This programme contains some scenes
which some viewers may find upsetting
and some strong language.
The word that you hear is "selfish."
I think, erm,
that used to get bandied around quite a lot, like,
"Why would they be so selfish?
"Look at the people they're leaving behind."
They literally think that everybody else around them will be
far better off without them there.
The voice in my head said, "Jump now!"
And I did.
Your world is turned inside out.
And the shock is extraordinary.
Quite simply, if I knew 10% of what I now know,
it's highly likely that my son would be alive.
I'm Dr Xand van Tulleken.
Over the years, I've seen lots of people coming through the doors
of A&E after they've attempted to take their own lives.
But for me, there's one UK statistic that is particularly worrying.
The hard fact is that suicide kills more men under the age of 50
than anything else.
More than car accidents, more than cancer.
According to the statistics, the most likely thing to kill me is me.
And I want to know why.
RADIO: Roger, we just received a CAD.
It said it, "Looks like he may jump."
We might have a job.
Battersea.
I'm joining the night shift at Tower Lifeboat Station in London
to see what it's really like on front line
of the fight against suicide in this country.
RADIO: Make your way down and just stand by for further information.
Reports that the person is now out of the water.
RADIO CHATTER
Fortunately, in this case, the man is already
receiving help by the time we arrive.
RADIO CHATTER
RADIO: ..safe and well. And we understand that
he's waiting with one of your landside units at that location.
But this call-out is just one example of a much bigger problem.
In the UK, someone takes their own life every 90 minutes.
It's estimated that for every person who dies by suicide,
20 more people attempt it.
That's got egg on it, which is good protein.
This is the meat one.
And the sad fact is
that if it weren't for the many last-minute interventions
by teams like this, the death rate would be much higher.
People who've been trying to take their own lives,
are there people where you get them out
and they're glad that they weren't successful?
A lot of people are just so desperately sad, and they'll tell
you, "I just wanted to end it all today."
Some of them will swim away from the boat.
We've had people duck-dive back under the water
to try and end it all, but then we've had a lot of people tell us
that they regretted it, just deciding on that particular day
that they'd had enough and wanted to end it all, but then we've
managed to get some feedback from them
letting us know that they're all right and,
"Thank you so much for saving me. I was just having a bad day."
It's clear to me that to prevent more suicide deaths,
we need to intervene much earlier.
But in order to do that, we need to better understand
what causes someone to get to the point of suicidal crisis
in the first place.
When I was younger, I found the idea of anyone thinking about
or trying to take their own life impossible to relate to.
But 20 years on, a lot of things have happened.
I've got a son who lives thousands of miles away,
which I feel very guilty about.
I worry about him. I worry about his future.
I worry about money. I worry about my career.
I've messed up relationships, and...
All of those things make me relate
to thoughts of suicide quite differently.
I now feel that I can relate to them
because I've experienced them myself.
And it's made me realise that no-one is immune
to the effects of suicidal thoughts.
It was a cold, crisp day.
The sun was shining and it was bright and normal.
And, in that sense, there was no difference between that Monday
and any other Monday.
I became aware that something maybe wasn't right when I heard,
strangely enough, on the radio,
a traffic report that mentioned the name of our village.
And we only live in a small village,
and you never hear your village on the radio particularly often,
and that obviously caught my attention.
Almost exactly the same time as
there was a very large knock on the door.
And some very large policemen walked into our house...
..and obviously informed us as to what had happened.
They leave you a leaflet.
And it was rather as if somebody had opened the front door
and thrown a hand grenade into our house.
And you're staring into an abyss of grief.
I can only describe it like that.
Your world is turned inside out.
Well, this is just like thousands of other village stations
up and down the country.
This is where Edward used to get the train up to Cambridge
for his sixth form college every morning and every afternoon.
Edward told five different medical professionals
that he wanted to potentially take his life on the railway.
And nobody told us.
Even though he had explicitly given his consent
for his parents to be consulted, on two occasions.
The very simple fact of the matter is
if I'd known at all that my son had any suicide ideation
involving the railway, do you honestly think I would have
let him go anywhere near the railway station in the very village
that he lives in and travelled on every single day?
We were never told.
Hey, son.
When Edward died, he was head boy at his school
and had recently been offered a place at Cambridge University.
We should not underestimate the catastrophic scars
that suicide has on society.
Time does not heal all.
You just learn to manage.
And you go through a period where
you wish the world would stop turning.
Ever since Edward's death, Steve has been trying to understand
how it could have been prevented.
It was really here that my journey into the whole issue
of mental health and suicide began, two and a half years ago.
I stood next to my son's coffin, here in this church.
I made him a public promise.
I promised him that I would thoroughly investigate
his terrible demise, but at the same time,
I would thoroughly investigate the whole issue of mental health
and suicide.
And what was clearly happening to his generation, and indeed,
across our society.
Traditionally, researchers trying to understand what leads someone
to take their own life have looked to mental illness
for an explanation.
My biological mum and dad...
..dealt terribly with severe mental illness,
which they masked and coped with by using hard-core drugs and alcohol.
They would leave us in very dangerous situations,
barely clothed, lying in a diaper, maybe,
screaming and crying not to be neglected.
Until one motel clerk heard our screams and cries and said,
"Enough is enough."
And he called the police.
So the beginning of my life was very traumatic.
And one day, Debbie Hinds showed up.
And very soon thereafter took me home.
I had a beautiful childhood after that.
And both my sister Elizabeth, from a different family, and myself,
were adopted on the same day, March 17th, 1986.
In fourth grade I'd heard voices, like auditory hallucinations,
but I didn't know what they were - I was in fourth grade.
And of course I didn't tell anybody, because I was scared.
And I had a complete... What they would then call a mental breakdown.
My mum picked me up...
..we had a family meeting.
I was then to see my first psychiatrist
in a few days after that.
It was terrifying.
Kevin was diagnosed with bipolar disorder with psychotic features.
It is, uh, 6am. Time to get to work.
So, I'm going to share with you guys my morning routine.
Morning coffee.
I'm going to take my medications before I work out.
And this one here is a mood stabiliser and antidepressant.
Formerly known as manic depression,
bipolar disorder can cause people to become hyperactive,
followed by long periods of feeling very low.
And it's a big, smelly pill.
And then this one here.
This is my second anti-psychotic, because, as I said,
without these kind of medications, my psychosis
can get pretty terrifying.
I probably have suicidal ideations two-three times a month.
Um... Planning, much more rare.
Once every couple of months.
I take this regimen twice a day every day.
I take them at the same time, no matter the time zone.
Because that allows your brain to get used to
your daily function, and it actually lends itself
to helping someone with mental illness stay as stable as possible.
Here we go.
Bottoms up.
We know that having a mental illness can increase your risk of suicide.
The level of risk varies for different conditions,
and research shows that worldwide, people like Kevin,
who suffer from bipolar disorder,
are up to 30 times more likely to die by suicide
than the general population.
I was having this constant conversation with a man
in the mirror that I know longer knew.
He would tell me how horrible I was, how useless I was.
"Kevin, you're so fucking worthless."
"Nobody cares about you."
"Nobody loves you."
"Everyone hates you."
"I'm going to kill you."
"And there's nothing you can do."
That would replay and repeat every day.
I so wanted to live...
..but my...my brain was trying to kill me.
Trying to predict and prevent suicide attempts
is heartbreakingly difficult.
Mental illness is obviously a very important factor,
but the majority of people with a diagnosed mental illness
will never go on to attempt suicide.
And the reality is that there are many, many more people out there
with suicidal thoughts who are not in contact
with mental health services.
The extent of this problem was recently revealed
in a ground-breaking survey published by Men's Health magazine.
So I've come to meet the magazine's editor in chief, Toby Wiseman,
who's agreed to talk me through some of the results.
Toby, you've reached out to your readers
and you've got 15,000 of them to respond
to a survey about their mental health. Mm-hm.
One of the bleakest stats in here,
which you've just put in a black box right in the middle of the page,
is that 56% of the men who responded admitted
to having had suicidal thoughts.
So, most men who you asked...
Yes.
..had thought about killing themselves.
What's interesting about that statistic is it's not necessarily
to say that 56% of men are mentally ill.
Suicide, the inclination to take one's own life,
or at least even consider it, isn't necessarily
wrapped up with someone having a long-standing mental condition.
But, nonetheless, it is indicative of a situation that men
are disproportionately finding themselves in
which desperately needs attention.
It's a shocking statistic, but there were other results from the survey
which Toby thinks may shed light on why so many of these men
have thought about suicide despite having never been diagnosed
with a mental illness.
Well, perhaps the starkest one is the fact that 70% of our respondents
acknowledge that their own personal mental health
was not what they would term good. Um...
I mean, that really stood out to me, that one.
Yeah. I think throughout the whole of this survey,
what's really, really sort of come to light is that there is
this conflict in notions of masculinity,
in the sense that all men these days subscribe to the idea
of the new man.
But I think men are in general struggling to reconcile that
with an older, shall we say, idea of masculinity,
which is still hard-wired, certainly into a certain generation
of some 30-50-year-olds.
And so I think through our surveys we learned that
men still define themselves by their career.
It gives them a sense of self-esteem.
I think men still find...
Of a certain age, think very much that they should be
the, um, the breadwinner and supporting the family.
And the struggle in trying to reconcile those different ideas
results in this kind of isolation and panic and withdrawal.
Despite the difficulties that many men find themselves in,
Toby thinks his survey shows that men are not unaware
of the danger this poses to them.
But the key thing, I think,
and I think this really gives you more of an insight
into the complexity of the issue, is that 69% of men were fairly good
at identifying markers of poor mental health in their friends,
in their family, partners, and intervening to help remedy that.
And yet not being able to look at themselves in the mirror,
acknowledge that they personally have a problem,
and to act upon that.
Do you think that's because people don't know where to go,
or do you think it's that self-care feels, um, self-indulgent,
or weak in some way?
I think people do know where to go.
I think perhaps men sort of back themselves into a corner
where they don't feel able to, or at least sort of
fighting some kind of internal dialogue between the man
they feel they should be, and yet the man that they can't help but be
is preventing them from speaking out.
Just like the men in Toby's survey,
I sometimes find it hard to ask for help when I'm feeling down.
It makes me wonder how many of the men I know
might be struggling in the same way.
I first met Dan Turnbull, he was a barman at my local bar,
The Black Bull, which is where we all used to go.
We had very similar interests.
I guess we were both into the social scene, we liked going out.
Um, I mean, when I think back, we would be out five days a week.
He was the most confident, outgoing,
funny guy you could ever possibly meet,
and you couldn't help but warm to him.
Dan built up such a persona that everything is
absolutely fine in my world.
He was one of those.
He didn't really talk about his feelings.
And to the outside looking in, he had everything.
And I think he worked really hard to try and protect that image,
and I think he worked too hard in the end.
I think he was struggling, and we could tell he was struggling.
I mean, to talk about social media,
certain things he was putting on when he'd a drink,
where you understood that something's not quite right here.
Unfortunately, the circle of friends that we had,
because of the type of guy Dan was, they saw it as banter,
so they would get involved in banter,
and I think that didn't help.
I think what Dan needed was an arm round his shoulder,
but nobody really understood just how low he'd actually got.
And I think on the back of some pretty bad life events
in terms of his relationships, and he'd lost his job.
I think everything just started to cave in a little bit,
and I could see the cracks appearing.
I remember it so well, unfortunately.
My friend Jamie rang me, and he just said, "Have you heard about Dan?"
And I was, "Well, no.
"What you mean, have I heard about Dan?"
And he said, "Apparently he's tried to kill himself."
And I just remember, I was just lost.
I didn't know how to process this.
I couldn't believe it.
I made a couple of phone calls,
I spoke to Danny, and he confirmed he was in the hospital
and it didn't look good.
And I remember stood in this pub waiting for a text, essentially.
Just, "Look, please keep me informed."
And I can still to this day see the text that came through.
"He's gone." And I...
What do you do? I just broke down.
I didn't know what to do.
Nothing... It just didn't make sense.
Because I hadn't seen it coming.
I'd understood he was down and he wasn't feeling great,
but he was just the last person you could ever have imagined
going through with something like that.
And one of the worst parts about it for me,
I've kept all of Dan's text messages.
It's nice to keep him close and to be able to laugh and look through
them, but just three months before he died he'd actually...
He'd used the words, "I'm on suicide watch, mate."
So looking back at that, it's difficult.
The challenge of understanding of what causes someone
to take their own life is further complicated by the fact that
suicide rates are not the same across the country.
So I'm headed up to the north-east of England,
which has one of the highest suicide rates in the UK,
to see if I can find out how your risk of suicide
could be linked to your postcode.
Statistics show that if you live in the north-east,
you're around 35% more likely to die by suicide
than if you live in London.
I'm meeting Shirley Smith from the charity If You Care, Share,
which works with people who have been bereaved by suicide
and people who are thinking about taking their own life.
The pink are female, the blue are male.
Each represents a death by suicide. Wow.
And these are only the referrals that have been made into service.
What I guess is very, very depressing and very shocking is that
you have two huge bags of pins down there,
that you will keep filling this board.
Unfortunately, yes.
Wow.
I'm looking at this, which is obviously not a very big town...
No.
And that's...
In three years, 15 suicides, something like that? Mm-hm.
That's unbelievable.
Shirley set up the charity after losing her 19-year-old son, Daniel,
to suicide in 2005.
Before Daniel's death, he had not been diagnosed with a mental illness
nor shown any outward signs of his intentions.
So I want to know what Shirley thinks are the biggest risk factors
causing the high suicide rate in her local area.
Do you get any sense of what is driving that,
what's different about living here, and dying here,
compared to other places in the UK?
I think that's a really difficult question to answer,
because, you know, each death is individual.
What we know through the likes of audits is that
the three factors associated with, certainly within this area -
bereavement, finance and relationship,
or relationship breakdown.
So there isn't really a chapter in any medical textbook
on relationships, bereavement or finance.
Those aren't things that typically your GP can offer you
a lot of help with.
Rates of unemployment are higher than the average in the north-east,
and if you lose your job, that can have a huge impact on, you know,
erm, your home, the way in which your relationship may suffer,
and it can just be one of those that then basically it's like
the domino effect, that it has an impact on others.
But the problem goes deeper.
Research shows that those in the lowest socioeconomic group,
living in the most deprived areas,
are up to ten times more at risk of dying by suicide than those
in the highest groups living in the most affluent areas.
You're dealing with this very, very complicated picture
of all the different things that might lead someone
to take their own life, and whether it's safety nets falling away,
whether it's the experience of people around them, it's not...
..it's not something you can easily get a handle on.
And, you know, those safety nets become an integral part
of, um, staying alive.
If you don't have that coping network,
or maybe you're not aware of the support that's out there,
you feel alone.
And feeling alone, feeling hopeless, you know,
is a very, very dangerous place.
One other factor that can increase your risk of suicidal behaviour
is knowing someone close to you who has taken their own life.
Dan's death, it had a massive impact on me in a number of different ways.
At the time, I was suffering with depression. Um,
I was becoming a little bit too dependent on alcohol.
It did feel like I was living a double life.
I had this image on the outside of, um,
confidence, outgoing, everything was going great.
I've got a great job, all of this.
Whereas inside, my head was an absolute mess.
It was... It was hell on Earth. It was...
Nothing made sense to me.
Um, the simplest decisions I couldn't make
because they were so many things in my head
just bouncing off each other.
I didn't know where to turn,
I didn't know how to articulate how I was feeling.
In one fell swoop, I lost my job, I lost my home and I went bankrupt.
Those six, 12 months, I think it was around when my daughter was born
as well, I'd never felt more lost.
Sadly, I didn't talk to anybody about it.
I just kind of kept it inside.
It had a massive negative impact on the way I thought about everything.
I just became so depressed as a result of it.
Things have just got to the point now where
I'd actually rather not be here -
I genuinely meant that.
And that was the point where I said, "I'm going to kill myself."
It's a matter of when.
And that was the only option I saw that was available to me.
I got home, and I tried to hang myself.
And it's...
It's...
That's quite a blunt way to say it, and I appreciate that
it's not easy for a lot of people to hear or think about,
but it's not a nice place to be at.
It was that painful.
You would think if you are serious about not wanting to be here,
a bit of pain isn't going to stop you,
but there was something stopping me to the point where
I couldn't go through with that.
It's almost like a Eureka moment.
It was just...
This isn't... This isn't the way it has to be.
I don't have to go down this road.
I just kind of re-evaluated things, re-evaluated my life.
I almost made a decision that, "I'm here now.
"I don't want to go anywhere.
"Enough now."
And things just started to slot into place a little bit.
I became more comfortable in my own skin over a period of time.
To think that if things had gone the other way,
if things had gone a little bit too far,
I wouldn't be here today to be able to explain that,
the difference, and how that feels.
It's scary, but at the same time it just gives me something else to be
really, really thankful for.
I'm beginning to get a handle on the wide range of factors
that can lead to suicidal thoughts.
But there's one thing I'm still no clearer on.
Why is it that three times more men than women go on to die in this way,
when far more women than men attempt suicide?
I've come to Scotland to meet Professor Rory O'Connor.
I want to see to see if he can explain what causes this disparity
between the sexes.
One of the things I'm still really struggling to get a handle on
is why do more men take their own lives than women?
One of the key parts of the answer is to do with method selection.
Men sadly use more lethal methods of suicide,
so when they attempt suicide, they're more likely to die.
We've been doing work on pain sensitivity
and physical pain sensitivity, and so again,
we've looked at people who've attempted suicide,
both men and women, and men's physical pain capacity,
their physical pain tolerance, is higher than women.
And that physical pain tolerance may develop over time.
We don't really know how it develops, but we think it's partly
to do with the fact that if men engage in more risky behaviours,
engage in self-harm, engage in sort of more traumatic
or experience more traumatic events, we think that may elevate
your physical pain tolerance.
And men arguably are less likely to seek help,
and that's part of this puzzle of understanding why men
are more likely to kill themselves than women.
I guess, from my own experience, in my '20s, I had lots of friends,
or at least I had lots of... I had a big gang.
So I was at university, or my job involved lots of colleagues. Mm-hm.
In a way that now it doesn't feel the same.
I have a smaller group of people I can lean on.
You wouldn't have to remove many people from my life
for me to be pretty isolated.
I mean, that's important that you mention that,
because men in general, and this is a generalisation, I appreciate that,
they invest a lot of their emotional support in their partner.
Now, if their partner leaves them, or for whatever reason
the relationship breaks down, that man is potentially isolated,
or more likely to be emotionally isolated,
because men don't tend to have the broader network of emotional support
that women have.
When people say, "Speak to a friend,"
and I think as a guy you hear this particularly, people go,
"You've got to talk, you've got to open up,
"you've got to speak to people."
Do you literally mean just saying to someone,
"Are you about to kill yourself, are you suicidal?"
Indeed, there is evidence out there that asking somebody directly
whether they're suicidal can actually protect them.
Because it'll get them hopefully the help and support that they require,
but also the sense that they feel listened to,
this sense in which, actually, my feelings are validated
and somebody cares about me.
And that reaching out in moments of crisis can save a life.
My brother does phone me every once in a while and go,
"You're not going to kill yourself, are you?"
And it's... It's light-hearted. It doesn't feel significant,
but I hadn't...
It never occurred to me that, um...
That he may have saved my life, doing that.
As I've seen so far,
there are a whole range of factors that can lead to suicidal thoughts.
But the problem is that none of these factors help to predict
who will take their own life.
And without the ability to predict,
it is hugely challenging to prevent suicide deaths.
But what is nice is that there is something that
you don't need to be a health care professional to do,
that I can start doing immediately -
and that is communicating better and talking more, and asking people
specifically about suicide.
And I'm going to start by phoning my brother,
who I probably should've asked about this a long time ago.
We know that different people need different kinds of help,
and in the UK, there is a diverse range of support on offer.
But in the fight against suicide,
the power of a single conversation should not be underestimated.
Depression is a liar.
And it tells you...
..horrible things about yourself,
and it makes you believe them.
I got onto the next bus that took me to the Golden Gate Bridge.
I sat on the very back row in the middle seat,
and I started screaming aloud at the voices in my head.
The same words I would scream in the mirror.
"Leave me alone!"
"I don't want to die!"
"Why do you hate me so much?"
I remember saying that really loud.
And now 100 people are looking right down the barrel of the bus at me
and saying nothing.
And you have to understand, I had made a pact with myself on that bus.
If one person looks at me and says, "Kid, are you OK?
"Is something wrong?
"Can I help you, buddy?"
I told myself if one person does that or a variation,
I'll tell that person everything
and beg for their help.
Then the bus got to the bridge.
I walked out to the bridge walkway,
and I paced back and forth for 40 minutes, crying.
Bikers, joggers, tourists, everybody.
Police officers searching for suicidal people,
they all went by me, twice.
That's when a woman from my left approached me,
pulled out a digital camera and said, "Will you take my picture?"
She posed.
I took her picture quite a few times.
Then she walked away.
And that's when I said, "Absolutely nobody cares."
The voice in my head said, "Jump now!"
And I did.
The millisecond my hands left that rail
and my legs cleared it,
I had an instant regret for my actions...
..and the complete recognition that I just made the greatest mistake
of my life, and it was too late.
You hit that water like you're hitting a brick wall.
The impact reverberated through my legs, into my lower back,
and it shattered my T12 lower vertebrae.
I went down 70 feet,
and I opened my eyes.
I couldn't hear the depressed thoughts.
I could not hear the voice that was in my head telling me, "Jump now!"
I couldn't hear any of that.
Just the complete will to not die.
I bobbed up and down in the water and I did the only thing I...
The only thing I had control over.
I prayed.
I prayed on repeat, "God, please save me. I don't want to die.
"I made a mistake."
The coastguard got there.
They fished me out of the water.
This guy looks at me and he goes,
"Kid, do you know what you just did?"
I said, "Yeah, I do."
Guy next to him said, "Why?"
And I didn't know.
I said, "I don't know. I thought I had to die today."
they didn't give me a necessarily good chance of making it
through the first night.
The surgery, I believe, was ten and a half hours.
My father was at his office downtown.
He got to the hospital.
I lay there, you know, broken, battered, mangled, bent,
IVs in both arms, tubes everywhere and a mask over my face.
And this man, who I had not seen cry in 19 years,
waterfalls flew from his eyes.
And my immediate reaction was guilt.
And he looked down at me and he said, "No, Kevin, I'm sorry."
And his immediate reaction was guilt.
Guilt that belonged to neither of us.
People think that I did this and, "Oh, he's all better now.
"He realised he didn't want to die and now he's got his life back."
No.
Seven psychiatric hospital stays in the next 11 years
for suicidal crisis.
Which is fine, because I'm here.
For decades, researchers across the globe
have been investigating whether there is more that we can do
to reduce suicide deaths.
It is a hugely complex task,
but there are glimmers of hope.
In the very place where Kevin nearly lost his life,
work has finally started on a surprisingly simple solution
that could stop suicides at the Golden Gate Bridge forever.
Until 2013, Kevin Briggs was a California Highway Patrol officer
on the Golden Gate Bridge.
I patrolled the bridge around 17 years.
It's like home to me.
It's where I worked, it's where I spent many, many years.
I enjoy it.
I think it's fabulous.
During his time on patrol, Kevin got called to hundreds of people
who were threatening to jump from bridge,
but only two of them ever did.
Everyone else came back from the edge.
I think most people come back because they have that little
glimmer of hope, and that's what folks need.
Talking's important because many, many times,
folks are just looking for someone to listen to them.
Not to give them advice, not to write them a prescription,
not to say, "You know would you should've done?"
But to just listen, not to argue or blame or say,
"How could you do this to me?"
But simply to listen to what's going on,
and I think that is a real key to this.
But the problem for Kevin was that he couldn't always be there.
Suicide attempts could happen at any time of the day or night,
so he joined a campaign to help build a safety net
that will run along the entire length of the Golden Gate Bridge.
This is a big deal.
We've been trying to get this for many, many, many years.
And it's about 20 feet down or so from the sidewalk,
and it's going to protrude about 20 feet out from the bridge,
a marine material that will last, because this is a harsh environment,
and if someone does decide to jump, they'll get caught into this mesh.
It's very loose, and then the Fire Department will come out and assist
those people out.
So hopefully we can get them some help.
Studies have shown that when nets or barriers have been installed
on other bridges, they have dramatically reduced the number
of deaths by suicide, not only in that location,
but in the surrounding area as a whole.
If we remove a means, that impulsive act, they won't do it,
because they'll see that that means is taken away.
I'm hoping this will stop suicides
from the Golden Gate Bridge altogether.
Although this is clearly a powerful intervention,
it's unrealistic to think that we'd ever be able to restrict access
to all methods of suicide.
And that's why it's so important to be able to predict who is at risk
before they reach crisis point.
The problem is that there are so many factors
which can lead to suicidal behaviour,
from having a mental illness to being unemployed.
And most people who have these problems don't attempt suicide.
So predicting who will has so far been impossible.
But Dr Joseph Franklin from Florida State University
believes he may have cracked the problem of prediction
using the power of mathematics.
Is it Joe?
Yes, Xand. Hey, very good to meet you. You too.
So, we know that there are individual risk factors for suicide,
so what's the problem with using them to predict
who will die by suicide?
I think it would be a lot like asking,
"Why did this car break down?"
I guess, looking at the car, I would have absolutely no idea.
Yeah, precisely. It seems like an absurd question
to ask why did this car break down without knowing a whole lot more
about this particular car.
Is it fair to say that's how lots of people and even researchers
think about suicide? Exactly.
And what we've discovered over time,
through a couple of large meta-analyses that we've done
is that, unfortunately, no one thing,
or small group of things predicts much better than a coin flip.
Really? Yes. Really?!
Yes.
So, instead, Joe and his team looked for a way to understand
the interactions between multiple risk factors all at the same time.
To do this, they used machine learning algorithms,
something most of us use every day in the map apps on our phones.
OK, so the app says sort of to 15 minutes to your office. Mm-hm.
And it's using an algorithm to do that.
Yeah, exactly.
So what it's able to do that I as a human am not able to do
is it's able to consider way more data that I could possibly consider,
and it's also able to combine that data together
in a much more complex way than I could ever possibly combine it.
Joe's team developed algorithms to analyse thousands
of Americans' health records,
looking at details such as age and gender,
as well as physical and mental illnesses.
The algorithms work by considering combinations of up to 800
of these factors at a time.
You ingest all these millions of data points into your algorithm,
and what does it give you?
What does it spit out?
Well, we're able to predict both non-fatal suicide attempts
and suicide death with about 90% accuracy
a few years before it happens.
Wow. 90%?
Mm-hm.
It's astonishing that simply by looking at combinations of factors
instead of taking any single one on its own,
Joe's team could be transforming our ability to predict suicide
from being no better than flipping a coin to a staggering 90% accuracy.
This could completely revolutionise how and when
we intervene in suicidal behaviour.
So, we know the algorithms are good,
whether it's driving across town or predicting suicide.
But where do you go from here, then?
What you do with this data?
A huge part of what we need to do on our end is to work hard
with clinicians to say, "Here is all of the evidence
"of how clinicians are able to predict this
"very dangerous phenomenon,
"versus how the algorithm is able to predict this kind of phenomenon."
Yeah. There are very few things more nerve-racking in medicine
than trying to figure out, once you think someone is at risk
of killing themselves, saying, do you let them leave the hospital
or not?
And putting that decision in the hands or in the microchip hands
of a machine is a very difficult thing to do.
Yeah, exactly.
So I don't think that there's a clear answer at this point,
but I think that these are the sorts of issues that various stakeholders
need to get together to discuss. OK.
What Joe's work suggests is that if we applied machine learning
to the NHS database, we might be able to identify those at high risk
of suicide with far greater accuracy.
There are resource implications and ethical challenges,
but this kind of new technology could save thousands of lives.
So far, I've seen that both removing access to a means of suicide
and improving our ability to predict who's at risk
of taking their own life can be hugely powerful interventions.
But in another part of America,
a group of doctors are claiming that simply changing our attitude towards
suicide could produce dramatic results.
I'm in Detroit, and this city probably more than any other
in America has the risk factors for a high suicide rate.
Massive unemployment, high levels of crime, extreme poverty.
And I'm off to meet a medical team who decided a few years ago
to start a new approach to reducing suicide in this town.
And at the heart of their approach is an idea that I think
is pretty controversial.
Here at the Henry Ford Health System,
I'm meeting one of the founders of the Zero Suicide Programme,
Dr Cathy Frank.
Cathy. Hi. Hey. Nice to see you.
How are you? Very nice to meet you. Thank you...
The goal of the Zero Suicide Programme
is to completely eliminate suicide among the health system's patients.
How did the doctors and nurses react to that goal?
That just seems like a huge amount to ask of them.
We had a lot of staff who were very upset, thought it was unrealistic,
thought they would get sued, it would put us at risk.
But when you get down to the hard part of saying, "Well,
"if it's not zero, what is the goal?"
You really can't come up with another goal.
No-one's got an answer.
Yeah, I mean, is it going to be your loved one,
is it going to be my neighbour?
Who is it going to be?
So, in real terms, it can only be zero.
In order to get to zero,
the Henry Ford team decided to change their approach
to mental health care.
They asked primary care doctors to start screening
every single patient every time they saw them,
regardless of what they'd come in for,
to find out if they'd had suicidal thoughts.
Each patient who was found to be at risk
was referred for appropriate care.
Whether that was talking therapy, medication,
or even a visit to their home to remove firearms.
I'm keen to see the programme in action,
so Dr Frank is letting me sit in on a consultation with a patient.
Hey.
Thanks for coming. We appreciate it...
Mike originally came to Henry Ford to treat his bowel complaint,
Crohn's disease.
But during that process, he was also asked
if he'd had suicidal thoughts.
So, Mike, when did you first encounter the system here?
The process that started to ask you about suicide?
My GI doctor, she asked me all of the gut questions.
And that was for your Crohn's disease?
Correct. I'll tell her, "I'm having trouble with this," you know,
I'd mention the depression and anxiety and those things.
And then she put me in touch with the behaviour health team here.
Another important part of the programme is equipping patients
to help themselves out of suicidal crisis.
So today, Dr Frank is helping Mike to draw up a safety plan.
You've been at points where it sounds like you were very close...
Yes. ..to taking your life. Yes.
So we want you to be able to rescue yourself.
Sometimes it helps if I have someone to socialise with,
somebody I can reach out to.
Is that Mum and Kyle, or is that somebody else?
Probably Kyle over
my mum - I would go to him first.
OK.
It's striking that the process does involve friends and family
in a way that, maybe when I trained,
that would have not been a thing we would have done.
Is that useful?
For me, personally, it's essential.
I have to have my friends and family involved.
They are, like, the key to all this, so I need them involved.
I need them to sort of
know what's going on and how to react.
You start this process, and what results do you see?
Does any of it work?
Yes, it did. Our suicide rate decreased by 80%.
And we even had some years where it was zero.
Wow. Wow!
So it was very significant in terms of saving lives.
That is almost unbelievable.
The idea of getting, actually getting, to zero.
I remember when I was training that...
..we would literally say, and people would leave the clinic
and we knew that they were at risk of suicide,
and almost to let ourselves off the hook,
you'd say, "Look, we know we can't stop everyone.
"We know that some of them will find a way."
It was literally the opposite of what you're saying.
Correct. That if we change the way we think about health care,
we can prevent suicides.
It's important to remember that Henry Ford is a private
health care company,
so despite the reduction of suicides among their patients,
some have argued that the poorest people, who are the most at risk,
are frequently not reached,
because they do not have private health insurance.
What I've seen in America is really encouraging,
because it suggests that there is a whole range of approaches
that could help us to reduce suicide deaths,
and it's possible that there's a lot more we could be doing
in this country.
At the moment in the UK, the Government target is to reduce
deaths by suicide by 10% before the year 2020.
But many campaigners think we should have a much bigger goal in mind.
Aiming for zero suicide,
identifying everyone at risk and treating them,
seems to me to be a much better idea.
And, increasingly, there are a large numbers of people
who feel the same way.
Steve Mallon, whose son Edward took his own life in 2015,
has spent the last year developing and initiative called
the Zero Suicide Alliance.
And today it's being launched at the Houses of Parliament.
Hello. Very nice to meet you. How are you?
Thank you so much for coming. It's a pleasure. Much appreciated.
Well, I had such a good visit to Mersey Care. Yes.
The aim of the Alliance is to bring the goal of zero suicide
to the UK, and apply it to a range of sectors, including the NHS,
education and the emergency services.
I think it's amazing that you're not asking for more money in the NHS,
but you're saying we can something better with the resources we have.
There's no point asking for more money,
because there isn't any there.
So, frankly, I think the Government would be foolish
not to support this, if only on financial grounds,
because if we can prevent people reaching crisis,
if we can prevent people taking their lives,
we will not only improve the happiness of our society,
but we will save billions in care costs
and all of the costs associated with mental illness.
It's estimated that each suicide death in the UK costs the economy
over £1.5 million.
So far, Steve has signed up around half of the NHS Trusts
in the country to the Zero Suicide Alliance.
And his hope is that, after today, the rest will follow.
My beloved son Edward took his life on the railway 500 yards
from where we live in Cambridgeshire
a little over two years ago.
It was six weeks after his 18th birthday,
which we celebrated over there at the Shard.
There are no words for such utter devastation.
The experts will tell you that you have an increased chance
of taking your own life if you have lost a close family member
to suicide.
Trust me when I say I know what that statistic looked like.
A complete abyss of grief.
At the bottom of that abyss, ladies and gentlemen,
I made my son a promise.
I stood next to his coffin at his funeral,
and I vowed before the congregation that I would investigate
his terrible death, and where appropriate,
and in the most effective way, seek reform in his memory,
and, indeed, on behalf of his generation.
It's the very least he would've expected of me,
and the very least he deserves.
I obviously asked myself, was this a horrible accident,
was this an isolated incident?
Because obviously we don't live in a perfect world.
And any system will have failings. Tragedies will always occur.
And I very rapidly came to the understanding
that this is not an isolated case.
This happens every single day.
If we took the very best of what we already do with the very best
of intentions, from every part of the system and from every locality,
and combine this in a single model,
change some basic protocols and attitudes,
and then deploy it everywhere,
I'm convinced that we will rapidly push back the frontiers
of both mental illness and suicide.
This is what the Zero Suicide Alliance is all about.
Society is now ready, and so are we.
Ladies and gentlemen, I thank you for your attention.
APPLAUSE
Have we got a society in which my son would still be alive?
We have not yet got there.
But I'm determined that we will.
It's incredible that Steve's managed to garner support
not just from not only all over the UK,
but from the highest levels of Westminster,
to work on zero suicide.
I had a very strong sense of how many people were in that room
because they'd lost someone to suicide.
And how important it is for the Government
to make good on the commitments they made in that room.
To prevent more people going through what Steve has gone through.
One of the astonishing things that I found during the making of
this programme is that funding for research into suicide prevention
lags well behind many other areas of health.
In fact, estimates show that there is 22 times more funding for
each cancer patient than for each person affected by mental health
problems, and suicide research gets an even smaller slice of that pie.
What I've learned is that we have to think of all these deaths from
suicide as preventable.
I don't know if we can ever actually get to zero suicide,
but I don't really care.
I think zero suicide is the only mind-set to get us
the reductions that we really desperately need.
I think there are two things that we can do.
The first is in the health care service.
I think we should be moving towards a place where most health care
professionals in most health care interactions are thinking about
mental health, and possibly asking about suicide.
And the other thing is something that you can do at home -
that we can all do.
Turn to the person next to you or phone a mate and ask them,
not just, "Are you doing OK",
but, "Are you thinking about killing yourself?"
You might save a life.
And if you're watching this and you are thinking about killing yourself,
please reach out, tell someone, and get the help you need.