Response to the Isle of Man Suicide Prevention Strategy 2023-2027

---

03 August 2023

---

Introduction
Our Chairman, Juan Moore, has submitted a response to the Isle of Man Suicide Strategy in
his personal capacity. The Forum’s submission which follows, has been written with input
and feedback from Forum members on the strategy, and this may include, where suitable,
our Chairmans input, and should be read as such.
As the Chamber of Commerce’s Positive Health and Wellbeing Forum, we recognise the Isle
of Man Suicide Strategy and the positive plans, aspirations and opportunities that it presents.
We very much welcome and support a strategy that will address a solution to this devastating problem on our Island. A strategy that includes an increase in interventions at all stages, before suicide occurs and before it feels like the only option.
This piece of work is extremely important, and it needs to be done well to ensure the best outcome for the Island, therefore it is vital that the time and resources allocated to it, mirrors that. In addition, an integrated approach across the board to support the delivery of the strategy and to ensure its success, is key. There is a huge amount of work for Public Health and Manx Care to do.
None of us exist in a vacuum and it is important to recognise and support current and
established projects and organisations that are already working in this area. We have a
wide range of both holistic and allopathic resources, and these can and should complement
what is on offer to those who need it. It should not be a one option approach; it should be
an integrated and personalised approach. This should be reflected in the strategy.
As an Island we have a duty of care to each other to improve population health and reduce
inequalities and use all the valuable and experienced resources we have on hand to do that.
This cannot be done by Government or Government run organisations/departments only,
we have enough whole health and wellbeing practices on the island for it to be combined
effort.
There are too many holes in our 'safety net'; too many 'haves nots' in our society. If we do
not address these, we are more likely to continue firefighting instead of removing the
pressures and barriers.
One final remark is around use of language. Whilst we are not absolute ‘experts’ in this area,
using terms such as suicide not being "acceptable", vulnerable people, already reluctant or
finding it hard to reach out for help, are at risk of feeling judged for their thoughts and
feelings. When the foundations of much of what the strategy is talking about lies in education within the community, those leading this initiative need to do so by absolute example and so
a high level of scrutiny, should not be seen as an unwanted criticism but necessity.

We want to create an Island where all residents can talk about their problems. A place where
everyone with suicidal ideations and intentions, their friends and family, can seek and receive
the help they deserve with compassion and understanding. A place where various options
are available for those who need it and where all the burden is not resting on Manx Care or
Public Health, but where we have created space and opened doors to the world of
complementary and holistic options too – a truly personalised and integrated approach to
overall health and wellbeing.

Statistics
There are a lot of statistics within the strategy but none of which have significant meaning.
There is no analysis between the various statistics. Stating 52% of those dying from suicide
had mental health problems is not only misleading but almost certainly inaccurate.
An educated guess would lead to thinking that there are various journeys people go on that
gradually increase their risk over time. We need to delve into the wider journey that leads
someone to suicide, by analysing the data in a more meaningful way. Whilst mental health
difficulties are often present in people who die by suicide, it is often the culmination of a
sequence of inequalities and events that has led to this point - it is rarely a single cause.
For example, a bereavement that leads to mental health problems that if not dealt with might
lead to the breakdown of a relationship, or job loss that may lead to substance misuse which
further impacts mental health etc.
Has enough consideration has been given to the journey that leads someone to suicide in
order to develop earlier intervention pathways? More work, or evidence of work if it already
exists, into what these journeys look like should inform the actions in terms of what is needed,
what the priorities are and would help break down the risks into those that could be
absorbed/supported by the community and those which require more professional support.
Resulting in a more integrated and personalised approach to things like split of actions,
communications and any campaigns.
Looking at the recent statistics it is clear there is a problem with the suicide rates now. That
would therefore indicate that the measures that are currently being undertaken are not as
effective as we want. We all agree we need to educate our young people, but that is looking
at a long-term solution, not the here and now. The immediate problem for young people and
adults is accessing the care they need.
There is a theme throughout the report of building resilience, so people have the skills to
cope. This ignores the fact that many major life stressors can happen within a short space of
time. We must never blame individuals for mental ill health, nor must we say they are in
anyway weak or lacking life skills. No matter the resilience of the community or individuals,
people will always struggle when under excessive stress.

The cost of Suicide
We understand why the costs have been included within the strategy, which has been a
matter of much discussion within the chamber. It is certainly a factor to bear in mind, and
the public need to understand the cost of suicide in financial terms especially if they are
reading it purely from a cost basis.
As a forum, overall we feel that this should not be included within the strategy, it does not sit
well. Whilst we recognise that with every strategy and initiative financial questions will
need answering, these costs should be included within a business case, as a separate cost
benefit document, including required investment in budget. There is something about
attaching a cost to suicide that undervalues the more compassionate intentions of the
strategy.

What we are doing already
Whilst it is vital to know what work is currently being undertaken, we also need to admit that
what we have been doing is not having the desired result. The danger is we look to build on
something that might not be working rather than re-examining everything we are doing. In
so doing we might miss different solutions and more importantly, that integrated and
personalised care approach mentioned in the introduction.
There are two aspects to what we are doing now. By providing education to children, we are
undertaking the important work towards the long-term goal. Time will tell as to how effective
that is, and it is important that statistics from that work are collected now. The other aspect
is the immediate urgent need for action for all those struggling with their mental health in a
system that is overstretched.

Setting the ambition
“Over a life course traumas and inequalities can add up to the point that after a suicide it
seems like it was inevitable. However, each of these points are opportunities to intervene. “
This is getting to the heart of the problem and the basis of the strategy. The resources must
be in place to ensure that intervention is possible at each of the stages mentioned. That is
currently not the case, indeed those at rock bottom often struggle to access the system.
Those who have not reached crisis point often cannot access the system at all.
Those seeking help before they reach crisis should be offered suitable services, again building
on the integrated and personalised care approach referenced before, including access to and
alternatives to medication. As an Island we can offer a whole range of support to those who
need it, public and private sector working together in collaboration, holistically as well as
allopathically, which could lead to less pressure on our publicly funded health service, Manx
Care and the economy.
The question the strategy must answer is how we can support communities by making early
help available and ensuring that that help is readily available in whatever form it is needed by
an individual.
It is unrealistic to stop everyone from thinking suicide is the only option. What we can do,
however, is create a community where there is no stigma, where it is ok to say I feel suicidal
and need help, and that help is readily available.

Developing the strategy
The flow chart looks at the challenges the wrong way round. It starts with a premise of zero
suicides and then includes ideas as to how to reach that target. A bottom-up approach is
needed. Identify where we are now to design a strategy as to how to reduce the suicide rate.
The outcomes are similarly the wrong way round, medium term outcomes should follow short
term outcomes, one leads to the next. The outcomes are not strategic but a list of wishes.
So, if we look at prevention in the short-term strategy section, primary prevention talks of
stopping mental health problems before they start. Individuals and the community are more
resilient, wellbeing is promoted, and people have the tools to deal with crisis. Surely this will
take longer to develop and is not really short-term?
Priority in the next three years
We must ensure we are focusing on the right areas. If we do not get this right the whole
strategy fails. If the goal is zero suicides, by limiting our resources we are setting ourselves
up to fail. Yes, it will cost money, use valuable resources and take time, but that is the whole
point of the strategy, to get it right.
We need to promote the awareness and adoption of whole health and wellbeing practices to
improve the health of our Islands population and reduce the unsustainable burden on our
health services.
An integrated and personalised approach is key both in the short and long term and this can
only be achieved by truly engaging with society and organisations as a whole, those that can
work alongside and support the implementation of the strategy.

Suicide Prevention Action Plan.
The final section of the strategy focuses on the action plan.
The Island’s suicide rate is currently high which indicates that what we are doing already is
not, for whatever reason, working. It is therefore crucial that what we intend to do is correct,
rather than follow current policies and ideas.
The action plan is to cover the next five years, however, there are no dates included within
the plan. Dates must be included to monitor the progress and ensure that we are keeping on
track. Some of the action points are relatively simple and should already have been
completed, others will take more time, but they should all be timebound.
Various lead agencies have been identified but, as with dates, there is little in the way of
structure and no mention of overall governance. There is in fact no mention of governance
throughout the strategy, which is a crucial part of any strategy. Details should be provided as
to how it will be delivered, who is in overall control, how budgets will be managed, how
communication will flow, and how the Government will work with the third sector, local
businesses and all other stakeholders.

Strategy
It is crucial we focus on the correct areas in the right way to ensure the best outcomes for the
Isle of Man. This cannot be done in isolation and cannot be done by one body or department
solely.
The Island’s mental health services are certainly under-resourced. Charities and the private
sector have much to offer which should be an integral part of the strategy. As such this Forum,
for example, should be working alongside Government, promoting how it can complement
and provide services to the Island, in terms of helping to deliver overall wellbeing. The
Government should promote healthy living on the Island and work with businesses.
Imagine if someone was suffering from burn out, instead of building up courage to see the GP
or having to wait for a GP appointment, that individual could seek the services of a health or
lifestyle coach. Perhaps even being referred by the doctor or learning about them by their
employer. That alone could provide a huge saving to Manx Care freeing up resources to treat
other patients. It could also prevent longer term health issues, including mental health.
The key here is the advantages are already available waiting to be fully utilised, co-ordinated
effectively with the proper governance structures, system of rules, practices and processes
implemented. It is vital that a holistic approach is taken not just throughout Government,
with all departments working together, but also with local businesses and charities.

Public Health should reach out to businesses to encourage wellbeing and open conversations.
We all need to take a broader approach to what encompasses good mental health (diet, sleep,
exercise, mindfulness, yoga) - businesses and charities are already doing this and Government
needs to leverage the work being undertaken.

Funding
We are disappointed that funding was not included within the strategy. Whilst it is welcomed
that Departments have been instructed to calculate costs, this is far from taking a holistic
approach that includes the Island business and charity sectors.
In addition to this, there is a huge amount of work for Public Health and Manx Care to
undertake and no timeframe to do this, under the current financial constraints, there is
concern that suicide prevention will be lost to other pressing issues by Government.

Summary
The Government plays a huge role in our wellbeing, but it cannot and should not work in
isolation from all the other resources and opportunities that our Island presents and can offer
its local communities.
It must allow the community to thrive, including promoting and offering opportunities for
people to access all health and wellbeing resources available in the wellbeing sector. This is
how we begin to create and promote an integrated and personalised care approach to
healthcare for longer term health benefits. This is not only about creating a thriving
community; it’s about creating a community that truly demonstrates the benefits of taking
advantage of all the Island has to offer in terms of health and wellbeing.
There must be a holistic policy in place. All Government Departments must work together
with the third sector and the business community. That is after all how true change happens
– by everyone working together towards a shared vision, utilising all the available and relevant
resources for the greater good of the whole of society.
The Government must address the huge mental health crisis. The suicide strategy is a
welcome first step, but care must be taken to get it right. Everyone in crisis must have access
to the correct level of care immediately, in whatever form that may take.
Whilst the Isle of Man Suicide Prevention Strategy has now been launched, we do believe as
the Chamber of Commerce Positive Health and Wellbeing Forum, that we have an integral
role to play in supporting this and would welcome the opportunity to open the discussion on
how this can be achieved.

We therefore look forward to hearing from you.
Wendy Ranft-Gerber
Joint Vice Chair, Positive Health and Wellbeing Forum
IOM Chamber of Commerce

Acknowledgements
Members of the Chamber of Commerce Positive Health and Wellbeing Forum

Juan Moore - Chair & Resolute Consultancy
Paula Dunlop - Cushla
Joanne Posey - Life Lessons Nutrition
Jude Honor - Games Global
Terri Canty - Derivco
Joe O'Hara - Lloyds
Swati Lohan - QHHT practitioner (Quantum
healing hypnosis technique
Sinead O’Connor - Samaritans
Jennie Bronte-Hearne - Standard Bank
Jayne Kennell - Swagelok
Lisa Trimigliozzi - Burri Better Be
Karen Davies - EPL Recruitment
Haafizah Hoosen - Lyph Lab
Cathryn Bradley - Sight Matters
Natalie Cellamare - Isle Listen
Rebekah Dalrymple - Simply Sleep
Sindy Lambert - Joint Vice Chair & The Firm
Nikki Soutter - Manx Telecom
Adrian Bell - The Dome
Wendy Ranft-Gerber - Joint Vice Chair & Health &
Balance
Joanna Crookhall - Ramsey Crookhall
Amy Howse - Secretary & Soundology
Elaine Cordona - Solasta Coaching
Rebecca Netten - MAC Financial
Nick Pledger - Island Seafare
Ollie Chrzanowski-Smith - Isle of Man Sport