Missing lifelines

DDN feature on links between problem alcohol use and suicide

This month, WithYou published our latest report with our partners at the Suicide Prevention Consortium (SPC). The project, Exploring experiences of accessing support for alcohol issues and suicidal ideation, develops on a recurring theme from our previous work – that there are still many barriers stopping people from accessing mental health and alcohol services.

We previously researched the link between suicide and alcohol in our 2022 project, Insights from experience: alcohol and suicide. There is extensive evidence of a complex relationship, including an increased risk of suicidal behaviour following alcohol consumption, as well as co-occurring alcohol misuse and mental health issues over longer periods of time. According to the National Confidential Enquiry into Suicide and Safety in Mental Health’s 2023 annual report, among people in contact with mental health services in England who died by suicide between 2010 and 2020, 48 per cent had a history of alcohol misuse.

Mental Health
Photo by Nik Shuliahin on Unsplash

Improving access
Increasing the number of people accessing support is one of the most pressing issues for treatment providers. Around four out of five people experiencing alcohol dependence are not in treatment, and around two thirds of people who die by suicide are not in touch with mental health services a year before they die.

This work is especially timely following the government’s commitment to the ‘no wrong door’ approach in last year’s Suicide prevention strategy for England. No wrong door, which means that someone reaching out with suicidal thoughts or feelings receives timely support no matter what type of service they speak to, is particularly important in relation to co-occurring mental health needs and alcohol issues.

One of the most important parts of any SPC project is that we focus on the perspectives of people with lived experience. We recognise that support pathways must be shaped by people with lived experience, as they are best placed to tell us what does and does not work for them. For this project, we wanted to hear from people who had experience of suicidal thoughts, feelings, or acts, as well as issues with alcohol. To do this, we conducted a questionnaire, and then invited five participants to be interviewed about their experiences in more detail.

Missing lifelines - alcohol and suicideClear patterns
We asked participants about the different types of support they were offered and received for alcohol issues and suicidality. Clear patterns emerged from the interviews – it was evident that peer support networks and third sector services form a vital part of the support pathway. Many participants highlighted that spending time with others who shared similar experiences was extremely profound and impactful, and peer support groups were consistently described as a highlight of people’s support pathway.

We also heard many positive descriptions of third sector services, where people reported feeling listened to and empowered to make choices about their care. Participants also spoke highly of support helplines.

Worryingly, we heard from many participants that crisis support, particularly at A&E, was the worst part of their support pathway. Healthcare professionals at A&E did not always understand the role of alcohol in suicidality, and follow up care was described as inconsistent and lacking in genuine compassion and interest in a person’s needs.

One of our interviewees, Louise, spoke about her experiences. She described a cycle of self-harm and suicidal behaviour that led her to A&E, where she was treated and discharged without follow-up care on more than one occasion.

During this time, Louise felt that alcohol was her only coping mechanism for dealing with traumatic events from her childhood, but she also recognised that her drinking was increasing her suicidality. Louise couldn’t recall any health professionals asking about her drinking, and when she did seek out support, by attending a local AA meeting, she felt she had been left to ‘clutch at straws’.

alcohol suicide linkIntense support
The recurring theme of people’s positive experiences can be summarised in one word: consistency. It was essential that people were able to develop a relationship with a support worker, and did not feel that their support was conditional on ‘getting better’ within a certain time frame. This is especially important for people seeking support for more than one issue, who are more likely to need longer key worker sessions and more intensive support.

It’s clear that navigating the support system is still difficult and confusing for many people. Participants said they were put off seeking help by uncertainty about what the next steps might be, and how the rest of their lives would be impacted.

Participants also felt they needed to present a certain way or say the right things at their first appointment in order to access support. Several referred to feeling ‘lucky’ if they were offered any help. We heard about people being made to feel like they should be able to help themselves, or that they are not ‘unwell enough’ to deserve support and compassion. These assumptions stem from pervasive stigma around mental health, alcohol and suicidality, and a misunderstanding about the relationship between them.

No wrong door
The resounding message from our participants echoes the existing commitment to person-centred care within the Suicide prevention strategy for England and other recent policy documents. We hope that this work can form part of a body of evidence from lived experience perspectives emphasising the importance of the ‘no wrong door’ approach.

Over the next year the SPC will be developing more practical guidance on how the ‘no wrong door’ approach can be embedded and implemented in the treatment sector. We need to ensure that once someone has made the important and brave decision to access support they’re not turned away by healthcare professionals perceiving them to be under the remit of another part of the system.

Holly Wood is policy and public affairs officer at WithYou

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