Dr Frank Farnham, Dr Alan Underwood, Rebecca Key and Tom Squire
This reprint of a piece from NOTA News volume 86 (Nov/Dec 2018). Kieran
This 90-minute workshop focused on the work and, in particular, the research undertaken by the Suicide Prevention Working Group [SPWG] set up through the National Police Chief’s Council [NPCC] Pursue Board, in relation to the prevalence and prevention of suicide amongst men under investigation for IIOC offences.
At the outset of the workshop, Tom provided an overview of the work of the Stop it Now! Helpline. The Helpline has three key target groups – (1) adults who have sexually abused or are at risk of abusing children; (2) adults concerned about another adult’s behaviour; and (3) parents / carers concerned about a child or young person with worrying sexual behaviour – and Tom spoke about how Helpline operators respond to different callers’ needs. Focussing on calls from men under investigation for offences involving indecent images of children [IIOC], Tom highlighted the increase in calls from this group since the Helpline’s inception in 2002. In 2017, approximately 1500 of these individuals called the Helpline, many at a point of crisis and experiencing suicidal ideation.
Alan then provided some background information about the prevalence of suicide amongst this population. For example, in 2014, the Police arrested 660 people suspected of IIOC offences as part of Operation Notarise. Twenty-four (4%) of them committed suicide at an estimated cost to the public finances of £34.8 million. Alan also shared the key findings of the systematic literature review undertaken by the SPWG in this area. Some studies found the risk of suicide amongst this group to be 230 times that of the general population and several times that of people with a diagnosed mental health disorder. Many of those under investigation had professional backgrounds, were often married with children and had no prior criminal history. The highest risk periods for suicide were observed during the 48 hours post discovery/arrest and risk factors were associated with shame, a loss of social status, and irreparable reputational damage. The SPWG hypothesised that suspects’ private justifications for their offending collapsed in the face of exposure, which, combined with a lack of belonging and increased burdensomeness, led to an increased risk of death by suicide.
Next, Rebecca presented the findings of the primary research undertaken by the SPWG, involving three exploratory qualitative studies with (1) 16 police officers; (2) 6 Helpline operators; and (3) 5 men who had either attempted suicide or experienced high levels of suicidal ideation following investigation for IIOC offences (recruited through the Lucy Faithfull Foundation). The findings resonated with those of the literature review. For example, high risk periods included the 48 hours after the onset of a police investigation as well as the days leading up to court appearances and sentencing; the studies highlighted the toxic levels of shame experienced by those under investigation; and the men’s anxiety about public exposure and media reporting. In addition, participants described the different responses of professional groups: the police and the Stop it Now! Helpline were seen as supportive in terms of their interaction with those under investigation while the response of healthcare professionals was reported as more mixed.
In conclusion, the research of the SPWG found that men under investigation for IIOC offences are a highly vulnerable group, at high risk of suicide. At the point of arrest, they are faced with a traumatic life event, resulting in feelings of shock, numbness, helplessness, hopelessness, intense worry and increasing shame. For many this response fits the criteria for an adjustment disorder, a recognised mental illness that occurs when a person has great difficulty coping with, or adjusting to, a particular source of stress such as a major life event. Consequently the SPWG made a number of key recommendations: (1) all suspects should be considered as being at high risk of suicide; (2) their risk should be reassessed at critical points during the life of the investigation; (3) training on how to discuss suicide risk should be provided to police officers; (4) all those under investigation should see a health professional before leaving custody, and, where possible, (5) be provided with a mobile phone; (6) the prospect of media exposure should be considered; (7) wider education and training for healthcare workers be developed; and (8) there is an overall need for more multi-agency working to manage suicide risk.
The workshop concluded with some wider discussions about next steps, including research into the impact of death by suicide on the family members of IIOC suspects, as well as developing a more robust evidence-base about which individuals, in particular, amongst this group may be most at risk of death by suicide.
Dr Frank Farnham, Dr Alan Underwood and Rebecca Key, North London Forensic Service, Barnet, Enfield and Haringey Mental Health NHS Trust
Tom Squire, The Lucy Faithfull Foundation