The new analysis shows that between 2019 and 2021, 46,200 people lost their lives due to Death of Despair in England – the equivalent of 42 people every day.

However, in the North East of England more than twice as many people lost their lives due to Deaths of Despair compared to London.

Deaths of Despair is a collective term for deaths from alcohol, drugs and suicide, which tend to occur much more frequently in socially deprived communities.

The study, led by academics from Health Equity North (HEN), The University of Manchester and the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater 91ֱ�� (ARC-GM) examined local authority data to identify geographical trends and risk factors that contribute to these kind of deaths.

The analysis found that northern regions and coastal areas of England are experiencing a much higher burden of mortality from these avoidable causes.

Out of the 20 local authority areas that experience the highest rates of Deaths of Despair, 16 are in the North, and all of the top 10 areas are in the North.

Conversely, none of the 20 local authorities with the lowest rates of Deaths of Despair are in the North.

The analysis also looked at associated factors that predict the risk of these kinds of deaths; living in the North was the strongest predictor. Local authorities with higher proportions of unemployment, white British ethnicity, people living alone, economic inactivity, employment in elementary occupations, and people living in urban areas had higher rates of Deaths of Despair.

The study found that:

• On average, 14.8 per 100,000 more people die from Deaths of Despair in the North compared to the rest of England
• Even after accounting for multiple social and economic factors, living in the North of England was associated with a 5.8 per 100,000 increase in Deaths of Despair rate
• More than twice as many people died from Deaths of Despair in the North East of England than they did in London (54.7 per 100,000 and 25.1 per 100,000 respectively)
• The highest rate of Deaths of Despair in England (at local authority level) is in Blackpool – almost 2.5 times the national average
• Three areas in England, all in the North, experienced more than double the average Deaths of Despair – Blackpool (83.8 in 100,000 deaths), Middlesbrough (71.6 per 100,000 deaths) and Hartlepool (70.5 per 100,000 deaths)
• Alcohol-specific deaths made up almost half of Deaths of Despair in England, accounting for 44.1% of all such deaths
• Deaths of Despair accounted for 2.9% of all deaths in England
• Deaths of Despair were highest among people aged 45-54 (55 per 100,000)
• Deaths of Despair accounted for 2 in 5 deaths in people aged 25-29 (41.1% of all deaths)
• Coastal local authorities had a significantly higher average Deaths of Despair rate than inland local authorities (41.6 per 100,000 compared to 31.5 per 100,000)

The study is believed to be the first of its kind to explore geographical patterning and contributing causes of deaths of despair in England.

The researchers are calling on government to prioritise preventative policies which address the longstanding inequalities across England, with fair funding allocation distributed according to need.

Christine Camacho, lead author and PhD Fellow NIHR ARC-GM, said: “Our study shows that some of the risk factors of deaths of despair have a more pronounced impact in the North of England, where inequalities in health and wealth are persistent and have widened during recent decades.

“As well as specific public health interventions to prevent deaths from drugs, alcohol and suicide, we need to move further and faster with Levelling Up in England to tackle the underlying inequalities which are leading people to die from despair.”

, Co-Academic Director at Health Equity North, and Senior Lecturer in Health Economics at The University of Manchester, said: “Time and time again, we see research exposing regional inequity with the North of England often being hit the hardest. Unsurprisingly, the findings of this study further highlight the persistent health inequalities in northern regions. This can’t be ignored – it is not acceptable that more than twice as many people in some deprived communities in the North are dying due to deaths of this nature.

“This research provides policymakers with a novel insight into the associated social factors of deaths of despair, which can help when developing comprehensive strategies that not only target specific risk factors but also consider the intricate relationships among these causes, contributing to more effective prevention and intervention efforts.”

The MISST (Mental Imagery for Suicidality in Students Trial) is a collaboration between Greater 91ֱ�� Mental Health NHS Foundation Trust, University of Lancaster, and The University of Manchester.

It is funded by the National Institute of Health Research (NIHR), the research partner of the NHS, public health and social care.

Moving away from home, academic stress, and financial pressures can all impact on students, who sometimes struggle with their mental health at university.

A previous study found that up to 42% of students thought about suicide in the previous 12 months.

Universities offer counselling and mental health services which  are a source of support and help for struggling students, however, further effective therapies for preventing suicide are still needed.

MISST focuses on a novel talking therapy that is designed to help strengthen a person’s ability to recall and relive positive memories.

the therapy  is used as a way to counter the spiral of negative thoughts and feelings that can lead to suicidal thoughts.

Psychologists argue that by having the therapy, a person may be able to strengthen their ability to break free of spiralling  negative thoughts by immersing themselves in memories of more positive times.

Co-Principal Investigator Dr Jasper Palmier-Claus from Lancaster University said: “When people are suicidal, we know it can be hard for them to focus on positive experiences in the past, or imagine positive experiences in the future. There is a sort of tunnel-vision. The therapy aims to help people break free from this state by re-connecting with positive experiences in their life.”

The trial will aim to test the therapy with students studying in the North-West of England, who have had recent difficulties with suicidal thoughts or behaviour.

Participants will be randomly put into a group to either receive the new therapy, or regular treatment through their university counselling or support services.

MISST is a feasibility trial, which means the aim is to determine if a more powerful large-scale clinical trial would be possible to run. This includes checking what students think about the therapy and whether it is possible to recruit people to take part.

Co-Principal Investigator Dr Peter Taylor from The University of Manchester said: “This is a first step, but an important one. This trial will give us the information we need to plan what we call a “definitive trial”, one that will then tell us how effective the therapy is. The aim is to work towards having effective therapies available for universities to help prevent student suicide.”

MISST was funded as part of a wider mental health research initiative run by the NIHR. You can find out more about it

Samaritans (116 123) samaritans.org operates a 24-hour service available every day of the year. If you prefer to write down how you’re feeling, or if you’re worried about being overheard on the phone, you can email Samaritans at jo@samaritans.org , write to Freepost RSRB-KKBY-CYJK, PO Box 9090, STIRLING, FK8 2SA and visit www.samaritans.org/branches to find your nearest branch.

To mark World Suicide Prevention Day on Thursday 10 September a patient safety research centre has created a virtual photographic exhibition, ‘Hope during the COVID-19 Pandemic: perspectives from people with personal experience of self-harm, suicide, and mental health.’

The exhibition of eight pictures is organised by a team from the National Institute for Health Research Greater 91ֱ�� Patient Safety Translational Research Centre (NIHR GM PSTRC) who work across the organisation’s mental health theme. The centre is a partnership between The University of Manchester and Salford Royal NHS Foundation Trust.

The mental health theme at the NIHR GM PSTRC work in partnership with a patient involvement and engagement group, Mutual Support 4 Mental Health Research (MS4MH-R), who designed the exhibition with the help of researchers. All members of the group either have personal experience of self-harm, suicide, and mental health services or of caring for someone who has.

Dr Leah Quinlivan, Research Fellow at the NIHR GM PSTRC, said: “Our virtual exhibition is a great way to visually raise awareness of World Suicide Prevention Day during these challenging times, and the importance of involving experts by experience in mental health research. Living through the pandemic has been challenging and the message of hope is now particularly relevant. We aim to bring that message to others through sharing the pictures from people who really understand what it’s like to experience recovery through tough times.

“We are grateful to our group for helping to shape our research which aims to improve patient safety. They have bravely shared powerful images which are extremely personal to them and are sure to bring hope to others during these strange times.”

The exhibition aims to build on the successes of a similar event from the group which was held at 91ֱ�� Town Hall to mark World Suicide Prevention Day 2019.

Dr Louise Gorman who is a Research Associate at the NIHR GM PSTRC and works alongside Dr Leah Quinlivan said: “Last year we shared pictures of hope from our public involvement and engagement group for the first time. It was a success both for the members of our group but also for the members of the public who visited the exhibition. We’re hopeful that this year the images will reach more people and spread the message of hope while reminding them that research is underway to help.”

There are around 10 members of the public involvement and engagement group who meet regularly. The group which includes members from across the North West was formed two years ago as an important part of the NIHR GM PSTRC’s mental health theme’s research. They have continued to meet, while observing social distancing rules.

Stephen, group member whose picture is included in the exhibition, said: “The title of my picture is ‘light at the end of the tunnel”. It’s an image of the pier at Southport and for me is my light at the end of the tunnel and reminds me to stay positive. I hope it helps to inspire others.

“Being part of mental health research is incredibly important to me and has a positive impact on my life. I’m hopeful that I’m helping to improve understanding and treatment. I understand what it’s like not to have any hope so was keen to share a picture which represents the hope that has got me through the COVID -19 pandemic. This year has been so hard for so many so we need hope more than ever. If any of our work can plant that seed then I personally will be so proud.”

Nav Kapur, Professor of Psychiatry at The University of Manchester and lead for the mental health work at the PSTRC, said: “Suicide prevention is one of our major mental health, public health, and societal challenges. Effective suicide prevention can only happen when we listen to the powerful and moving voices of people with lived experience. This is more important particularly now. “

There are two main studies underway by researchers at the NIHR GM PSTRC’s mental health theme. The first is investigating patient, carer, and clinician experiences of psychosocial assessment following self-harm, and their access to psychological therapies. The second, aims to examine how involving patients families in their mental healthcare can positively contribute to improved patient wellbeing and reduce their risks of self-harm and suicide. Both the studies are designed to improve safety and outcomes for patients.

Visit the virtual exhibition here -

Click on ‘start guided tour’ to begin the exhibition, and use the navigation buttons. The exhibition will be Tweeted from @PSTRC_GM.

Ambulance workers who took part in a University of Manchester led study have told of the complex challenges they face in responding to suicide without adequate training and support.

The qualitative interview study by experts at 91ֱ�� and Keele University, funded by the National Institute for Health Research is published in the journal Frontiers in Psychology.

The ambulance workers told the research team that as first responders to the scene of a death by suicide:

• they are exposed to many distressing suicides during their working lives, including the suicide of colleagues, and all had been personally bereaved by suicide;
• they are often faced with managing distressed friends and relatives of the deceased with little professional training in how to respond to those bereaved by suicide;
• there is little acknowledgement in the workplace that suicides may be traumatic, opportunities for staff debriefing are rare, and staff are reluctant to access work-based support services due to potential stigmatisation.

Though limited by a relatively small sample of 9 people from one English ambulance service in 2014, its themes, say the researchers, may be relevant in other parts of the UK and beyond.

“We know ambulance staff are exposed to suicide related incidents on almost a daily basis. However, we fail to identify, acknowledge and address their unmet needs dealing with this issue, despite our awareness that exposure to suicide, is a known risk factor for further suicide,” said Dr Sharon McDonnell, Honorary Research Fellow at The University of Manchester, Managing Director of Suicide Bereavement UK and PI of the study.

“All participants in the study reported losing at least one colleague to suicide. This finding alone highlights the urgency of future research, exploring the magnitude of this problem.”

She added: “Ambulance staff reported feeling helpless, hopeless, ill-equipped and unsupported in the workplace, when exposed to suicide. This issue was especially pertinent when they encountered intense grief reactions from those bereaved by suicide. The urgency of providing high quality care, support and training to assist and empower staff to manage these profoundly distressing circumstances cannot be underestimated.”

Full paper available at: 

Community pharmacy staff are to be offered training on suicide prevention, based on findings from a new study published today. As a result, a first of its kind training video has been developed and will also be available from today to mark World Suicide Prevention Day.

The research from the National Institute for Health Research Greater 91ֱ�� Patient Safety Translational Research Centre's () mental health theme was published in the journal, .

The team conducted in-depth qualitative interviews with 25 community pharmacy staff and identified 6 key themes. The first two; relationship with patient and suitable pharmacy environment formed a basis for interacting about suicide. If supported by training, staff felt that they could maximise opportunities for contact. The need to create facilitated referral pathways and understand more about restricting access to means was recognised.

Dr Hayley Gorton who led the research team whilst at The University of Manchester, said: “This is the first qualitative interview study which has explored the important role of community pharmacy teams in suicide prevention. Our research discovered that, staff felt they could do more to support individuals if they were given training.

“It is heartening to see that pharmacists and their teams recognise that they can contribute to the suicide prevention agenda and welcome training to support them to do so.”

Community pharmacists are the most visited healthcare professionals in the UK, with pharmacy teams caring for over 1.6 million people in England alone every day. Yet, these teams are seldom mentioned in the suicide prevention plans, which are a current national and global priority.

Dr Gorton has worked with the Centre for Pharmacy Postgraduate Education (CPPE) to make the training a reality. They have produced a suicide awareness learning video aimed at pharmacy teams.

The innovative training video aims to prompt pharmacy staff to reflect on their current role in suicide prevention, and what it might be in the future. Three special guests, who speak about their experience in relation to suicide, also provide learning messages.

Dr Gorton, added: “We hope that the CPPE suicide awareness learning video is the first step in supporting our colleagues to have potentially life-saving conversations.”

The GM PSTRC mental health theme is also launching a campaign today to mark World Suicide Prevention Day, #seedsofhope with a photographic exhibition at 91ֱ�� Town Hall. Pictures carefully selected by members of the mental health theme’s patient and carer involvement group to represent what hope means to them will be on display for the day from 10:30 until 17:30. Everyone who visits will receive a packet of seeds. Once planted pictures of the plants growth can be tweeted with using #seedsofgrowth to raise awareness of the research underway by the PSTRC to make a difference to the treatment of mental health.

Self-harm in middle-aged men increased significantly following the 2008 financial crisis, according to a study led by researchers at The University of Manchester.

The research from the Multi-Centre 91ֱ�� of Self-harm in England, funded by the Department of Health is published online by The British Journal of Psychiatry today (30 May).

The team investigated self-poisoning and self-injury in three cities, finding a quarter of all emergency department presentations for self-harm were made by men and women aged 40 to 59.

Risk of further self-harm was also high, with 25% attending hospital for self-harm again within 12 months.

The team, who examined the rate of self-harm in England from 2000-2013, showed that self-harm in middle-aged men increased by nearly 50% between 2008 and 2012.

The results followed the pattern of national suicide rates in middle aged men, though there was no equivalent increase in middle-aged women.

The researchers also found that self-harm in middle-aged men was associated with alcohol use and unemployment, as well as housing and financial problems.

Men in midlife who harmed themselves were more likely to repeat self-harm or die in the follow up period than women, but were less likely to be under the care of mental health services.

Dr Caroline Clements, lead author of the paper, said: “This is the first really detailed study of self-harm in people in midlife involving nearly 25,000 presentations to hospital. There were striking increases in the rate of self-harm in men which may well have been related to economic as well as clinical factors.”

Prof Nav Kapur, the senior author of the paper said: “Men in midlife are a group we are particularly worried about because of their high rate of suicide. This study shows how important self-harm is too. It’s the main risk factor for suicide but crucially it’s an opportunity to intervene.

“Our research highlights the potential importance of economic factors, so providing advice for unemployment, housing, and financial problems is likely to be helpful. But improving access to services and tackling alcohol misuse could have a big impact too.

“Some men, though, might be reluctant to seek help for their problems and there are a number of initiatives around the country trying to reach men through sporting or other awareness raising campaigns.”

In England, the highest suicide rates are in men and women aged 40 to 59 years, with rates in men increasing to a peak of 25 suicide deaths per 100,000 population in 2013. Similar patterns were found internationally.

Between 2000 and 2013, 363/100,000 men in midlife self-harmed compared to 449/100,000 women, in England.

Young people belonging to alternative subcultures, such as goths, emos or metal fans, are at a greater risk of self-harm and suicide than those who do not, according to a research review out today.

, a clinical psychologist from The University of Manchester, says health, educational and social services need to be more aware of the risks to these young people.

“Victimisation, stigma and hate crime may explain the greater risk these individuals face. A prime example of that is the aggression faced by Sophie Lancaster in 2007,” said Dr Taylor.

“Sophie was tragically murdered by a group of young men purely because of her affiliation to Goth culture.”

The systematic review of 12 English language papers published in the British Journal of Clinical Psychology was conducted by experts at The University of Manchester, University of Liverpool, the psychological services organisation Changing Minds UK, Leeds Beckett University and The University of Central Lancashire.

The findings reflect the growing concerns over the risks of young people: Suicide is a leading cause of death in adolescents and the second leading cause of death in 15-29 year olds according to a 2017 report by the WHO.

Dr Taylor, from The University of Manchester, said: “The belief that alternative subcultures may be at an increased risk of self-harm and suicide is considered by some to be a myth.

“But the literature we reviewed does suggest that these individuals are indeed in greater danger.

“But this research requires interpretation within the wider context of public concern around alternative subcultures and their impact on the mental health of young people.

“The public and media have at times, unhelpfully, demonised alternative subcultures and music as a cause of problems including self-harm.

“That is why organisations such as the Sophie Lancaster Foundation have an important job of increasing awareness about victimisation of alternative subcultures.

“Getting the message to health, education and social services staff is also an important consideration.”

Dr Mairead Hughes, from The University of Liverpool said: “There is not enough evidence to tell us why it is that people belonging to these subcultures are at greater risk.

“Young people who have faced more adversity may be more likely to become part of a subculture, but this does not seem to fully explain the increased risk.

“stress associated with being different and belonging to a minority group may also explain some of the risk”

The paper “” is published in the British Journal of Clinical Psychology