The Bishop of St Albans moved his Coroners (Determination of Suicide) Bill in the House of Lords on 19th November 2021, and gave a speech outlining the purpose of the bill, which focuses on gambling-related suicide:
The Lord Bishop of St Albans: That the Bill now be read a second time.
My Lords, I declare my interest as a vice-chair of Peers for Gambling Reform. The focus of this Bill is on gambling-related suicide; indeed, I have heard one Member of your Lordships’ House describe it as a “gambling Bill”. It is no secret that gambling reform is a major concern of mine, but I start by stressing that the scope of the Bill extends far beyond gambling-related suicides and can include a wide range of factors that contribute to death by suicide.
I will give some background to set the scene. Under the current legislative framework in England and Wales, once a suspected suicide is reported, the death is classified as “sudden and unexplained” until an official determination is made. The coroner is then required to undertake an inquest alongside a jury to make a determination as to the cause of death and whether the death is to be registered as a suicide—a process that often takes up to six months from the confirmed date of death of the deceased.
The benchmark for making a determination of suicide was lowered in 2018 from the criminal standard of “beyond all reasonable doubt” to a civil standard of balance of probabilities, although it is still a high benchmark to make that determination. My reason for outlining the current framework for determining whether a death by suicide has occurred is to emphasise that the Bill I propose does not alter this framework. One Member of this House expressed the concern that a determination of suicide might affect life insurance claims. While it is clearly upsetting and deeply regrettable for the families who are denied life insurance claims on those grounds, the remit of this Bill would occur only once a coroner or jury has already made a determination of suicide, which would therefore have no bearing on this particular matter.
The Bill would amend the Coroners and Justice Act 2009 to allow for the coroner or juries in inquests to record an opinion as to any factors that were relevant to a death in the case of a suicide. It would also amend the Coroners (Inquests) Rules 2013 to insert a new rule that would legally require the coroner or jury to record an opinion as to any factors that were relevant to the death by suicide and that explicit consideration be given as to whether the deceased had an addiction to gambling. The intention is that, by collecting more reliable data on the underlying factors that cause suicide in the UK, suicide prevention efforts by the Government can therefore be targeted at the underlying risk factors which cause suicides and allow for better interventions for those characterised as at risk.
Having spoken many times on suicides due to gambling-related harm, again and again I have heard the Government say that they do not have reliable statistics, and I keep asking them to help us to get some. Absolutely nothing has come back. I am hopeful that out of this some noble Lords will come up with even better suggestions, but this is my stab, and I hope that it will help us as a way forward. I realise that I may need a lot of help to look at exactly the best way forward.
Coroners are not required by law to record factors relevant to a death by suicide, but can do so on a discretionary basis. Since it is not legally required, there exists an inconsistency in how suicides are registered between those coroners who record the relevant factors and those who do not, which prevents reliable data being gathered on factors that were pertinent to the death. According to the ONS figures for 2020, there were 5,224 registered deaths by suicide in England and Wales. We know that 75% of them were males and that suicide rates were highest among those aged 45 to 49. ONS figures also highlight the regional variations in suicide rates: the death rate per 100,000 in London was nearly half that in the north-east of England, followed by Yorkshire and then the south-west.
Although they are not recorded in official registration, the Government do recognise many of the risk factors that lead to suicide. Before I continue, I echo the sentiments of the fifth progress report on suicide prevention, the most recent one, where it states:
“There are many complex factors driving suicide rates”
and expands on this further to say that rarely can a suicide be reduced “to one factor alone”. At the same time, I do not believe that this is an argument against recording the risk factor, or factors, underlying a suicide, especially when there are circumstances, the extent of which are unknown, where one or two risk factors were particularly prevalent.
The fifth progress report recognises that self-harm is a major risk factor in suicide, with evidence suggesting that 50% of people who have died by suicide have previously self-harmed. The report also recognises the risk posed through exposure to harmful online content, something that caught the public attention after the tragic case of Molly Russell.
Other risk factors that the report outlines include economic risks, with evidence suggesting that during the last recession the suicide rate rose 1.4% for every 10% increase in unemployment within men, and social risk factors such as homelessness, which the ONS is able to have official records on. Most of these assertions, however, do not rely on concrete data collected during the registration, which in reality means that we do not know how many suicides are attributable to these factors.
Coroners currently have the option to mark the relevant risk factors underlying a suicide. I have a copy of a sheet from one of the coroners in my diocese, which lists various options. You can tick financial difficulties, marital difficulties, recent or past mental health involvement, bereavement in the last 12 months, self-harm, physical health issues, a history of violence or being under investigation for criminal matters, and so on. I will not read them all; indeed, there are some caveats in brackets, which are important to take into account. The document I have dates from 2018, and I may need to defer to the Minister if I have an outdated version.
Some may argue that to record comorbidities is fraught with difficulties, yet doctors record them and the data has proved very valuable for medical research. This method of marking predetermined risk factors would allow accurate data on the relevant risk factors in a suicide to be accurately recorded; it is the approach that I favour. But conspicuously missing from these options is gambling-related harm, which, according to Public Health England’s evidence review on gambling harms, just published, is estimated to be responsible for 409 suicides annually. That translates to nearly 8% of the recorded suicides in 2020.
It is for this reason that included in the Bill is a specific requirement on the coroner to consider whether the deceased had an addiction to gambling. However, I recognise that the inclusion of gambling-related harms in the options of risk factors might be more appropriately set out in regulations or official guidance than in primary legislation. I am sure that I will get some advice in this debate on that provision. What matters is that it is included within these options, so that we can get accurate data on all the relevant risk factors, including gambling-related harm. We should collect them and publish them anonymously. This would be invaluable to the Government’s strategy to drive down the number of suicides. You do not drive them down in general but work out the reasons why they are happening, then have a strategy for a range of things, of which gambling-related harms is just one.
I believe that the Bill would be a great asset to the Government’s suicide prevention efforts. I hope it will allow us to give much more support and earlier intervention to those who are at risk of suicide. I beg to move.
Extracts from the speeches that followed:
Baroness Bakewell of Hartington Mandeville (LD): My Lords, I declare my interest as a vice-chair of Peers for Gambling Reform. I congratulate the right reverend Prelate the Bishop of St Albans on securing this debate and on his excellent introduction to this important issue.
Addictions of whatever sort, whether alcohol, drugs, or gambling, have a devastating effect on those suffering, and their friends and relatives. Perhaps gambling is the most invidious, as it is often hidden. It is relatively easy to see when someone is an alcoholic or a drug addict. Those with gambling addiction will be locking themselves in their bedroom with a computer, betting long into the night. This is not a social activity which brings friendship and camaraderie among sufferers. Quite the opposite: it is a lonely, deeply depressing activity, where the participant thinks that just one more chance will bring a better result.
Currently, coroners are not required to record whether those who take their own life are suffering from a gambling addiction. There is, therefore, insufficient information to judge accurately just how prevalent the problem is. From the information on the Gambling with Lives website, it would seem that those most at their wits’ end are young men under 30, on the threshold of their adult lives, who become trapped and feel unable to escape through any other means than ending their own life.
Baroness Meacher (Con): My Lords, I rise to support this excellent Bill, so strongly introduced by the right reverend Prelate the Bishop of St Albans. In order to achieve a reduction in the number of suicides and the number of attempted suicides—which is thought to be about 20 times higher—it is crucial to know more about the factors that lead a person to consider this course of action. The right reverend Prelate gave clear examples of the role of gambling addiction in suicides, and I welcome his efforts to ensure that this is recorded as a factor by coroners when appropriate.
I agree with the approach outlined in the Bill and I very much welcome its breadth. It is not simply about gambling, though that is profoundly important. The approach is that the coroner must record an opinion about the factors which were relevant to the death. It should of course be noted, as Samaritans explains clearly and as the right reverend Prelate said, that there are rarely single causes or factors that lead someone to consider ending their own life. However, where there are common themes, we need to understand them so that we can make every effort to reduce the number of suicides and—as I have said—often very violent and dangerous attempted suicides, which can leave the person with serious injuries and profound medical problems, at huge cost to the NHS apart from anything else. If coroners’ records included the information envisaged in the Bill, they would be a priceless source of information for the development of preventive measures.
Baroness Greengrass (CB): My Lords, I thank the right reverend Prelate the Bishop of St Albans for this Private Member’s Bill, which raises many important issues, and for the very moving way he presented them. Too often when we look at mental health issues or suicide, we fail to look at the cumulative effects of things such as addiction to understand what has happened. Through collecting data on things such as gambling addiction, we get a greater understanding of the problem and, hopefully, can try to reduce the harm currently being caused.
Earlier this year, this House debated the Domestic Abuse Bill, when I and others raised concerns about the abuse of older people. One very common form of abuse against older people is financial abuse. Studies have shown a direct link between gambling addiction and financial abuse. A recent example of this was reported to Hourglass—formerly Action on Elder Abuse —where a grandparent aged 88 suffered economic abuse. In this case, their adult grandchild, who had both gambling and drug addictions, stole £100,000. However, that story is all too common, and we know that gambling addiction is one of the key motivators of financial abuse. Gambling is bidirectional: it can be a risk factor in both the perpetration and the victimisation of domestic abuse. A recent study by Australia’s National Research Organisation for Women’s Safety found that gambling was often a contributing factor in physical as well as financial abuse. This study also found that it was often older women who were the most vulnerable and had the least support.
We know that gambling addictions often lead to abuse, but we do not know how often this then leads on to suicide, either by those who have the gambling addiction or those who have been victims of abuse from someone with this addiction. A first step is to start collecting data on gambling addiction and suicide.
Baroness Brinton (LD): My Lords, I add my congratulations to the right reverend Prelate the Bishop of St Albans on introducing this important Bill to your Lordships’ House. He helpfully outlined the scope of the Bill—that it starts only once a coroner has determined that death by suicide has occurred, and it requires the coroner to give their opinion on the underlying factors of suicide.
I am pleased that he also reminded your Lordships’ House that this is not just about suicides by people with gambling addictions. I am mindful of the families of young people who have taken their own lives, including Molly Russell, following encouragement from others on social media. This is a particularly unpleasant trend that has resulted in an increase in attempted and successful suicides in the past few years. That this Bill would require a coroner to also comment on underlying reasons for such suicides is important. My noble friend Lady Bakewell of Hardington Mandeville outlined that young men are the most likely to take their lives, but the right reverend Prelate is right to say that collection of data is vital, not just the ONS style of characteristics data, but also the softer, more underlying reasons for their suicide that would enable assistance to be targeted at people at risk.
Baroness Scott of Bybrook (Con): At the outset, I have to say that the Government are absolutely determined to prevent gambling-related harm and suicide. Gambling is one of our society’s major ills. It causes untold misery and distress to countless families across this land. The Government recognise that gathering quality information on the circumstances leading to self-harm and suicide, including gambling issues, can help prevent future deaths and support better outcomes. However, we do not agree that this Bill will achieve the desired effect as intended.
During the course of their investigation, a coroner may be made aware of motivating or contributory factors in a suspected suicide. However, the legislation is clear on the coroner’s jurisdiction, which does not include determining why, in the sense of deeper or more sociological explanations, someone died. Under Section 5 of the Coroners and Justice Act 2009, the scope of the coroner’s investigation is to determine who died and how, and when and where they died. “How”, in most cases, equates to “by what means”. The investigation is designed to be a limited and proportionate fact-finding exercise, and under Section 10 of the 2009 Act, coroners are prohibited from appearing to determine any question of criminal liability against another person or civil liability.
If the Government were to support this Bill and change the scope of what the coroner would determine, to include why a person took their life, this would also have to apply to all other types of inquest conclusions. As many noble Lords have noted, including the noble Baronesses, Lady Meacher, Lady Bakewell of Hardington Mandeville, Lady Finlay and Lady Greengross, there are many multifactorial reasons and complexities within the Bill that has been put forward—changes that would cover veterans, terminal illness and addictions. As the noble Lord, Lord Ponsonby, clearly said, it is a very complex area of recording for the coroner.
The Lord Bishop of St Albans: I thank the Minister for her response and I am glad to hear that more attempts are being made to find out the data for us. I have been involved in this area for six or seven years now, and it feels as though the Government are constantly dragging their feet—as though we are having to pull them along. I am currently in contact with the Ministry of Defence. We have had to ask endless questions to try to find the information that we want; in fact, the MoD is putting down a Statement today because it has got confused too. This is an area that is not being attended to by Her Majesty’s Government.
I am grateful to all noble Lords, who have brought out some really interesting points; I have made notes. I am hugely grateful and will think about those things. I would say to the noble Lord, Lord Ponsonby, that, as I understand it, it is down to the coroner or jury to record a relevant opinion. Although the Minister said that she did not recognise this form, the coroner who gave it to me said, “All of us coroners starting out are using this; it is the old ones who won’t do it.” She was quite frustrated about it. I will go back and find out more information.
From what I can see, we are already recording this data. I know that the law is all about where, who, how and when—not why—but we have some of the “whys” already. We use “whys” widely in the world of medicine. It is complicated but, when we bring forward, for example, regulations to do with finance, and there is complexity, we just get our heads down and get our minds around the complexity. We do not say, “Because it is difficult, we are not going to try to do it.”
I do not pretend to know the best way of doing it. I would be hugely grateful if those of your Lordships who are much more expert in this could point me to the relevant people. I particularly like the idea of talking with others who also want this sort of data; I think there would be quite a groundswell of people saying that, while it may not be perfect, this form of data could give us some helpful ways forward. I am, of course, disappointed that Her Majesty’s Government cannot support the Bill. I will think very carefully about the points that have been made, but I will be minded to take this on to the next stage and work with others if they are willing to work with me.
Bill read a second time and committed to a Committee of the Whole House.
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