Submission from Dr Sarah Waters, Prof Martin McKee and Dr Marina Karanikolos (SPR0047)

 

Author information:

  1. Dr Sarah Waters, University of Leeds, Leeds, UK
  2. Prof Martin McKee, European Observatory on Health Systems and Policies, London, UK and London School of Hygiene & Tropical Medicine, London, UK 
  3. Dr Marina Karanikolos, European Observatory on Health Systems and Policies, London, UK and London School of Hygiene & Tropical Medicine, London, UK 

 

Background to submission:

The submission draws on the findings of a Wellcome Trust-funded research project on international workplace suicides that brings together researchers in the humanities, public health and social sciences who specialise in a range of national contexts including the UK, Ireland, France, China, Taiwan and South Korea. Grant reference: 110436/Z/15/Z.

 

Summary

 

 

  1. Recent studies carried out in the US, Australia, France, Japan, China, India, Taiwan and South Korea  point to a sharp rise in work-related suicides across a range of occupations and economic sectors. In the United States, workplace suicides decreased between 2003 and 2007, but then rose sharply in the following years with rates particularly high amongst law enforcement officers and firefighters. In France, experts have estimated that there are currently 700 to 800 cases of workplace suicide each year, including a high-profile judicial investigation into a ‘suicide wave’ at one multinational company. Meanwhile in Japan, suicides have increased by 45% over the past four years and are particularly prevalent amongst male white-collar employees working in highly pressurised environments.
  2. Although in the UK, data on workplace suicides is not collated nationally, evidence from diverse sources points to comparable trends. Research on suicide in the UK has identified a consistent relationship between occupation and suicide with the following occupations identified with high risks: farmers, doctors, nurses, dentists, veterinarians, pharmacists, police and military. One study shows that socio-economic factors including occupational stress, income and employment status are important determinants of suicide risk across occupational groups. Studies of specific occupations, such as teachers have pointed to rising problems of mental health in the workplace that may trigger suicide. Similarly, the Samaritans have warned that construction workers are six times more likely to die from suicide than falls. Meanwhile, trade unions contend that there have been several hundred recent workplace suicides, representing what is, in effect, a hidden epidemic. In a special dossier on workplace suicide, the trade union publication Hazards recounts stories of suicide cases involving teachers, NHS managers, engineers, factory workers, police officers and doctors. Both media sources and legal publications also provide details of suicide cases.

 

  1. Yet, in the UK, workplace suicide is insufficiently studied and documented and there are no official figures recording the number of workplace suicides that take place annually. ONS statistics show that nationally, the suicide rate is highest amongst working age men between 45 and 59 years of age, at a rate of 23.9 per 100,000 inhabitants and that this rate has been increasing since 2007. However, data on the causes of suicide amongst this age group and the potential connections to work or working conditions is not made publically available.
  2. Workplace suicide is an extreme manifestation of a more generalised mental health crisis in today’s globalised and competitive workplaces. In the UK, 1 in 6 employees is experiencing stress, anxiety or depression at any given time and two fifths of businesses report an increase in mental health problems. Each year, poor mental health is costing businesses £26 billion. Rising suicides are linked to specific transformations in the workplace over the past 10 to 15 years and an associated erosion in employment conditions. On the one hand, the rise of precarious employment with an increase in short-term, flexible or zero-hours contracts has been proven to have deleterious effects on mental health. Such forms of employment do not provide the employee with the financial security or career prospects needed to build a stable future. In March 2016, just over 800,000 UK workers were on zero-hours contracts, according to the Office for National Statistics, although some researchers have suggested that the actual figures are substantially higher. On the other hand, work intensification in the context of heightened market competition has meant that the individual employee is today subject to unprecedented levels of pressure and stress. The rise in suicides amongst white-collar employees in France and Japan has been linked to pressurised working environments and chronic levels of stress amongst employees.
  3. A significant barrier to tackling this issue in the UK is that workplace suicide is not recognised in legislation. Whilst the Health and Safety Executive lists a wide range of accidents that need to be reported to the authorities for investigation, it specifically excludes suicide. Even when it is committed in the workplace, suicide is presumed to be an individual and voluntary act and according to Health and Safety Executive legislation: ‘All deaths to workers and non-workers, with the exception of suicides, must be reported if they arise from a work-related accident’ (emphasis added). This contrasts with the situation in France, for instance, where legislation protects the individual employee and his or her family in the case of a suicide. When a suicide takes place in the French workplace, it is immediately investigated as a work-related accident and the burden of proof is on the employer to prove that it is not work-related. Even in cases where a suicide takes place outside of work, it is still investigated as a work-related accident where the victim (in the case of attempted suicide) or the family can prove a causal link to work. This presumption of causality is designed to protect employees (in an attempted suicide) or their families and circumvent the need for them to engage in legal action in order to prove the employer is liable. Hence, one in every five employee suicides reported to the authorities (Sécurité sociale) in France is officially recognised as being work-related.
  4. National governments have put in place specific measures to monitor, document and respond to this rising public health phenomenon. The French government set up a National Observatory of Suicide in 2013 to analyse rising suicide rates nationally and propose preventative measures. This new structure has launched a series of studies on workplace suicide with a view to improving and centralising methods of data collection. For instance, a recent pilot study examined how recording could be improved by combining data from multiple of sources (death certificates, labour inspectorate, social insurance and autopsy reports). In the US, the National Strategy for Suicide Prevention specifically targets employers as critical stakeholders in the prevention of suicide. In Japan, karo-jisatu or suicide by overwork is treated as an urgent social problem and a 2014 law requires government to put in place measures to address this phenomenon. In the UK, similar concerted action by government, researchers and experts is urgently needed in order to better understand and prevent workplace suicide. Whilst rigorous mechanisms are in place in UK workplaces for managing physical risk, the risks associated with mental health are often overlooked or misunderstood.
  5. The consequences of the non-recognition of workplace suicide in the UK can be catastrophic for individuals, families, businesses and communities. On the one hand, families may be obliged to pursue protracted litigation proceedings in the aftermath of the suicide of a loved one, in an effort to establish a causal link to the workplace. On the other, the employment conditions that trigger suicide and pose risks for the mental health of other employees may be left unquestioned and unchanged. There has so far been only one successful claim against employers in the British courts, concerning a maintenance engineer who committed suicide following a severe injury at Vauxhall Motors where he worked. In another case, the judge ruled that it would not be in the public interest to undertake a fatal accident inquiry requested by the widow of a manager with British Telecom who was found hanging in his office in 2009. In theory, such deaths could be identified by coroners, but their willingness even to make a finding of suicide at all has declined substantially in recent years. An increasing number of deaths, especially poisoning, deemed as suicide by researchers have led to coroners’ verdicts of accident or misadventure. Coroners can give narrative verdicts, which would provide additional information that might point to a workplace link, but these are extremely rare.
  6. As a group of researchers collaborating in a network on international workplace suicides, we call on the Health Committee to support further research on workplace suicides in the UK, so that we can better understand, monitor and prevent this urgent public health phenomenon. We believe examples of best practice from other countries and in particular, measures put in place in countries including the US, Japan and France can help provide potential models for tackling this issue in the UK. In the light of evidence of rising cases of workplace suicide and a societal cost of non-action, it is also crucial that current legislation on reportable work-related accidents is reviewed, so that workplace suicide is recognised and that employees, families and businesses are protected.

 

September 2016