In this blog, Sarah Marsay from Samaritans and Robin Pollard from With You talk about recent work from the Suicide Prevention Consortium to capture the views of people with lived experience of alcohol use, suicidality and/or self-harm.

There is a close, well-evidenced relationship between alcohol, suicide and self-harm. This relationship varies depending on a range of factors, including how different groups of people use alcohol. For example, heavy episodic or binge drinking is associated with increased likelihood of attempting suicide amongst adolescents, while people who are dependent on alcohol are approximately 2.5 times more likely to die by suicide than the general population. In England, nearly half of all patients under the care of mental health services who die by suicide have a history of alcohol use.

Despite these links being well researched and documented, the Suicide Prevention Consortium* found the voices and perspectives of people with lived experiences were often hard to find. In 2021, the consortium launched a new project exploring the relationship between alcohol, suicide and self-harm, focusing on the perspectives of people with lived experience and putting their insights at the forefront of our work.

The complex relationship between alcohol use and mental health

From the 125 people with lived experience that completed our surveys, we heard how people had a diverse range of relationships with alcohol, and there were many different ways they viewed the link between their suicidality, self-harm or mental health.

For some people, alcohol helped them reduce their inhibitions, while for others it was a coping mechanism – usually a way of dealing with trauma. Many people were aware of why they drank, and the effect it had on them. This included both the negative impact on their mental health or mood at the time of drinking, but also the longer-term impact, often experienced days or weeks later.

“Alcohol used to take all of the bad feelings away for the moment but always left [me] sad after. Depression hits the day after I drink.”

One of the most common themes we heard was how people used alcohol to cope with other underlying issues. We also heard how support services were sometimes unprepared, unable to understand or unwilling to respond to the underlying trauma.

Alcohol as a barrier to mental health services

We heard how despite alcohol being closely linked to people’s mental health and suicidality, services they accessed struggled to treat them as such. Experiences of support services working in isolation were common. Some people said they felt afraid to disclose their alcohol use when seeking mental health support fearing they could be deemed ineligible for mental health treatment, and/or because they didn’t feel ‘safe’ to do so. Far too many people told us they couldn’t access appropriate support due to strict eligibility criteria, often at a local level, excluding people from the help they need. Their co-occurring needs around alcohol and mental health weren’t treated as a shared responsibility for different services.

However, despite these systemic problems, we did hear examples of good individual practice. Many people in our survey experienced what they felt was good care, and pointed to the expertise, empathy and compassion of individual practitioners who sought to understand their personal experiences with alcohol.

The role of alcohol in suicide is not taken seriously 

One of our most concerning findings was that some people who were intoxicated at the time of a suicide attempt experienced dismissive attitudes from frontline professionals who down-played or misunderstood the seriousness of the attempt/intent and failed to offer appropriate support. The persistence of shame and stigma associated with alcohol issues was commonplace.

“I once attempted suicide whilst drunk was taken to A&E and treated with disdain by the nurses because they just saw a drunk young girl… What they didn’t ask/know was that I’d been planning to die for months… They assumed because I was drunk that it was a silly drunken cry for help.”

Integrated care, improved training, and the need for additional lived experience insight

It was clear from responses from both people with lived experience and practitioners that improved specialist and integrated care is essential, along with a better understanding among professionals that there is ‘no wrong door’ for people with co-occurring conditions who want to access services. The indications are that national guidance may have been poorly implemented, or misinterpreted, locally, and access to services remains inadequate in some areas. There is also a need to ensure all frontline staff receive appropriate training to ensure that everyone who is experiencing suicidal thoughts is treated appropriately and with compassion.

Though we have tried to bring the voices of people with lived experiences to the fore, we know we have just skimmed the surface. There is a need for further exploration of people’s experiences of both alcohol and suicide, including examining the intersection with particular identities and life experiences, as well as the protective factors that can reduce peoples’ suicidality. This would further support the development of policies and services that are able to intervene more effectively and earlier. Insights from particular population groups, especially those that appear to be at higher risk, may help to design more interventions and services for people with specific needs.

Click here to access our briefing in full or to learn more about the Suicide Prevention Consortium.

* The Suicide Prevention Consortium is led by Samaritans and includes With You, the National Suicide Prevention Alliance (NSPA) and Support After Suicide Partnership (SASP).

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