Over the last decade the hallowed principle of ‘evidence-based policy-making’ has become cliché in government and policy circles in the UK, and it is now generally accepted that public policy can only be as good as the evidence that it is based upon. An important outcome of this development is that the Government is now expected to base all policy initiatives on evidence that firstly, an initiative is needed and secondly, it is likely to achieve the desired outcomes. The Government must then collect data to allow monitoring of whether the initiative is successful in achieving the identified policy outcome, and whether it is achieving value-for-money.
Once the Government has identified a particular social group, such as children in care or NEETS (young people not in education, employment or training) as a policy priority and has invested in improving outcomes for this group, it will tend to increase the quantity of data that is collected on the group to allow for greater monitoring of their social outcomes (for example, educational attainment or offending behaviour). However, the flip-side of this process is that if the Government is unaware of a social problem or does not view a social group to be deserving of Government investment, it is less likely that it will choose to collect data on the problem or social group. This can lead to a circular situation in which an issue is not identified as a policy priority because no data exists, and no data is collected because the issue has not already been identified a policy priority. The outcome of this can be a policy blind spot.
Demos’s new report The Truth About Suicide exposes this significant problem in the context of policy on suicide. The UK Coalition Government’s new suicide prevention strategy, which was published for consultation last month, currently focuses its efforts on five groups that it deems to be at most ‘high-risk’ of suicide. These groups are: people using mental health services, people who have previously self-harmed, people in contact with the criminal justice system, men aged under 50 and occupational groups including doctors, nurses and farmers. To defend this choice of priority groups, the strategy flexes its evidence-based credentials:
In identifying the high-risk groups who are priorities for prevention we have selected only those whose suicide rates can be monitored – this is essential if we are to report on what the final strategy achieves.
However, what the strategy does not acknowledge is that these ‘high-risk’ groups can be monitored because they have already been targeted by suicide prevention policy (as initiated by the Labour Government in 2002) for the previous nine years. It remains unclear why these groups were initially selected for data-collection and monitoring and other social groups were not.
Demos’s research for The Truth About Suicide found that a growing body of evidence demonstrates that people diagnosed with cancer and other diseases including Motor Neurone Disease and HIV have a higher risk of suicide than the general population. However, despite this evidence, no national data is currently collected on the role of serious physical illness as a risk factor for suicide to allow for monitoring. As a result, little is known about the extent of the issue.
To fill this evidence-gap, Demos conducted research with Primary Care Trusts (PCTs) and coroners to explore what proportion of people who die by suicide have either a chronic or terminal illness. We received good quality data from 29 PCTs and were also able to conduct a detailed audit of Norwich Coroner’s District’s suicide inquest records. Both sources of data suggested that approximately 10 per cent of suicides involve a person with either a chronic or terminal illness. Chronic illness was associated with a larger proportion of suicide deaths than terminal illness (approximately 10 per cent compared with 2 per cent according to the PCT data). According to published data 4390 people died by suicide in England in 2009. Therefore, these findings suggest that around a tenth of these, or 400 people, who die by suicide each year had a chronic or terminal illness at the time. This is more than five times the number of people who die by suicide while in custody – one of the ‘high risk’ groups identified by the Coalition’s new strategy.
If the Government continues to fail to address this ‘blind spot’ and does not improve its data collection on the association between physical illness and suicide, it will be unable to develop an informed policy response to this problem. Therefore, in The Truth About Suicide, Demos calls on the Government to improve its data collection and monitoring of suicide, and to clarify the responsibilities of coroners and PCTs to collect this data at a local level. We cannot achieve ‘evidence-based policy-making’ unless there is political will to collect the evidence.
Louise Bazalgette is a Researcher at the think tank Demos and lead author of Demos’s new report The Truth About Suicide. The full report can be downloaded from the Demos website.