who are particular at risk of suicide when made homeless. The associated risk between homelessness and vulnerability to suicide was further echoed by research carried out by the Salvation Army, which highlighted how 36% of homeless respondents to a national survey reported that they had attempted to take their own life at least once.

Chris Holmes, the national director of Shelter, summarised the findings of the research and pointed to how; “Extremely vulnerable people are often left homeless or in unsuitable accommodation, which wreaks havoc with their emotional and physical wellbeing.” He highlighted how a lack of secure accommodation often also “acts as a barrier to providing help and support to those at risk of taking their own lives”.

However, evidence for a strong correlation between experiences of homelessness and an increased risk of suicide is far from conclusive,

as the relationship also involves a complex interplay of additional risk factors and pre-existing vulnerabilities. As a report from the Joseph Rowntree Foundation recently highlighted; ‘homelessness is not just a housing issue, but something that is inextricably linked with complex and chaotic life experiences’.

One such example of this is the complex interplay between homelessness and mental health related issues, which can be considered to be both a cause and a consequence of not having a secure form of accommodation.

McDonagh et al (2011) found that nearly half of respondents to a nationwide survey reported experiences of institutional care, substance misuse, and trauma as well as homelessness. Indeed, it is commonly accepted amongst academics that there is often a strong overlap between homelessness and other support needs, which are commonly established in their own right to presuppose an increased vulnerability to suicide. The experience of becoming homeless can often compound these pre-existing vulnerabilities/risk factors thereby leading someone to take their own life.

Another crucial risk factor to consider is the barrier that being homeless represents to accessing services and support. A report by the national support charity Crisis, pointed to how homelessness and bad housing often cut people off

from family, friends, GPs and social services, which often represent vital lifelines to those in crisis. These findings were further bolstered by an American study that found that 73% of those who had experienced homelessness for a period longer than 6 months had considered suicide, compared with 55% of those who were homeless for less than 6 months.

What can be done?

There has been a recent campaign by Crisis for both more flexible services and more targeted interventions in order to better meet the needs of homeless populations. The organisation has also called for reform of mainstream healthcare services, such as GP surgeries, to remove barriers which homeless people often face in accessing services. This includes making it easier to register without a permanent address and providing more out-of-hours and drop-in services. These changes could also be applied to more specialised services such as mental health and substance misuse teams, in order to help remove obstacles to accessing support and treatment.

References: Mc Donagh, T (2011) ‘Tackling Homelessness and Exclusion: Understanding complex lives’ London: Joseph Rowntree Foundation Rita Diaz (2005) Young People and Homelessness; A Fact Sheet London: Shelter Rees S (2009) Mental ill Health in the Adult Single Homeless Population, London: Crisis Salvation Army (2009) ‘The Seeds of Exclusion 2009’ http://www.salvationarmy.org.uk/uki/www_uki.nsf/0/ 58A56A802FEAE3EC802575E5004A2FED/$file/The%20Seeds% 20of%20Exclusion%202009.pdf Homeless Link (2011) ‘Survey of Needs and Provision 2011’ http://homeless.org.uk/snap-2011 Homeless Link (2010) ‘The Health and Wellbeing of People Who Are Homeless: Evidence from a National Audit – Interim Report’ http://www.homeless.org.uk/sites/default/files/Interim%20report_HomelessHealthAudit0910.pdf PAPYRUS SPRING 2013 9

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Are veterans more at risk o

PAPYRUS Training

Once discharged, many ex-military personnel face enormous challenges, both in coming to terms with their experiences of combat and managing the difficult transition into civilian life. Many veterans face a difficult adjustment back in the UK, often compounded by physical injury or psychological trauma. The loss of their social network, a regular wage, respect, and the difficulties of finding employment in a fluctuating job market, all add to the stress facing returning military personnel.

A sizable proportion of ex-service men and women also struggle with the psychological fall out of losing friends and witnessing harrowing acts of violence whilst serving in war torn areas. The charity Combat Stress, which supports ex-military personnel affected by post-traumatic stress disorder and other mental health issues, has reported a 52% increase in referrals since 2005. The charity currently supports nearly five thousand ex-military personnel, the majority of which (75%) suffer from

Post-traumatic Stress Disorder (PTSD) while others have depression, alcohol and/or drug abuse, anxiety and phobic disorders.

Psychologists refer to a ‘cycle of despair’ that characterises the struggle of many who leave the military. As Mark Townsend recently highlighted in an article published in the Observer newspaper; ‘in a society submerged in statistics the incidence of broken marriages, suicides, alcoholism, deep depression and homelessness among service veterans remains largely un-quantified’.

In terms of addressing the underlying question of whether veterans are at higher risk of suicide, the evidence remains largely inconclusive. As Louis Appleby, the National Director of Mental Health in England, recently commented, not only is the issue of military suicide hard to measure; it is also ‘increasingly difficult to talk about’.

Research by Kapur et al (2009) highlighted how the risk of suicide in men aged 24 years or younger who had left the military was three times greater than that in the same age group in both

Our Suicide Prevention Team delivers training to parents, professionals, organisations, and young people.

Our Suicide Awareness information sessions are delivered in a sensitive and interactive manner.

We focus on: ● Looking at some of the difficulties young people may be facing today ● Identifying the resources young people have around them and encourage them to access these ● Helping young people become aware of PAPYRUS as a source of suicide prevention support ● De-stigmatising suicide SuicideTALK is a seminar for whole staff groups and/or groups of parents/carers (2 hours) which ● Looks to the benefit of speaking safely and openly about suicide ● Helps to remove the stigma

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which can prevent help-seeking behaviours Applied Suicide Intervention Skills Training (ASIST) (2 days) a training workshop for those with contact with young people throughout their working day which ● Helps participants to identify when a young person may be at risk of suicide ● Provides caregivers with an evidence-based intervention model which keeps young people safe ● Equips participants to feel more ready, willing and able to address the needs of someone at risk.

Our team can also meet the requirements of your organisation through our bespoke packages,

tailored to meet the needs of the participants, as well as raising awareness of young suicide and the impact this can have. We have delivered training to: ● Counsellors ● Schools ● University students ● Telephone helpline organisations ● Charitable organisations We discuss the prevalence of suicide, what difficulties young people face today and how we can help and support them.

Suicide is everybody’s business.

To book training for your organisation, or for more details, contact: training@papyrus-uk.org or call Alexis Elliott on 01925 572 444.

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the male general population and in men serving in the Armed Forces.

Enhanced risk factors for suicide cited amongst ex-military personnel include being male, serving in the Army, having a short length of service, and being of lower rank.

These findings were more broadly echoed by Frances Hoy, a spokeswoman for the Royal British Legion, who described how her organisation regularly receives ‘calls from anxious parents explaining that their children are on the edge’.

So, what can be done not only to better support ex-military personnel who make the transition back into civilian life, but to also ensure that the right services are

available to those individuals who may be experiencing mental health difficulties? One way may be to remove the barriers that stand in the way of ex-service personnel accessing help. David Wilcox, from the South West Veterans Mental Health Service, recently highlighted one major obstacle as the ‘big issue of stigma’ attached to mental health issues. This is especially prevalent in the military, which often underlies the potential reluctance of many veterans to ask for support. Research by Combat Stress highlighted how 81 per cent of veterans felt ashamed or embarrassed about discussing their mental health issues.

References: Combat Stress Annual Review 2012 http://www.combatstress.org.uk/media/56674/combat_stress_annual _review_2011-12.pdf Kapur Mail, N, While, D, Blatchley, N, Bray, I, Harrison, K (2009) Suicide after Leaving the UK Armed Forces A Cohort Study PLoS Medical 6(3) Townsend, M ‘They're back from the front line - so why are these ex-soldiers still fighting their own wars?’ The Observer, 3.2 2008

Roving Ambassadors This week I met a journalist covering another story – nothing to do with mental health. Realising his readers had relevance to our PAPYRUS target audience, at the end of our discussion I asked if I could tell him about the work of PAPYRUS and preventing young suicide.

Oh no! he said, not suicide and looked horrified. After a pause he said: “I am so worried about my son: my wife and I are at our wit’s end.” We withdrew from the gathering to speak in private about how he and his wife – and indeed his son – could be helped by our HOPELineUK helpline team.

I find this is quite a common occurrence. We can all be roving ambassadors for PAPYRUS. Rosemary Vaux

A relaxing smoke?

Maybe not...

Researchers from King's College London, the University of Southampton and the University of Birmingham have found that abstaining from smoking can reduce anxiety.

The study followed 633 participants over a period of six months and measured their anxiety levels during this time. After six months, 491 participants completed the study and the results showed that the participants who abstained from smoking reported a reduction in anxiety, while those who relapsed experienced an increase in anxiety.

Furthermore, this finding was more pronounced among participants that smoked to cope with stress and had a psychiatric diagnosis.

These results suggest that quitting smoking may have beneficial effects for both physical and mental health.

Reference: McDermott MS, Marteau TM, Hollands GJ, et al. Change in anxiety following successful and unsuccessful attempts at smoking cessation: cohort study. British Journal of Psychiatry.

Published online January 2 2013.

CBT can be effective for antidepressant-resistant depression Researchers from University of Bristol, University of Exeter and several other academic institutions in the UK found that Cognitive Behavioural Therapy (CBT) in addition to antidepressant medication reduced the symptoms of depression among people who did not respond to medication alone.

The researchers recruited people with depression whose symptoms did not improve after six months of antidepressant medication and allocated half of the group to receive CBT in addition to medication. CBT is a well-established talking therapy that works on the principle that there is a link between thinking and behaviour, whereby unhelpful or negative thoughts may lead to unhelpful, self-destructive behaviours. CBT focuses on breaking the cycle between negative thoughts and behaviours by setting practical tasks which challenge these beliefs. The study found that the participants who received CBT in addition to antidepressant medication reported a reduction in depressive symptoms over a 12-month period, compared to medication alone. These results show that CBT is an effective treatment for depression among people who do not respond to antidepressant medication alone.

Reference: Wiles N, Thomas L, Abel A, et al.

Cognitive behavioural therapy as an adjunct to pharmacotherapy for primary care based patients with treatment resistant depression: results of the CoBalT randomised controlled trial. Published online December 7 2012.

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Research UPDATE

of Suicide?

6/4/13

Frequently asked questions during a day in the life of our HOPELineUK team

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Q: I found myself really struggling in my last term at university; a close friend of mine took his own life over the Christmas period and I’ve found it incredibly hard to come to terms with his death and manage the pressures of completing my finals. As a result, I’ve been drinking a lot more than usual and occasionally using drugs as a means of escaping. I’m reluctant to talk to friends or family as I don’t think they’d fully understand the situation and would probably just tell me to ‘get a grip’.

A: The loss of a close friend through suicide is a tragic and devastating event; the grieving process can be a very painful experience. It’s understandable that you’re feeling overwhelmed. Although alcohol and drugs may offer a short-term escape, they can make you feel a lot worse in the long run and will not help to alleviate the underlying sense of pain you’re currently experiencing.

We understand it can be tough sharing these painful thoughts and feelings with those around you, but it can help to talk to the people in your life who are also experiencing a similar sense of grief. Mutual support can help to reduce some of the intensity of the feelings by sharing your sense of loss. It might also be worth speaking to your student support service, which will be able to refer you to the university counsellor as well as other support groups.

Q: I’m currently serving a three year prison sentence for a repeat offence. Since beginning my term a couple of months ago, my long term partner has ended our relationship. Since then I’ve been finding it tough holding myself together and coping with the pressures of being inside.

More recently I have found myself getting into fights for no reason and putting myself in risky situations. My moods have been up and down over the last few weeks and I’ve also been experiencing strong suicidal thoughts.

A: The breakdown of a long term relationship can be painful.

Q: I lost my job a couple of weeks ago and now it even seems to be a struggle to get out of bed in the morning. I’ve stopped looking for work as I just don’t see a future any more. My friends have been trying to keep me involved in things but I’ve been avoiding them. I don’t feel I’m the person I used to be any more.

A: It sounds as though you are going through a difficult time at the moment. The loss of your job has clearly had a big impact on your life and as a result it seems you’re finding it difficult to keep yourself motivated. By making a plan for Q: My 14 year old daughter has been very withdrawn lately and has been spending a lot of time in her room.

She won’t speak to any of us and it is really unusual for her to be like this, what should I do?

A: You are obviously concerned by your daughter’s sudden change in behaviour.

Are you aware of anything that may have happened to her recently – school struggles or issues at home? Try to find a quiet time to ask her how she feels and whether there is anything she wants to talk about. It can help 12 PAPYRUS SPRING 2013

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Managing these emotions within the stressful and restrictive environment of a prison away from your friends and family, must understandably be hard. It’s important while you’re experiencing suicidal thoughts that you keep yourself safe, by avoiding high risk situations and by making contact with your prison’s mental health service, which will be able to provide you with the support you need. Some prisons also run listening projects, which are staffed by volunteer inmates who provide a confidential support service for individuals encountering personal difficulties and experiencing thoughts of suicide. We advise that you speak to a member of the prison staff team who will be able to talk through the options available in terms of support.

each day and setting realistic goals that you want to achieve, you will begin to feel more motivated throughout the day. It’s also important that you put some time aside to do things that you enjoy, like hobbies and socialising. It sounds as though your friends are trying to keep you involved and want to see you, so the next time that they ask you out – say yes!

Your friends can help you to take your mind off things, but they are also there for you to talk to when you’re struggling.

You mention that you don’t see a future any more – please speak to your GP if you are having thoughts of suicide or call HOPELineUK 0800 068 41 41 to talk about your feelings.

You don’t have to cope on your own.

your daughter a lot to know that you’re concerned about her and you’re there when she’s ready to talk. By trying to understand things from her point of view, she will know that you care. Your daughter’s school may also have a counsellor available that she can speak to if she’s struggling. If you think it might be serious, encourage your daughter to go to the GP to talk about how she’s been feeling. In the meantime, please call HOPELineUK on 0800 068 41 41 if you are concerned that your daughter may be experiencing suicidal thoughts.

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Fundraising... ●

Tom Moran and Team hit their 10k target

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ar to the New Ye iary cted as a benefic A superb start RUS have been ele PY ided PA ov at pr th ich ar he wh to e,

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For all our events, please see our website for details of how you can join in:

A 250km walk organised by Tom Moran of the Moran & Bewley Hotel Group and dubbed the Tomathon has helped raise a superb £10k to help fund the services PAPYRUS runs across the UK. Tom says ‘I feel the 'Tomathon' is a positive response to the devastating reality of suicide, an opportunity to get together with friends and neighbours to do something collectively to help continue their vital work.’

Employees in each of the Moran hotels around the UK also took part in the Tomathon by setting up treadmills in the hotel lobbies and walking step by step with Tom as he completed his journey.

Pictured above left, PAPYRUS Chief Executive Ged Flynn with Tom Moran, Tommy Moran and Tom Ward.

Have trunk, will travel… with the help of BT colleagues

BT employees in Warrington have recently nominated PAPYRUS as one of their chosen charities and as part of their fundraising efforts have introduced a new member to their team.

Team leader Joyce Hammond says “I wanted to nominate PAPYRUS through the charity scheme at work as I thought this would be a brilliant way to raise awareness of a problem which is so prevalent in the UK, and yet rarely talked about. We introduced PAPYRUS the Elephant to our team to encourage people to talk about the elephant in the room and know what help is available if they or a young person they know may be feeling suicidal.”

PAPYRUS the Elephant will travel with his BT colleagues throughout the UK on a mission to help others talk openly and safely about suicide and emotional wellbeing. He’s already been in to school, helped out with a fundraising raffle and made friends with the lollipop man…

Left, crossing the road in Ashton in Makerfield, and right, ‘at home’ in the PAPYRUS office.

www.papyrus-uk.org

… simply by Gift Please don’t forget Gift Aid ing an additional Aiding your fundraising you are rais 25p per £1. raiser for PAPYRUS, Zoe hosted ● Following the success of her first fund . py’ Gig night in Stafford in February her second ‘Punk Yourself Hap to hing touc so is for this event. It ‘Raising £700 is just the beginning which not only helps raise awaret even the ort supp ple see so many peo ide but offers support to those who ness of the prevelance of young suic be or someone they know. People can may be worried about themselves k, wor hard of lot a is and although it affected by suicide in many ways elf and my awesome team, it is mys from on icati ded e requiring hug nd they have someone to turn to ersta und always worth it to help others to not always feel okay. Hosting this if they’re feeling low; that it’s okay e embered and help others find hop event means lives lost can be rem out, it rock to inue cont will We of. which is the biggest joy to be a part ed." just as those people would have wish Zoe Lawson PAPYRUS SPRING 2013 13

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Fundraising A Few Words from the Fundraising Team To all our supporters, members and those who share our belief that suicide is preventable, we would like to say a heartfelt thank you.

As a charity we rely almost entirely on the contributions we receive from our supporters and we are so very grateful to everyone who continues to help us in saving young lives.

We are planning a number of exciting new things for 2013, from sponsored HOPEWalks up and down the country to fantastic fundraisers for you and friends to get involved with at home. So if you’ve been inspired to take on a charity

challenge of your own at home, work or even overseas, we would be delighted to hear from you.

Details of our new events will be available on our website very soon and, in the meantime, if you would like to register an event you are already planning or perhaps would like some ideas and advice on holding a fantastic fundraiser yourself, we would be delighted to hear from you.

Aanika and Laura Email: fundraising@papyrus-uk.org Tel. 01925 572 444

d down the an up rs te or pp su r ou to u yo k ‘A huge than country for getting 2013 off to fantastic start’ They include ... ● Francesca Seden organised a Gig Night in Harrow ● Jess Edwards organised a Band Night in Towyn ● Claire Burke did a sky dive ● Shannon Devaney ran a fundraising party in Berwick for the sky dive she will be doing later this year ● Graeme Scragg and Ste Flynn organised ‘Merry Hell’ folk/rock band gigs ● Jacqui Hanks organised a Ceilidh in Alvechurch ● Hazel Powell ran the Bath half marathon ● Kayleigh Smith organised a band night in Prestatyn

● Sally Jenkins from Wigton has been busy hosting a range of events in memory of her daughter Helen. Her recent tea party hosted with the help of Helen’s friends turned out to be a particular success: ‘The support from friends and the local community meant that the event was great. One of Helen’s friends, Emily, visited all the local businesses asking for donations for a raffle; we were astounded by their kindness and were soon inundated with prizes from a Good luck to all of you donated TV, gifts from garden training for or planning centres and hairdressers. We also a future fundraising benefited from the generosity of a pub and hotel who donated event to support meals and B&B vouchers. In the PAPYRUS. Do contact end we had so many prizes that our fundraising team we also held a tombola.’ fundraising@ Sally Jenkins

Above, Northern band Merry Hell support PAPYRUS.

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papyrus-uk.org for ideas, publicity support, shirts and collection boxes.

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you would g an event? If in n n la p u o y Are ture Events in our website Fu ow at like it advertised support, let us kn er th ga lp he to section rus-uk.org fundraising@papy

286 miles across Scotland for PAPYRUS PAPYRUS supporter, Simon Barnett (pictured right) from Aberdeen sets out to run 286 miles… and here he shares his story with us

“Tell Mum and Dad I'm sorry, I'm just so tired”.

23 years old, just home from a night out when I receive this phone message from my friend. It took a minute for the realisation to hit that she meant suicide.

My head was swimming but I had to do something.

I still think about that night. I remember the calmness of the paramedics and I remember my walk home alone that night but most of all I remember the fear behind her eyes.

The ‘what if’s’ just don't bear thinking about and today, that friend is now my wife. It's not been an easy road, sometimes things still get very dark but she’s fighting the fight and has shared her story to help others know they are not alone and that help is at hand.

Suicide is still the leading cause of death of young people in the UK. In

2011 alone, 286 people in Scotland under the age of 35 took their own lives. That’s 286 too high and that is why, over 11 weeks this spring, I’m running a mile for each of them.

I’ll be raising awareness and vital funds to help PAPYRUS make sure those who face the darkest battles every day have the help and support often needed to find hope and stay safe.

The challenge will be testing, especially given my sweet tooth and love of beer but I’m doing this for the thousands who feel like they are constantly running uphill on their own.

The money I raise will go towards funding HOPELineUK as well as supporting the charity to deliver suicide intervention training across the UK. I’ll be blogging throughout these 11

weeks, raising as much money as possible for PAPYRUS, which relies almost entirely on donations, but if nothing else I hope by sharing this story I’ll help others see that everyone is running their own race and we can all play a part to support them.

To visit Simon’s blog or to show your support, simply go to http://simon-barnett.blogspot.co.uk/

Why not join us... Membership form When PAPYRUS Trustees discuss what the charity needs to do, we look to the experiences of our members to help us. If you want to help young people to live with hope, you can give our work some special meaning. Family, friends and professionals, please join PAPYRUS now.

Name

GIFT AID DECLARATION.

Address

Post code

I want to treat this and all donations I may make in the future, until I notify you otherwise, as GIFT AID DONATIONS.

Phone Email

Signed: I enclose £40 for annual membership.

I enclose a donation of £ Only one newsletter and information will be sent to an address, if you want additional copies of mailings, please tick this box.

By filling in the Gift Aid declaration, we will be able to claim back from the Inland Revenue the income tax that has already been paid on any donation you may make.

Date: Please Note: Remember to notify us if you no longer pay an amount of Income Tax/Capital Gain Tax equal to the tax we reclaim on your donation. This declaration can be cancelled at any time by notifying PAPYRUS.

Please tick this box if you require a receipt.

Please return this form to: PAPYRUS Prevention of Young Suicide, 67 Bewsey Street, Warrington, Cheshire WA2 7JQ. PAPYRUS SPRING 2013 15