Ripples of Despair -  Shining a light on the impact of lives lost to alcohol, drugs, and suicide (2024)

Data on suicide

In England and Wales, when somebody dies unexpectedly, a Coroner investigates the circumstances to establish the cause of death. The investigation, referred to as an 'inquest,' is a process that can take months, and in some cases, years. When an inquest has concluded, the death is officially registered.

The figures for suicide include deaths that are registered within the calendar year, rather than deaths occurring in the calendar year due to the long registration process. 39% of deaths registered in 2023 had a date of death in the same year, 51% occurred in 2022 and the remaining deaths occurred in 2021 or earlier.

Data on suicide includes all deaths from intentional self-harm (for those aged 10 years and above). It also includes deaths caused by injury or poisoning of undetermined intent (for those aged 15 years and above), based on the assumption that the majority of these deaths will be suicide. This is referred to as the National Statistics definition of suicide.

The area data on suicide is based on the persons usual residence, so does not take into account people that have travelled to end their life. Calculating rates, allows us to make comparisons between geographic areas over time. The rates show the age-standardised mortality rate (ASMR) of deaths per 100,000 people.

Data on deaths related to drug poisoning (23)

The data from ONS on deaths from drug misuse are a directly standardised rate of deaths per 100,000 and based on a 3-year rolling period. The data comes from a wider data set - Deaths related to drug poisoning. Those deaths directly attributed to drug misuse are included within this subset.

As with suicide, the figures show the deaths registered rather than deaths occurring in each calendar year. Due to the length of time, it can take to complete a coroner's inquest, it can take months or even years for a drug related death to be registered. Therefore, it is impossible to compare the numbers in the ONS data to the numbers we review in our local Drug Related Death process which we undertake when notified of a suspected drug related death.

Public Health England, and previously the National Treatment Agency for Substance Misuse recommended that a confidential inquiry should be undertaken following a drug related death. In Gateshead this process is referred to as a drug related death (DRD) review and all suspected DRDs are discussed within the review process. Drug-related deaths need to be reviewed in a timely manner to identify learning, or actions, which may reduce the risk of further deaths attributed to drugs. This may happen before a coroner's inquest has taken place, to review specific cases, where we suspect the death may be as a direct consequence of drugs, (drug related death), and take learning from these cases that could implement change to reduce drug related deaths. This process involves numerous statutory and non-statutory agencies to ascertain common themes and learning.

Caution regarding data for the reporting of deaths related to alcohol, drugs and suicide

Drug-related death figures reported by the Office for National Statistics (ONS) are categorised as either 'drug poisoning' or 'drug misuse.'

'Drug poisoning' deaths involve a broad spectrum of substances, including controlled and non-controlled drugs, prescription medicines and over-the-counter medications. They also include accidents, assaults and suicides involving drug poisonings, as well as deaths from drug abuse and drug dependence.

'Drug misuse' deaths are defined as a drug poisoning with one or both of the following conditions:

• The underlying cause is drug abuse or drug dependence
• Involvement of any controlled substance under the Misuse of Drugs Act 1971 (201)

The inclusion of suicides within drug poisoning deaths can result in "double-counting" where one death is included in the figures for suicide, as well as a drug-related death (213).

By focusing this report on data looking at deaths by drug misuse rather than drug poisoning, we have aimed to reduce the potential magnitude of double counting, although it cannot be excluded. If unintentional double counting has occurred, it is likely to be small numbers.

Deaths from alcohol, drugs and suicide do not exist in isolation,  for example some drug poisoning deaths involve alcohol and it is often not possible to establish the primary substance responsible for the death (201)(213).  In some cases a death recorded as an alcohol or drug-related death were a suicide, however in the absence of evidence such as a suicide note, it will be recorded as an alcohol or drug-related death.

Change to the standard of proof for suicide in England and Wales

In 2018 in England and Wales there was a change to the standard of proof - the level of evidence needed by coroners when determining whether a death was caused by suicide. This was lowered from the criminal standard of 'beyond reasonable doubt' to the civil standard of 'on the balance of probabilities' (202).

A report by the ONS concludes that this change did not significantly impact suicide rates, noting that the factors behind increasing suicide rates are likely to be complex (214).