Online Suicide Prevention A Pro-active Strategy for ... Suicide Prevention A Pro-active Strategy for Government and the Internet Industry 1 “Samaritans welcomes this report, which

OnlineSuicidePrevention:APro-activeStrategyforGovernmentandtheInternetIndustry

ByTheRt.HonGrantShappsMPJanuary2018

OnlineSuicidePrevention

APro-activeStrategyforGovernmentandtheInternetIndustry

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“Samaritanswelcomesthisreport,whichincludesanumberofimportantrecommendations.WehopethattheGovernmentandtechnologycompaniestakenoticeofitandworktoensurethatfewerpeoplediebysuicideasaresult.”

Barnardo'sChiefExecutive,JavedKhansaid:

“WewelcomethisreportbecausewhiletheGovernment’sGreenPaperonchildren’smentalhealthisastepintherightdirection,itlacksthenecessaryvisionandresourcesforatrulyjoinedupsystemofpreventionandsupport–bothonlineandoffline.

“WeknowfromourworkwiththeUK'smostvulnerablechildrenaboutthepositiveandnegativeimpacttheinternetcanhaveontheirlives.Itisdeeplyconcerningthatmaterialwhicheffectivelypromotessuicideissoeasilyaccessibleonline.

“GrantShappsiscorrectthatmuchmoreneedstobedonetoprotectchildrenfromsuchshockingmaterial.It’svitaltheGovernmentworkscloselywithmentalhealthcharities,internetcompaniesandcontentcreatorstoworkoutwhenandhowrestrictingsuchitemsisappropriateandnecessary.

“Insteadoffacilitatingaccesstosuchsites,internetfirmsshouldbeencouragedtocreatesignpostsontheirwebpageswithhelplinenumbersforthosewhoappearparticularlyvulnerable.”



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"Wetakeourdutytoensurethatourplatformisusedresponsiblyandnottocauseharm,veryseriously.Mentalhealthcanbeacomplexissue;andsowepartnerandlearnfromleadingexpertsinthisareasuchastheTheSamaritans.Wearegratefulfortheinsightofthereportandlookforwardtocontinuingtoworkwithawiderangeoforganisationsonprotectingpeople'smentalhealth."KatieO'Donovan,UKPublicPolicyManager

"Thistimelyreportmakesclearhowthereismoretodoacrossgovernment,industryandwithinsocietytopreventsuicideandsupportpeoplewhomaybeindistress.ThisisanissuewearecommittedtoandwewillshortlybefurtherimprovingthewayTwitterhelpspeoplefindexperthelp."NickPickles,headofUKpublicpolicyforTwitter.

Itissoimportantthatwecontinuetoworktogethersothatinternetserviceproviders,socialmediaplatforms,contenteditors,legislators,organisations,familiesandcommunitiesandyoungpeoplethemselveseffectivelyplaytheirpartinpreventingyoungsuicides.PAPYRUShopesthattodayreigniteseveryone’sinterestincreatinganevermoresuicidesafeinternet.



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PrefaceforOnlineSuicidePreventionReport

ThisreporthasbeencompiledfollowingacomprehensiveCallforEvidenceandanOnlineSuicidePreventionSummit,whichwasheldinParliamenton10thMay2016.Thesummitbroughttogetherrepresentativesfromsearchengines,internetserviceproviders,socialmediasitesandsuicidepreventioncharitiestodiscusswhatmorecanbedoneononlinesuicideprevention.

CharitiesandorganisationshavebeeninvolvedintheworkofthisreportincludeGoogle,NSPCC,Samaritans,VirginMedia,Papyrus,BT,Twitter,Facebook,ActionforChildrenandmanymore.

ThereportincludesrecommendationsforGovernmentonwhatactionwebelieveshouldbetakennowtoaddressthisgrowingproblem,suchaslaunchingamoredetailedpublichealthstrategyononlinesuicideprevention,andenforcingexistingguidelinesontheavailabilityofsuicide-relatedcontent.

Thereportalsoincludesrecommendationsfortheinternetindustry,suchasensuringtherearesignpoststohelplinesandsupportsitesandcurbingtheauto-completefunctionsofsearchengineswhensuicide-relatedtermsaresearchedfor,aswellasregularlygettingthesectortogethertofindmorewaysofassistinginonlinesuicideprevention.

WeconcludethatmoreneedstobedonebyGovernmentandtheinternetindustryintheirapproachtotacklingonlinesuicide.Governmenthasanimportantroletoplayinproducingamoredetailedandspecificstrategytodealwiththisproblem,andinternetserviceproviders,searchenginesandsocialmediasitescandomoretoensurethattheinternetisasourceofsupportandguidanceforpeoplewhoarevulnerable.



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ExecutiveSummaryAlotofimportantworkisbeingdoneandhasbeendoneintacklingmentalhealthandinpreventingsuicide.Weareontherighttracktochangingattitudesandresponsesinthisarea.However,wherethereiscurrentlyagapiswithregardtothelackofpro-activepolicy.Thisisclearforexampleinthecurrentgovernment’sapproachtoonlinesuicideprevention.Inaddition,therestillremainsmuchmorethattheinternetindustry*candoasawhole.

Recentresearchhashighlightedtheaffectthattheinternetishavingonthosewhoarevulnerable.Thestudyshowedthat8%ofpeoplewhowerepresentedtohospitalafterasuicideattemptsaidtheyhadusedtheinternetinconnectionwiththeirattempt,andthisrisesto12%forthoseaged16-24.Thosewhohadself-harmedandwereidentifiedashavingahighsuicidalriskwereevenhigherat24%.Italsofoundthatinasurveyof21yearolds,ofthosewhohadmadesuicideattempts,almostthreequartershadusedoraccessedsuiciderelatedmaterialontheinternet.1

However,thisreportsuggeststhatthismostlikelyrepresentsonlypartofthepicture.Atthemomentthereisalackofstrategyanddirectionfromthegovernmentinconfrontingasizableproblemandwhilemanypositivestepsarebeingmadebysuicidepreventioncharitiesandintheinternetindustryinaddressingtheseissues,morecanbedone.AfteracomprehensiveCallForEvidencefrominternetproviders,internetsearchengines,socialnetworkingsites,andsuicideandmentalhealthcharities,plusanOnlineSuicidePreventionSummitheldinParliamentonthe10thMay2016**thisreportcallsforthegovernmentandtheinternetindustrytotakeamorepro-activeapproach.

1LBiddleetal,“Prioritiesforsuicideprevention:balancingtherisksandopportunitiesofinternetuse”PolicyBristol7(2016).*”InternetIndustry”-Termusedinthisreport,andbymanycharitiesconsultedtorefertointernetproviders,searchengines,andsocialmediasites.**ThissummitwasledbyapanelconsistingoftheRt.HonGrantShappsMP,AlistairCampbell,RuthSutherland,ChiefExecutiveofSamaritans,andHamishElvidgeoftheMatthewElvidgeTrust.Theeventwasattendedbysuicidepreventioncharities,internetproviders,searchengines,andthoserepresentingsocialmediatodiscussmorestepsthatcouldbetakeninrelationtoonlinesuicideprevention.



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Recommendationsforthegovernment:WerecommendtheGovernmentlaunchesanewandmoredetailedpublichealthstrategyononlinesuicideprevention.Thisstrategyshouldinclude:

• TheGovernmentworkingwithsuicidepreventioncharities,healthbodies,andtheinternetindustrytomake'theNationalSuicidePreventionAlliance'sguidelinesforonlinecommunitymoderators'Respondingtosuicidalcontentonline'morevisible.Thereismorethegovernmentcandotopromotetheseguidelinesandbetterpublicisethem.

• Governmentmustalsobemorepro-activeinexploringwaysofrestrictingaccessthatexistprincipallytopromotesuicide.Ministerscanworkcloselywithsuicidepreventioncharitiesandtheinternetindustryaboutwhenitmaybebesttointervene.

• Recognisethattechnicalsolutionsaren’talwaystheanswerandeducationwilloftenbemoreeffective.ThereismoretheGovernmentcanbedoingtoeducatepeopleaboutusingtheinternetandaboutsuiciderelatedonlinesupport.ThiswouldinvolvetheGovernmentandtheNHSworkingcloserwiththeDepartmentofEducationandsuicidepreventioncharitiesabouthowbesttodothis.

• NotenoughdetailedresearchisbeingcarriedoutbytheGovernmentorpublichealthbodiesontheimpacttheinternetishavingonsuicide.WerecommendthattheGovernmentthereforeundertaketoworkcloselywithsuicidepreventioncharitiesandtheinternetindustrytodomoreresearchonactualonlinebehaviourofvulnerableindividualsandwhatapproacheswouldmosteffectivelyminimiseharm.



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Recommendationsfortheinternetindustry:Internetproviders,internetsearchengines,andsocialnetworkingsiteshavetakenpositivestepsinaddressingthethreatstheinternetposestothosewhoarevulnerable.Thisreportrecognisestheirprogressbutsuggeststhereismorethattheycanstilldo.Including:

• Stayingrelevantandexploringnewwaystheycanengagewiththosewhoarefeelingvulnerable,suchashelpingfacilitateinstantmessagingservicesforthosewhotheybelieve,throughforexamplethenatureoftheirinternetusage,maybevulnerable.

• Callingonallinternetproviderstocreatesignpostsontheirwebpageswithhelplinenumbersforthosewhoappearparticularlyvulnerable,includingforcingISP’sandsearchenginestocurbtheautocompletefeaturetoensureitexcludesasmallsetofsearchtermsthatwouldappearaspredictions.

• Optimisingsupportsiteswhensuiciderelatedtermshavebeensearched.

• Getthesectortogetherinconferenceregularlytodebatetheissueanddiscusshowtobemorevocalandpro-active.

WhileitisclearlywhollyunrealistictosuggestthatthreeorfourpoliciestakenupbytheGovernmentandthesectorwilleradicatesuicideattemptsorsuicidedeaths,thereareareascurrentlywhichinadvertentlyorotherwisehelp‘encourage’suicide.Tacklingthesewithproposalsthatbalancethedangerofover-regulationwiththesuggestionthatmoreneedstobedoneisadifficultyetnonethelessessentialtask.

ThousandsofpeopletaketheirownliveseachyearandyetthereremainsalackofdetailandspecificsonwhattheGovernmentisandhasbeendoingtoworkwiththeinternetindustryinthisarea.Havingsaidthis,theinternetplaysaninvaluableroleinpreventingsuicideandexpandingthisnetworkthroughsupportfromGovernment,localauthorities,internetproviders,searchenginesandsocialmediawillbevitalinensuringallthosewhoarevulnerablecanaccessthehelptheyneed.Anapproachisneededwhereworkingtochangeattitudestosuicidegoeshand-in-handwitheffectivepolicymaking.Thisreportproposesastepinthisdirection.



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1.HowmanypeoplehavetakentheirlifeintheUK?

• ThelatestfiguresfromtheOfficeofNationalStatisticsonsuicidedeathsintheUKarefrom2016.Theystatethattherewere5,965classifiedsuicidedeathsintheUK,whichisasuiciderateof10.4deathsper100,000people.

• 75%ofthesuicidesin2016weremalesand25%werefemales.Formalesthiswas16deathsper100,000,andthefemaleratewas5per100,000.

• ThehighestsuiciderateintheUKwasamongmenaged40-44with24.1deathsper100,000.Forwomen,thehighestsuicideagegroupwas50-54,with8.3deathsper100,000.

• InEnglandthehighestsuicideratewasintheSouthWest,with11.2deathsper100,000,whiletheLondonhadthelowestratewith7.8deathsper100,000.2

1.1 Itisimportanttonotreadtoomuchintoyearlystatistics,as

evaluatinglongtermtrendsisoftenmorebeneficialandappropriateasitwillbetteridentifythosewhoaremostvulnerable.Whatthelongtermstrendscurrentlyshowisthatmenaremuchmorelikelytotaketheirlifethanwomen,withthosewhomaremiddleagedandfrompoorersocio-economicbackgroundsthemostvulnerable.

1.2 Eachsuicideisatragiccaseandeveryindividualwillhavetheirownmotives.However,researchbythecharitySamaritanshasfoundthatthemaingeneralreasonsofthelong-termtrendsarebasedaroundunemployment,relationshipbreakdown,fragmentationofsocialrelationships,correlatingwithpsychologicalcharacteristicslikeimpulsivityandperceivedbarrierstotalkingaboutemotionsandseekinghelp.3

2SuicidesintheUK:2016registrations,OfficeforNationalStatistics,December2017.3“Men,Suicide,andSociety”,Samaritans,September2012.

“Therewere5,965classifiedsuicidedeathsintheUKin2016”



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2. Whatrolemighttheinternetbeplayinginfacilitatingsuicide?

2.1 Verylittleresearchhadbeendoneonassessinghowmanypeople

usetheinternetwhentheyarefeelingsuicidalandwhatimpactthematerialtheywereaccessingmightbehavingonthem.However,arecentground-breakingstudybytheUniversityofBristolinpartnershipwithcharitiesSamaritansandPapyrushasshedahugeamountoflightontheroletheinternetplays.Inaclinicalsampleofover1500patientsarrivingathospitalfollowingasuicideattempt,itfound:

§ 8%ofpeoplehadusedtheinternetinconnectionwiththeirsuicideattempt

§ Ofthoseaged16-24,12%usedtheinternetinconnectionwiththeirsuicideattempt

§ 24%ofthosewhohadself-harmedandwereidentifiedashavingahighsuicidalintenthadusedtheinternetinconnectionwiththeirsuicideattempt.

§ Inasurveyof21-yearolds,ofthe248participantswhohadmadesuicideattempts,threequartersreportedsomeformofsuiciderelatedinternetuse,whileoneinfivehadaccessedsitesgivinginformationonspecificmethodsofsuicide(althoughmostofthesepeoplehadalsoaccessedhelp-sites).

2.2 Thefindingshighlightedthattheinternetisusedbypeoplewhoself-harmand/orattemptsuicide,oftenasawaytoexplorepossiblemethodsandreadotheraccountsofthosewhoarefeelingsuicidal.Materialthatcouldbeseenasharmfulisalsoeasilyaccessiblethroughavarietyofdifferentmeans,includingthroughpopularinformationsites,anditistheyoungeruserstowhomtheinternetposesaparticulardanger.4

4LBiddleetal,“Prioritiesforsuicideprevention:balancingtherisksandopportunitiesofinternetuse”PolicyBristol7(2016).

“Theinternetisusedbypeoplewhoself-harmand/orattemptsuicide,oftenasawaytoexplorepossiblemethodsandreadotheraccountsofthosewhoarefeelingsuicidal.”



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3. WhatistheGovernment’scurrentonlinesuicidepreventionstrategy?

3.1 TheDepartmentofHealthsetouttheNationalSuicidePreventionstrategyforEnglandandWalesinSeptember2012withtheobjectiveofreducingthesuiciderateandofferingbettersupportforthosebereavedoraffectedbysuicide.Theylaidoutsixareaswhichtheybelievedactionwasneeded:

i. Reducetheriskofsuicideinkeyhigh-riskgroupsii. Tailorapproachestoimprovementalhealthin

specificgroupsiii. Reduceaccesstothemeansofsuicideiv. Providebetterinformationandsupporttothose

bereavedoraffectedbysuicidev. Supportthemediaindeliveringsensitive

approachestosuicideandsuicidalbehaviourvi. Supportresearch,datacollectionand

monitoring.5

3.2 TheGovernmentstrategyin2012statedthatpartofpointfiveofthestrategy,tosupportthemediaindeliveringsensitiveapproachestosuicideis“continuingtosupporttheinternetindustrytoremovecontentthatencouragessuicideandprovidereadyaccesstosuicidepreventionservices”.6

• Withinthis,theystresswhatthelawstatesinregardto

theencouragementofsuicideonline.TheyhighlightthattheDirectorofPublicProsecutionshasissuedguidelinesinrespecttoCasesofEncouragingSuicide,andstatetheircommitmenttoworkwiththeinternetindustryandcontentproviders.TheyplantodothisbypartneringwiththeUKCouncilforChildInternetSafety(UKCCIS)tocreateasaferonlineenvironment

5“PreventingsuicideinEngland:Across-governmentoutcomesstrategytosavelives”,DepartmentofHealth,September2012,Availablefromhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/430720/Preventing-Suicide-.pdf6PreventingsuicideinEngland,2012

“Bothreportsfailtoprovidesufficientdetailandanyspecificsaboutpreventingsuicideonline.Thisisnolongergoodenough.Morevocalandrobustactionisrequiredfromthegovernment”



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throughindustryself-regulation,improvinge-safetyeducation,andraisingpublicawareness.7

• TheGovernmentalsohighlighttheimportantworkSamaritansandothercharitiessuchasPapyrusaredoinginthisarea.

3.3 Thegovernmenthavefollowedthisupwithtwofurtherreports,oneinFebruary2015andasecondinJanuary2017intendedtoprovideanupdateontheprogressthatthisoriginalstrategyishaving.

3.4 However,theonlysignificantmentioningofonlinepreventioninthereportof2015highlightstheDepartmentofHealthfundedresearchstudyonunderstandingtheroleofsocialmediaandsuicide,whichfoundsuicidaltweetersshowahighdegreeofreciprocalconnectivitywhencomparedwithotherTwitterusers,suggestingacommunityofinterestandraisingconcernsthatsuiciderelatedcaseswereseentobenewsworthyinsocialmedia.8

3.5 ThereportinJanuary2017pointstothevitalworktheNationalSuicidePreventionAllianceandSamaritanshavebeenworkingon,highlightingtheguidelinesthattheyhaveissuedandtheprojectsthattheyhavetakenpartintolearnmoreabouttheonlineenvironment.ItalsonotesthefundingthatthegovernmentprovidedtosupporttheresearchcarriedoutbytheUniversityofBristolandSamaritans.9

3.6 Whileallthisiswelcome,bothfollowupreportsfailtoprovide

sufficientdetailandanyspecificsaboutwhatpolicyandwhatlargerrolethegovernmentcanorcouldplayinonlinesuicideprevention.Thisisnolongergoodenough.Morevocalandrobustactionisrequiredfromthegovernment.

7ibid8“PreventingsuicideinEngland:Twoyearson,Secondannualreportonthecross-governmentoutcomesstrategytosavelives”,DepartmentofHealth,February2015,Availablefromhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/405407/Annual_Report_acc.pdf9“PreventingsuicideinEngland:Thirdprogressreportofthecross-governmentoutcomesstrategytosavelives”,DepartmentofHealth,January2017,Availablefromhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/582117/Suicide_report_2016_A.pdf



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4. WhatmoremusttheGovernmentdo?4.1 Giventhelackofdetailsofar,werecommendthatthe

governmentlaunchesanewandmoredetailedpublichealthstrategyspecificallyrelatingtoonlinesuicideprevention.

Werecommend:

i. TheGovernmentworkingwithsuicidepreventioncharities,healthbodies,andtheinternetindustrytomakecurrentguidelinesonhowtheinternetindustryandusersshouldrespondtosuicidalcontentonlinemuchmorevisible.

o TheNationalSuicidePreventionAlliance

haveissuedguidelinesforonlinecommunitymoderators'Respondingtosuicidalcontentonline'.Theseguidelinesexplainclearlywhattodo,whatsuicidalcontentis,howtorespond,whattosay,andhowtodevelopeffectivepolicies.10o Theseguidelinesareinformative,easyto

understandandgiventhebackgroundsofthedraftees,authoritative.o Thegovernmenthasadutytomakethese

guidelinesmorevisible.Workingwithsuicidepreventioncharitiesandtheinternetindustryabouthowbesttodothis,throughfunding,educational,orvocalsupporttheGovernmentcancontributemuchmorethantheycurrentlydotoensurethatallusersknowwhattobeawareofwhencomingacrosssuicidalcontent.

ii. TheGovernmenttobemorepro-activeandmakeefforts

todiscourageaccesstositesthatexistprincipallytopromotesuicide.

10NationalSuicidePreventionAlliance,“Respondingtosuicidalcontentonline:Bestpracticeguidelines”,Availablefromhttp://www.nspa.org.uk/wp-content/uploads/2016/02/NSPA-Guidelines-Responding-to-Suicidal-Content-Online-2016.pdf

“Werecommendthegovernmentlaunchesanewandmoredetailedpublichealthstrategyspecificallyrelatedtoonlinesuicideprevention”



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Screenshotsofonlinematerialaredeliberatelylowresolutioninordernottopromoteitscontent,butinsteadtohighlightanoverviewofourresearchinthisarea.Originalscreenshotsofthematerialareavailablethroughaccreditedorganisations.

o Whileweunderstandthattherearedifficultiesin

regardstothelawandwhatmaybemostbeneficialfortheuser,theGovernmentmustdomoretorestrictaccesstocertainsites,pages,orchatroomsthatexistprimarilytopromotesuicideandself-harm.Wikipediainparticularpublishwhatcaneasilydeemedtobeirresponsiblematerial.Belowisjustasmallexampleofthematerialthatisaccessibleonlinethatwebelieveisinappropriateorpromotesandencouragessuicide.

FigureA:AdiagramshowingpeoplehowtouseasuicidebagonWikipedia

FigureB:AdetailedandgraphicexplanationoftheactofhangingonWikipedia



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FigureC:Websiterankingsuicidemethodsonlethality,time,andagony.

o Suchinformationservesnopositivepurpose,andtheGovernmentshouldbetakingamuchmoreaggressiveapproachinencouragingsiteslikeWikipediatoestablishmoreresponsiblepractices.o WewouldurgetheGovernmenttoworkcloselywithsuicidepreventioncharitiesandtheinternetindustryandtherelevantorganisationspublishingsuchmaterialtoworkoutwhenandhowrestrictingsuchmaterialisappropriateandnecessary.

o ThisisalsoanissuetheHealthSelectCommittee

recognise,astheycallintheirinterimreportonSuicidePreventionforthegovernmenttoworkwithinternetprovidersandsocialmediaplatformstoconsiderwhatchangesshouldbemadetorestrictaccesstositeswhichencourageself-harmorgivedetailedadviceonsuicidemethods.11

11HealthSelectCommittee,SuicidePrevention:InterimReport,December2016

“Governmentshouldbetakingamuchmoreaggressiveapproachinstampingdownonsitesthatexistprimarilytopromotesuicideandself-harm.”

“Thereremainsscopeforfurtherresearchinthisarea…TheGovernmenthaveanopportunityhere”



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iii. Recognisethattechnicalsolutionsaren’talwaystheanswerandeducationwilloftenbemoreeffective.

o Educationwilloftenbemoreeffectiveor

appropriatewheninformingyoungpeopleabouthowtousetheinternet,whattobeawareofinregardstosuiciderelatedmaterial,andhowtorespondappropriately.Technicalsolutionscanoffernecessaryandeffectivemeanstotacklingtheproblemsthatoccurasaresultofonlinesuicideuse,butultimatelytotackletherootcausesofsuchissuesitrequiresindeptheducationofthedangerstheinternetcanpose.Thisrequiresthegovernmenttobemorepro-activeanddetailspecificsaboutwhatfurthercanbedonetotacklethisproblem.

o Inordertoachievesubstantialresults,webelieve

thegovernmentandtheNHSshouldworkcloserwiththeDepartmentofEducationandcharitiestoexploreotherwaysthatmayproveeffectiveineducatingpeopleaboutonlinesuicidepreventionandthepositivesandnegativesthattheinternetposesinthisregard.

o Webelievethatwiththeareasoffurthereducation,

skills,andhighereducationmovingfromtheresponsibilityoftheDepartmentofBusiness,Energy,andIndustrialStrategy(BEIS)totheDepartmentofEducation(DfE)itoffersavaluableopportunitytoexplorenewwaysofhowmoreyoungpeoplecanbeeducatedaboutsuiciderelatedmaterialonline.

o Thismayincludeincreasingfundingtohelpsupport

charitieswhoaimtoprovidesucheducation,orlookingathowdigitalcitizenshipmethodscouldbeexploredandfurthered,soyoungstersaretaughthowtobestusetheinternetwiththeparticulardangersofonlinesuicidecontenthighlightedasanexample.



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iv. TheGovernmenttocommissionmoredetailedresearch

o ThemostrecentnewresearchbytheUniversityof

Bristolandthecharitieswhoworkedinpartnershipwiththemwasmuchneededandincrediblyinformative,butthereremainsscopeforfurtherresearchinthisarea.

o Thisareahastoooftenbeenleftsubjectiveand

therehasbeeninsufficientresearchinrelationtotheimportanceanddangeroftheinternet.TheGovernmenthaveanopportunityheretobecomemorepro-activeandsupportive.Findingthemostappropriatewaystoexploretheimpacttheinternetishavingonthosewhoaresuicidal,whytheyusetheinternet,howtheyviewthematerialthattheycomeacross,anddetermininghowmanyofthosewhohavetakentheirlifemighthaveusedtheinternetasasourceofinformationorreceivedencouragementthroughitmaybealengthyanddifficultprocess,butitisanessentialoneinordertoworkouthowbesttotacklethisproblem.

o Suchresearchisvitalforusersandcharitiestostay

uptodate,relevant,andtobeabletomaketherightdecisionsaroundcriticalissuesastheycontinuetodevelop.Moreresearchwillleadtomoreawareness,andbetterdesignedmethodsofengagementwiththosethatarevulnerable.



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5. Whathastheinternetindustrydonetohelptacklethisissue?

5.1. Theinternetplaysaninvaluableroleinreachingouttothosewhoarevulnerable.Whetherthisisthroughthelaudableworkmanycharitiesaredoingthroughonlinehelpsitesandinterventions,orthroughworkingwiththeinternetindustryandengaginginnewwaystohelppreventthepromotionandencouragementofsuicide,andexpandingtheinternetasasourceofsupport,theinternetcanbeaforceforgood.

5.2. Socialmediasites,internetproviders,andsearchengineswillallplayaroleinhelpingfacilitateconnections,andallowingandpromotingeasyaccesstositesthatprovideawarenessandsupport,aswellasofferingthissupportthemselvesandhelpingimplementcertainpreventiontechniques.Theinternetcanprovideaspaceforpeople,oftenanonymously,toshareanddiscusstheirfeelingsandwithoutfearofbeingjudged.Itisvitalthatpeoplecanfeelopenandsupportiveindiscussingsuicide,andtheinternetisaperfectwaytoengagepeopletotalkmoreabouttheseemotions.

5.3. Itisextremelyimportantthatthissupportiscontinuallyexpandeduponbyorganisationssuchassocialmediasites,internetproviders,andsearchengines.Theinternetmustbeusedasatooltoreachouttoasmanypeoplethatarefeelingvulnerableaspossible.AsthecharitySamaritanshavehighlighted,bydevelopingresponsiblepracticesrelatingtosuicideandhavingeasilyaccessibleguidanceonhowtoappropriatelyrespondtousersthatexpresssuicidalintentisaneffectivewayofbeingabletorespondquickly.Engagingwithorganisationsandcharitiesthatspecialiseinsuicidepreventionandmentalhealth,andwhomareoftenbestplacedtoknowandprovideaccurateinformationwhenformingandimplementingthisguidanceandstrategyisessential.12

5.4. Goodprogresshasbeenmadeonthisfront.SamaritansandFacebookhaveworkedonarevisedsuicidepreventiontool

12PolicyBriefing:SuicideandtheOnlineEnvironment,Samaritans,May2014

“Theinternetplaysaninvaluableroleinreachingouttothosewhoarevulnerable”

“Itisextremelyimportantthatsupportiscontinuallyexpandedbysocialmediasites,internetproviders,andsearchengines.Theinternetmustbeusedasatooltoreachouttoasmanypeoplethatarefeelingvulnerableaspossible…Goodprogresshasbeenmadeonthisfront”



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whichwasrolledoutinJanuary2011,andFacebookhaveadaptedtheir‘reportthispost’tooltoincludeacategoryhighlightingwhensomeonemightbeatriskofharmingthemselves.TheusercanthencontactSamaritansiftheywish.13SamaritanshavealsoestablishedpartnershipswithYouTubeandTwitter.14

5.5. WithTwitter,afterassessingareportofself-harmorsuicide

contactthereporteduserandlethimorherknowthatsomeonewhocaresaboutthemidentifiedthattheymightbeatrisk,andtheyprovidethereporteduserwithavailableonlineresourcesencouragingthemtoseekhelp.15

5.6. Instagramhasanewsuicidepreventiontoolthatallowsafriend

toreportapostthatworriesthem,andtheirfriendwillgetamessagesaying,"someonesawoneofyourpostsandthinksyoumightbegoingthroughadifficulttime.Ifyouneedsupport,we'dliketohelp."Theyarethengiventheoptiontotalktoafriend,contactahelplineorreceivefurthersupport.Instagramalsohasaresponseinplacethatwhensomeonesearchesforaself-harmflaggedhashtag,acontentadvisorywarningpopsup.ClickingonthatbuttonwillthenleadtoawebsiteforBefriendersWorldwide.16

5.7. Furthermore,theroleofsearchenginesisimportant,asitwill

bethefirstplacemanypeoplegotofindinformation.ImportantstepshavebeenmadeherewithGoogle,Yahoo,Bing,andAskJeevesalldisplayinghelplinenumbersaboveresultswhenusershavesearchedsuicideandself-harmrelatedkeywords.Thisishugelysignificantasitisthefirstthingthatsomeonewillseewhenarrivingonthepageanditisawelcomeattempttoreachoutandprovidesupport.

13SummitonOnlineSuicidePrevention:CallforEvidenceResponse,Samaritans,May201614ibid15“Dealingwithself-harmandsuicide”,Twitterhelpcentre,Availablefromhttps://support.twitter.com/articles/2017031316CallforEvidence:OnlineSuicidePreventionSummit,Facebook,May2016



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6. Whatmorecantheinternetindustrydo?6.1 Whilewehaveestablishedtheimportantrolethattheinternetcan

andmustcontinuetoplaywecannotignorethedangersitposes.Whetherthisisthroughonlinepro-suicidediscussionorallowingandpromotingaccesstopotentiallyharmfulinformation.Theinternethasbeenshowntonormaliseself-harmandpotentiallydiscourageprofessionalhelp-seekingwithcyberbullying17andultimatelythedifficultyishavingtostrikeabalancebetweenfreedomofexpressionandpublicprotection.Thisisespeciallydifficultgiventheglobalnatureoftheinternet.18

6.2 Assomehavearguedtheinternetiscurrentlyalotlessregulatedthanotherformsofmedia.Forexample,ifradio,television,andnewspapersbroadcastorpublishmaterialthatisquestionableorinaccuratethentheyareheldaccountablebyindependentregulatorsandcanloseanaudienceasaresult.However,withtheinternetandsocialmedia,informationisdecentralised,anditischangedorupdatedconstantlybyitsusersandthismeanstheinternethasveryfewrestrictionsoncontentcomparedtoothermediaoutlets.1920

6.3 AstheWorldHealthOrganizationhavealsoargued,internetsitesandsocialmediahavebeenimplicatedinbothincitingandfacilitatingsuicidalbehaviourandthereareconcernsoverthesupplementaryroletheInternetandsocialmediaareplayinginsuicidecommunication.21Socialmediacanallowaplatformforcyberbullying,andastheDepartmentofHealthfundedresearchstudyonunderstandingtheroleofsocialmediaandsuicidehasfound,suicidaltweetersshowahighdegreeofreciprocalconnectivity.22Furthermore,asshownbyfurther

17KDaineetal,“ThePoweroftheWeb:ASystematicReviewofStudiesoftheInfluenceoftheInternetonSelf-HarmandSuicideinYoungPeople”,PublicLibraryofScience8(October2013).18LBiddleetal,“Suicideandtheinternet”,BritishMedicalJournal336(April2008).19D.Luxtonetal,“SocialMediaandSuicide:APublicHealthPerspective”,AmericanJournalofPublicHealth102(May2012).20JGFiedorowiczetal,“InternetandSuicide”,(NewYork2009).21“PreventingSuicide:Aglobalperspective”,WorldHealthOrganisation(2014).22PreventingsuicideinEngland:Twoyearson(2015)

“Suicidaltweetersshowahighdegreeofreciprocalconnectivity…peoplepostingaboutsuicideontheinternetareofteninitiallyunsure,buttheirresolvestrengthensasothersencouragethem,andseekinghelpbecomesmoredifficult.”



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research,peoplepostingaboutsuicideontheinternetareofteninitiallyunsurebuttheirresolvestrengthensasothersencouragethemandseekinghelpbecomesmoredifficult.23

6.4 Thereisadifficultyinstrikinganappropriatebalanceontheissueasusers,charities,andbodiesneedtoworkwithintheparametersofthelawandrespecttherightofprivacy,freedomofspeech,moreoversocialmedia,searchengines,andinternetprovidersareallprivateactorsintheonlineworld.However,afteranonlinesuicidepreventionsummitheldinParliamentonthe10thMay2016,attendedbysuicidepreventionandmentalhealthcharities,internetproviders,socialnetworkingsites,andpoliticians,followedbyacomprehensivecallofevidencefromthosethatattendedwehaveadvancedaprogramme.Webelievethiscanshowwheretherearegapstobefilledandwherewecanmakearealdifference.Weaskedthreequestions:• “WhatdoyouthinkaboutSocialNetworkingSiteswithregard

totheirparticularinfluenceonmentalhealthandsuicideinparticular?DoyouthinkthatSocialNetworkingSitesshouldbedoingmoretotryandprotectvulnerableusers,orwouldthisbeaskingtheimpossibleinalargelyunregulatedspace?Doyoubelievethatpublicgoodisdeliveredfromsharedexperienceandinformationonsocialmedia?”

• “HowdoyouthinkInternetsearchenginescanhelp?Isthere

moretobelearntfromotherexperiences;e.g.tacklingextremismorchildpornographyonline?

• “WhatabouttheroleofInternetProvidersthemselves?Should

theyhaveagreaterroleandresponsibilityinmonitoringthestate(andpotentiallythementalstate)oftheirusers?Ordoesthisrepresentasteptoofar-isitrealistictoasktheprovideroftheinternetconnectionbeinvolvedinthisway?”

6.5 Basedontheresponsesthatwereceivedandwhatwasdebatedatthesummitweputforwardrecommendationsthatwebelievethe

23PBaumeetal,“Cybersuicide:theroleofinteractivesuicidenotesontheinternet”,Crisis18(1997).



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internetindustryshouldpursueinordertofurthertacklethisissue.

Werecommend:

i. Stayingrelevantandexploringnewwaystheycanengagewiththosewhoarefeelingvulnerable,suchashelpingfacilitateinstantmessagingservicesforthosewhotheybelievemaybevulnerable.

o Withthosewhoareyoungerbeingmorelikely

tousetheinternet,andindeedusetheinternettoengagewithsuiciderelatedmaterial,itisvitalthatinternetserviceproviders,searchengines,andsocialmediasitesstayrelevant.Forexample,formanyyoungpeoplefeelingvulnerableasignpostdirectingthemtophoneanumbermaynotbeenoughtoengagewiththemorencouragethemtoseekhelp.

o TheNationalSuicidePreventionAlliancehavearguedthatthereisscopeforsearchproviderstogofurtherthanjustdisplaynumbersatthetopofthepageandthinkabouthowtheycandelivermoresubstantialinformationonsourcestohelp.24Stayingrelevant,beinginnovativeandadaptingtoyouruser’sneedsisessentialforanybusinesstostaysuccessfulandthesamemustapplywhenreachingouttothosewhoarevulnerableonline.

o OrganisationssuchasSamaritansareexploring

suchmethods,includinginstantmessagingservicesastheyrecognisemanypeopleneedinstantonlinesupport.Thisissomethingtheinternetindustrycancontinuetoengagewith,andseehowtheymaybeabletohelpfacilitateorhelppromotesothatmorepeoplecanbereachedouttoinnewinnovativeandcreativewayssothatonlinesupportstayscurrentandeffective.

24“Response:SummitonOnlineSuicidePrevention”,NationalSuicidePreventionAlliance,May2016.

“Stayingrelevant,beinginnovativeandadaptingtoyouruser’sneedsisessentialforanybusinesstostaysuccessfulandthesamemustapplywhenreachingouttothosewhoarevulnerableonline”

“Formanyyoungpeoplefeelingvulnerableasignpostdirectingthemtophoneanumbermaynotbeenoughtoengagewiththemorencouragethemtoseekhelp”



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ii. Callingonallinternetprovidersandsearchenginestocreatesignpostsontheirwebpageswithhelplinenumbersforthosewhoappearparticularlyvulnerable.Thisincludedinternetserviceprovidersandsearchenginescurbingtheautocompletefeaturetoensureitexcludesasmallsetofsearchtermsthatwouldappearaspredictions.

o Whilesearchingfornewinnovativewaystoengagewithpeoplethatarevulnerableisessential,thereremainsroomforimprovementwithsignpostingontheinternet.

o Ofthefivemostusedandpopularsearchengines(includingGoogle,Yahoo,Bing,Aol,andAskJeeves)fourofthesehaveahelplinenumberonthetopoftheirnewsfeedaftersearchingspecifickeywords

relatingtovulnerability.

FigureD:RedcirclehighlightingwhereGoogledisplaysahelplinenumber



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FigureE:RedcirclehighlightingwhereYahoodisplaysahelplinenumber

FigureF:RedcirclehighlightingwhereAskJeevesdisplaysahelplinenumber

FigureG:RedcirclehighlightingwhereBingdisplaysahelplinenumber



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FigureH:AcrosshighlightingthatAOLdonotdisplayanyhelplinenumber



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o AOLdidnotprovideanyhelplinenumbersonitspage.Thereisanecessityforallsearchenginestoworktogetheronthis,andallshouldhavehelplinenumbersandsuitablesignposting.

o Furthermore,whenpeoplearesearchingforcertaintermsaroundthisissueeveryattemptshouldbemadetocurbtheautocompletefeaturesawayfrompredictingorencouragingdirectiontoharmfulcontent.

FigureI:Redcirclehighlightingtheunhelpfulsuggestionsthatappearonauto-completewhentyping‘howcanIkillmyself’onAoL.



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FigureJ:Redcirclehighlightingtheunhelpfulsuggestionsthatappearonauto-completewhentyping‘howcanIkillmyself’onYahoo.

FigureK:Screenshothighlightingthatnounhelpfulsuggestionsappearonauto-completewhentyping‘howcanIkillmyself’onGoogle.



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o Asyoucansee,whileGooglehascurbedtheseautocompletefeatures,othershavenot.WefeelGoogle’sapproachdemonstratesthebestpractice.Othershouldfollowtheirlead.

o Equally,searchenginesandinternetserviceprovidersshouldbeavoidinganyotherattemptstohelpusersfindpotentialharmfulmaterialandbyautomaticallytryingtofinishorfindwhattheuserissearchingforitgivestheimpressionthatwhattheyaresearchingforisthenorm.Theymustensurethattheyarenotsubtlyorindirectlyencouraginguser’stoengagewithsuiciderelatedcontent.

iii. Optimisingsupportsiteswhensuiciderelatedtermshavebeensearched.

o Aftertypinginsuchphrasessuchas“howtokillyourself”theinitialpagesthatsearchenginesdisplayaremainlynotonesofferingsupport.

FigureL:RedsquarehighlightingtheunhelpfulsuggestionsthatappearonthefirstpageonYahooaftersearching‘howtokillyourself’.



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FigureM:RedsquarehighlightingtheunhelpfulsuggestionsthatappearonthefirstpageonGoogleaftersearching‘howtokillyourself’



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FigureN:RedsquarehighlightingtheunhelpfulsuggestionsthatappearonthefirstpageonAskJeevesaftersearching‘howtokillyourself’



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FigureO:RedsquarehighlightingtheunhelpfulsuggestionsthatappearonthefirstpageonAoLaftersearching‘howtokillyourself’



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FigureP:RedsquarehighlightingtheunhelpfulsuggestionsthatappearonthefirstpageonBingaftersearching‘howtokillyourself’



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o Moremustbedone:searchenginesmustactivelyremoveharmfuloptionsrelatingtosearchtermsfromappearingatthetopofthelist.Thefirstnumberofresultsaftersearchingkeywordsliketheaboveshouldnotbesoexplicitbutinsteadbeofferingsupportorguidance.

o TheimportanceofencouragingsuchmethodsisenforcedbyfurtherresearchbyBiddleetalthathashighlightedthebenefitsofhavingserviceproviderspursuewebsiteoptimisationstrategiestomaximisethelikelihoodthatvulnerablepeoplehaveaccesstohelpfulratherthanharmfulsites.Theyhavepointedtohoweasyitisgetaccesstodetailedinformationaboutmethodsofsuicide,pointingouthowsuicidesiteswerethethreemostfrequentlyoccurringwebpages.25

o TheimportanceofresponsiblemediareportingwhentalkingandinformingaboutsuicideisvitalandhasbeenshowntoreducesuicideratesaccordingtotheWHO.26Thisresponsiblereportingisdefinedas“avoidingdetaileddescriptionofsuicidalacts,avoidingsensationalismandglamorization,usingresponsiblelanguage,minimizingtheprominenceofsuicidereports,avoidingoversimplifications,educatingthepublicaboutsuicideandavailabletreatments,andprovidinginformationonwheretoseekhelp”.27Thereforetheinternetindustryplaysahugelyimportantroleinensuringthattheaccessvulnerablepeoplehavetocertainsitesisappropriateandthattheyarenotcontributingbyindirectlyhelpingpeoplegaineasyaccesstositesthatsensationaliseandglamourizesuicide.

25Suicideandtheinternet,200826“Towardsevidence-basedsuicidepreventionprogrammes:WorldHealthOrganisationRegionalOfficefortheWesternPacific”,WorldHealthOrganisation(2010),Availablefrom,http://www.wpro.who.int/mnh/TowardsEvidencebasedSPP.pdf27“Preventingsuicide:aresourceformediaprofessionals”,WorldHealthOrganisation(2000),Availablefromhttp://www.who.int/mental_health/media/en/426.pdf

“Thosewhoareworkingintheinternetindustryareamongthebrightestintheworld.Theseinnovatorsshouldnotrelyoncharitiesandgovernmenttojusttakethelead”

“Wearecallingfortheinternetindustrytobeevenmorevocalandpositivearoundthepotentialtoimproveonlinesuicideprevention”

“Thereremainsroomforimprovementwithsignpostingontheinternet.Ofthefivemostusedandpopularsearchenginesonlythreeofthesehaveahelplinenumber”

“Searchenginesandinternetserviceprovidersshouldbeavoidinganyattemptstohelpuserseasilyaccesspotentiallyharmfulmaterial.However,aftertypinginphrasessuchas“howtokillyourself”theinitialpagesthataredisplayedaremainlyonesnotofferingsupport”



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o Byensuringsearchengineshavehelplinenumbers

availabletoall,andthatthefirstmainpostsareonesinwhichofferemotionalsupportandguidance,itincreasestheeffectivenessoftheinternetasaplaceofsupport.

iv. Increasecommunicationandcohesiveactionamongthesector

o Thosewhoareworkingintheinternetindustryareamongthebrightestintheworld,withinnovation,creativityandimaginationatthecentreofeverythingthattheydo.Theseinnovatorsshouldnotrelyoncharitiesandgovernmenttojusttaketheleadandrelyonthemtoimplementthenecessarymeasures.

o Whiletheremaybepeoplebetterplacedtoadviseonthespecificsofhowtorespondtothosewhoarefeelingvulnerable,internetproviders,searchengines,andsocialmediasitescanandmustbemorevocalasanindustryonthisissue.

o Theyhavemademanypositivesteps,butweare

callingfortheinternetindustrytobeevenmorevocalandpositivearoundthepotentialtoimproveonlinesuicidepreventionandbytheendof2017wewouldliketoseeinternetserviceproviders,searchengines,andsocialmediasitesworkingandsharingtheirbestpracticesontheissue.



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7. Conclusions7.1 Whatthisreporthasattemptedtodoishighlightthatthe

Government,internetproviders,searchengines,andsocialmediasitesmustbemorepro-activeandcontinuetotakepositivestepsintheirapproachtotacklingsuicideandonlinesuicideprevention.

7.2 Wehaveestablishedthatalotofgoodandimportantworkhasbeendoneinattemptingtoreachouttothosewhoarevulnerable,andthatattitudesarechangingacrossthecountrywhenitcomestomentalhealthandsuicide.However,wecannotbecomplacent,andwemustrecognizethattherearegapsandmorecanbedone.

7.3 TheGovernmenthaslaidoutastrategytohelptacklesuicide,but

itlacksdetailandspecificsandwebelievewithrecentresearchhighlightingtheimpacttheinternetishaving,thereismoreforthemtodo.

7.4 Furthermore,inanerawheretheinternetisnowthego-tosource

forinformationandaccesstoawealthofknowledge,itmustcontinueasaneffectivesourceofsupportforpeoplewhoarevulnerable.Internetserviceproviders,searchengines,andsocialmediasiteshavetakenimportantstepsinhelpingpreventsuicidesbytryingtoreducewheretheinternetcaninadvertentlypromoteorencouragesuicide.However,theytoomustrecognizethatthereismorethatcanbedonebymakingsuretheinternetisasourceofsupportandguidanceabouttheimpacttheinternetishavingonsuicide.



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ThankyouThankyoutothefollowingindividualsandorganisationswhohaveinsomewaycontributedtotheworkincludedinthisreport:ActionforChildrenAlastairCampbellAndrewandArnoldLtdAnnCulley,ChairoftheSupportforBereavementbySuicidecharityAnti-BullyingAllianceAnxietyUKAquissAsk4BipolarUKBritishTelecommunicationsClareMilton-Haven,co-FounderoftheJamesWentworthStanleyMemorialFundCLASPConsole:TheNationalSuicideCharityCruseBereavementCareDrLukeSullivanFacebookNetworkRailFarmingCommunityNetworkGedFlynn,PAPYRUSGoogleGrassrootsSuicidePreventionGreatLumleyStreetCommunityCentreHafalHamishElvidge,theMatthewElvidgeTrustHanoverCommunicationsHarmlessIfUCareShareIMAGOJanePowell,wholaunchedCALMJonnyBenjaminMBEKidscapeLighthouseListeningEarMaytree:ASanctuaryfortheSuicidalMedConfidentialNationalSuicidePreventionAlliance



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NightlineNSPCCOriginBroadbandOutlookSouthWestPaddyBazeley,founderoftheMaytreeFoundationSuicideRespiteCentrePaulFarmer,ChiefExecutiveofMINDProfLouisAppleby,ChairandgeneralspearheadofNationalSuicidePreventionStrategyRedBalloonLearnerCentresRuthSutherland,ChiefExecutiveoftheSamaritansSANESelfharmUKSelfhelp:ImprovingMentalHealthSuicideSaferLondonTalkTalkTheChildren’sSocietyTheJamesWentworthStanleyMemorialFundTheOpenRightsGroupTwitterUNO(xilo)YouthAccessYouthScapeZenInternet

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Online Suicide Prevention A Pro-active Strategy for ... Suicide Prevention A Pro-active Strategy for Government and the Internet Industry 1 “Samaritans welcomes this report, which