Coroners (Determination of Suicide) Bill [HL] — House of Lords, 2021-11-19
Topic: Health
Ilora Gillian Finlay (Crossbench, Unknown): My Lords, I add my congratulations to those offered to the right reverend Prelate the Bishop of St Albans on all the work that he has done to shine a light on the devastation that gambling addiction has wreaked in our society I must declare that I am a patron of the Louise Tebboth Foundation, which aims to support the mental health of doctors, particularly those who are at risk of suicide. It has already been said that gambling addiction is often associated with other addictions, such as to alcohol, and sometimes with different types of substance abuse and abnormal behaviour such as sex addiction. There is a problem, too, of suicide contagion, of which we have had clear examples in our society at times The noble Baroness, Lady Bakewell of Hardington Mandeville, spoke about veterans from the Armed Forces. It has been suggested that the buzz that they get from gambling when they are traumatised mimics some of the buzz they got in the battlefield. Then they get the "down" afterwards and seek to compensate for that, so they become particularly at risk of the psychology of gambling We must recognise that coroners’ services have been poorly supported for many years. Inquests are often held in situations which are far from ideal to inquire into whether distressing background factors contributed to a person’s suicide. As has been said, the coroners have to establish who, when, where and how, through evidence, a person had taken the action to end their own life. The question of why they did so may be a speculative parameter on the evidence before them and may be difficult to piece together as factors from the things that a person left behind. The coroners to whom I have spoken—I have had the privilege of attending the Coroners’ Society of England and Wales on a couple of occasions—do all they can to act in the public interest and to establish and recognise the burden of responsibility that sits very heavily on their shoulders. They are often conducting an inquest in the face of an extremely distressed family, with the family asking the question why. Known, obvious and contributory factors, including gambling, alcohol use, domestic abuse, financial problems, a raft of other things and perceptions of inadequacy, are often promoted through online platforms and the person may even have been goaded or manipulated into suicide. We have just debated the urgent need for age-assurance minimum standards in the Second Reading of my noble friend Lady Kidron’s Bill. I have to say that the Government’s response to it has been deeply disappointing There is clear evidence that loneliness is associated with many factors, including gambling addiction. Loneliness is associated with depression. A recent paper, published after a 12-year study, showed that about one-fifth of depression could be prevented if the loneliness and social isolation in our society were tackled Coroners take evidence in open court so it is very important that, should the Bill be adopted, speculative evidence of underlying causes is recognised to be important, but that it does not carry the same burden of proof as some other factors that coroners are asked to record. When someone has had a difficult life, the coroner will try to conduct the inquest in such a way as to give them dignity in death and help the family to celebrate their life and humanity, rather than focusing on the problems they lived with. That is not to deny the real problems in society, which are often multifactorial, leading to a person’s suicide, and an inquest in open court may make it very difficult to expose contributory factors. I wonder, therefore, whether the right reverend Prelate is right to think that it may be better to go for regulation and guidance than to enshrine this in primary legislation. There are many complex factors and coroners’ inquests are held in different places As well as that, we must change the language. We must stop talking of "committing suicide" and talk about "died by suicide". The stigmatisation of "committing" is a hangover from the days when it was a criminal offence. Those days are long behind us, and how heartless they were, yet sui cide—self-killing—is what the action is. Some years ago, I undertook a study of suicide in patients receiving hospice care. We found a low incidence of suicide. It was no higher than in the rest of the population, and certainly lower than in other groups of patients. Suicide in cancer patients is generally compounded by chronic disease, advancing age, multiple losses and all kinds of reasons for their suffering. It is not possible to draw a direct causative link between one factor and another. The background to suicide is multifactorial in many circumstances When data on suicides is collected, there is a danger, if it is not classified hierarchically, of double counting, so such data needs to be presented very carefully. The multiple known factors may make it difficult or impossible to discern which was the main trigger, but unless we are able confidentially to record all known risk factors, we will not be able to tackle the public health disaster of suicide. When it comes to the overwhelming destruction from addiction, the sense of personal shame and the failure of social support, combined with demoralisation, can lead to the downward spiral that is the public health problem that we face today. As has been said, we just do not have enough data.