Content warning: The article below contains discussion of suicide acute mental health difficulties. Please read with caution. If you're struggling with thoughts of suicide or self-harm, call the Samaritans for free on 116 123.
Jessica* witnessed her mother make several suicide attempts, but the most devastating came at the age of 51. A bad accident at work left her with a severe back injury and constant pain, leading to a decline in her mental health. “She had a suicide attempt, which failed,” says Jessica. “She declined into severe alcoholism very quickly afterward, after being sober for 14 years. My parents divorced, not because my dad had ever stopped loving her, but because he was unable to deal with the drinking.”
Her mother’s life began to unravel, with both mental and physical health deteriorating fast. Eventually, she died at the age of 64 with stage 4 stomach cancer, diagnosed late due to doctors blaming symptoms on her alcohol use. But Jessica says the real cause of her tragic end was a long battle with her mental health.
“For me and my sister, and my mum, it was a slow, painful suicide,” she says. “She often wished she was dead, and she only kept living for me and my sister. It may sound very selfish, yet I mean this in the best possible way; it would have been kinder if she had succeeded in her attempt.”
Jessica says a significant factor in her mother’s repeated attempts at suicide were her employment: she was an NHS nurse. Her work was stressful, and her serious injury resulted in a one-off compensation payment of just £70,000, though she was unable to work again. Her daughters say this was “very little”, not commensurate with her change in circumstances.
“I know a lot of people in the caring professions, and suicide is a common ideation. The carers receive no care themselves,” Jessica says.
Data suggests that she is very likely to be right. High suicide rates among female nurses have been documented for more than two decades in the UK, and the phenomenon is global too. Now, with the NHS in crisis, it seems to be getting worse.
According to figures held by the Office for National Statistics, the rate of suicide for female nurses - a heavily gendered profession which is 89% female in the UK - is 23% higher than for women in the general population. In 2022, the Laura Hyde Foundation - a mental health charity for workers in emergency services established in memory of Ms Hyde, a nurse who took her own life in 2016 - revealed that 366 nurses, both male and female, who had used its services in the 12 months of that year had attempted suicide.
“The carers receive no care themselves.”
Occupation suicide data for 2023 is yet to be published after being requested under the Freedom of Information Act, but the overall figures are expected to be far higher. The advice line for Royal College of Nursing (RCN) recorded a 98% increase in nursing staff telling hotline advisors that they are having suicidal thoughts during an initial call, compared with the same time frame in the previous year. And across the College’s whole counselling service, the numbers of members self-declaring suicidal thoughts increased by 56% in a year, from 113 cases in the whole of 2022 to 176 cases in the first 10 months of 2023.
Long working hours and high workload
Speaking at a public event organised by the RCN in May 2023, a registered mental health nurse, Chantel Rose, described how she had more fellow nurses on her caseload than she had ever seen before. “I could be next,” she warned. “I wish that everyone could normalise speaking about suicide.”
These troubling figures have prompted a new wave of research and project work to understand why women in nursing roles are suffering mental distress and how to prevent further suicides. At the RCN’s congress last summer, members voted to lobby the government for a suicide prevention programme for the entire nursing workforce across the UK.
A study published during spring 2023 by academics at the University of Oxford, which took in studies from multiple countries including the UK, confirmed that nursing professionals and especially women in nursing, were at increased risk of suicide. It highlighted, perhaps unsurprisingly, other contributing factors such as existing psychiatric disorders, alcohol and substance misuse, physical health problems and occupational difficulties - many of which chime with the experience of Jessica’s mother.
However it also highlighted crucial issues around the nature of the profession, including the physical and psychological demands of long, irregular working hours and a high workload. In addition, the report cited “low staffing levels, frequent emotional demands and challenging working relationships” within nursing, as contributing factors. All these issues are more acute than ever before within the UK’s crisis-hit and cash-stripped NHS.
The academics concluded: “For female nurses, there is often the additional challenge of balancing work and home life, with women still undertaking most of the burden of unpaid care work. These challenges may contribute to the prevalence of psychiatric conditions and burnout among nurses.”
Stephen Jones, the RCN’s interim head of nursing practice, tells The Lead that the suicide rate has only recently received the attention it deserves because the issue is so complex and sensitive, with a stigma around suicide still holding up progress on preventing suicidal ideation within the nursing community. He described the recent figures published by the college as a “wake up call” to the profession in the UK, where unique challenges in the post-COVID NHS were also likely to be direct contributors to the latest alarming data.
“The increasing burden on nursing staff, as they try to help clear the excessive backlog in care, has created intolerable working conditions on every shift,” Jones says. “Coupled with nursing pay not keeping up with the cost-of-living, we’re alarmed by the growing mental health crisis among nursing staff.
“The bottom line is that working conditions must change for nursing staff. With over 40,000 nurse vacancies in England’s NHS alone, nurses are facing intolerable conditions. It’s only by investing in and valuing nursing staff that we’ll be able to recruit and retain the nursing staff we need.”
But he adds a note of extreme caution: “The NHS is operating under incredible pressure and many leaders do not have the resources and capacity to implement and embed the policies that would help to make a difference.”
Why are women at higher risk?
The RCN itself has commissioned new research looking into whether there is a disproportionate impact on the mental health or rates of suicidal ideation on marginalised groups within the existing data set.
But some academics believe there is still a huge gap in our understanding of why female nurses might be particularly at risk. Dr Ruth Riley, senior lecturer in sociology at the University of Surrey, is spearheading a five-year research study funded by the Wellcome Trust, which seeks to get away from simple explanations that personal issues such as alcoholism or psychological illness combined with the pressure of nursing is leading to high rates of suicide.
Data suggests there are good reasons to do this. The proportion of women who take their life who have previously been in contact with mental health services is 40%, and that figure is the same for female nurses who die by suicide. However the overall suicide rate for nurses is higher. Of that 40% per cent, almost a fifth (19%) were cited to have had workplace problems compared to 6% in the general female population.
Dr Riley’s global study, which takes in the views and experiences of international nurses and those from the global south, will focus more closely on the issues that impact nurses as women.
“There’s way too much pathologising of nurses. For me as a sociologist, it overlooks the important context which impacts on women and nurses as women: it is a dominant gendered position,” she says. “Rather than say it’s because they’ve got alcohol and drug problems, as are reported in suicide data, or anxiety or depression. But why are they depressed, why are they anxious, why are they drinking? These are the questions we need to be asking.”
The study is only in its first year but Dr Riley says it has generated early evidence that female nurses are more likely to experience discrimination and harassment in the workplace, are more likely to be victims of domestic violence outside the workplace, and also be experiencing gendered health issues such as menopause symptoms. The study is also reflecting on data which shows that the age group of female nurses with the highest rates of suicide is 45-55 years, making up 45% of deaths compared to just 30% in the general population (which is nevertheless still the dominant majority age category).
“It feels like lip service to be told to do some complementary yoga on your break - if you get a break - when the source of your stress is that you have half the staff that you’re supposed to have.”
Dr Riley says her team are also interested in the impact of “moral distress and psychological distress” caused by the way healthcare systems, and particularly the struggling NHS, operate.
“We’re looking at the experiences of undergoing complaint and protracted referrals. You’re more likely to be a recipient of a complaint or be under investigation if you’re an international nurse,” she says.
To date, no information is gathered on the ethnicity or race of nurses who take their own lives, but the Office for National Statistics is planning an overhaul of their recording processes to make sure this crucial information is also captured.
It’s not only the nursing profession that will be interested in the findings. Similarly disproportionate high rates of suicidal ideation are also experienced by midwives - and, says midwife and author Leah Hazard, without public recognition.
“Nurses are widely recognised in the media as having a very challenging role and are applauded for coping with that role, but I think the public perception of midwifery is much more mixed,” she explains. “One factor is of course we’ve had various scandals and investigations of maternity standards. Unfortunately sometimes those findings are portrayed in a polarising, binary way. We are viewed with suspicion in a way that nurses are not.”
Hazard, who is an ambassador for the Laura Hyde Foundation, says that, just like nurses, midwives are facing a “cognitive dissonance” of working in a system that trains them to carry out a complex and essential role but a lack of resources prevents them from doing it to the standards they expect of themselves. This can be devastating to mental health. Hazard adds: “When you know you don't even have the support of vast swathes of the public, that is particularly crippling. It’s very psychologically isolating.”
Hazard suffered her own mental health difficulties after the pressure working through the pandemic, but was able to access counselling quickly through the Healthcare Workers Foundation. Two years later, that service has now closed its waiting list because it has been overwhelmed with demand.
What can be done in the short term? Hazard sighs with resignation: “On a broad scale, senior management within the NHS have their hands tied to an extent because they don’t hold the purse strings,” she says. “But it definitely feels like lip service to be told to do some complementary yoga on your break - if you get a break - when the source of your stress is that you have half the staff that you’re supposed to have.”
If you're struggling with your mental health - reach out for help. Contact your GP, or call the Samaritans for free on 116 123. If you or someone you know needs urgent help, call 999 or go to A&E.