Why US suicide rate is on the rise

A new government study released reveals that suicide has been on the rise nationwide since 1999. The figures were released in the week when the deaths of designer Kate Spade and celebrity chef Anthony Bourdain brought the issue to the fore.

In the days following Spade's death, the US suicide prevention hotline - 1-800-273-8255 - saw a 25% spike in calls, the Wall Street Journal reported.

International research has shown an apparent "contagion" effect after high-profile suicides.

But what has spurred such a steady increase in American suicides?

In 17 years, 30%

That's how much the overall suicide rate has increased in more than half of US states in that time, according to the US Centers for Disease Control and Prevention (CDC). The overall rise nationwide is about 25%.

It means that around 16 out of every 100,000 Americans will take their own life.

Nearly 45,000 Americans took their own life in 2016 alone.

According to CDC data, suicide increased among all sexes, ages, races and ethnic groups.

Lead researcher Dr Deborah Stone told the BBC that the agency had been tracking the rise for some time.

"Knowing the rates were increasing, we [wanted to] look at state level increases and contributing factors," Dr Stone says.

"There were 25 states that had increases of more than 30% - that was a new finding for us."

Nearly all of those states are in the western and Midwestern regions of the US.

Why are suicide rates increasing?

While there is no single factor that leads to suicide, Dr Stone says relationship issues and financial troubles tend to be top factors contributing to suicide across the country.

She also notes that some western states have some of the highest rates of suicide historically, which could be related to the fact that they tend to be more rural.

Rural states, she explained, are still recovering from economic downturns. People also tend to be more isolated, without access to proper care. And, these states have been hit hard by the opioid epidemic.

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Prof Julie Cerel, president of the American Association of Suicidology, noted that having better reporting standards could account for some of the increase, but also pointed to a lack of adequate funding for mental health research and preventative care.

"Our mental health systems are just really struggling across the country," Prof Cerel says. "In terms of training mental health professionals, we're not doing a great job."

As of 2018, only 10 states mandate suicide prevention training for health professionals.

And Prof Cerel raised another related, though often sidelined, public health issue - firearms.

"The gun debate in the US has been about the horrific school shootings, and we want to prevent those, but the vast majority of deaths from firearms are suicides," she says.

In fact, two-thirds of gun-related deaths in America are suicides, according to the CDC.

"We just don't talk about that in the US because there are stigmas against mental health. People think suicides are different - why should they want gun control? Nobody in their family is going do that."

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Middle age health crisis' warning

Unfit in middle age

After accounting for other factors (including socio-economic status, a number of long-term conditions, smoking, alcohol and BMI), researchers found men between the ages of 37 and 45 were over two-and-a-half times more likely to die than non-frail people of the same age.

The figures were similar in all the other age groups (45-55, 55-65, and 65-73).

Similar associations were found in women who were judged to be frail and were 45 or older.

Frail people were also far more likely to have conditions such as multiple sclerosis and chronic fatigue syndrome.

Lead author of the study, Prof Frances Mair, from the University of Glasgow, said the findings suggested there was a need to both identify and treat frailty much earlier in life.

So what can we do?

Dr Peter Hanlon, a co-author on the frailty study, said the good news is that frailty might be reversible in people, particularly if it is identified early.

The key for those who are unfit in middle age is making healthy changes "as soon as possible", says Ilaria Bellantuono, professor of musculoskeletal ageing at the University of Sheffield.

"The key is a healthy diet and exercise. It's the only thing we know that works," she says.

Losing weight, stopping smoking, cutting back on alcohol, exercising regularly and eating less salt are just some of the things you can do to lower your blood pressure.

And similar advice applies to reducing your risk of dementia and helping to keep your brain healthy as you age, says Dr Laura Phipps from Alzheimer's Research UK.

But the million pound question is how do you get people to change their habits?

Prof Bellantuono said that for some, health warnings won't be enough.

Instead, finding an "internal motive that speaks to them" will be key to getting some people to exercise and be healthier.

"That could be picking up the grandchildren or going to watch the football," she adds.

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Student mental health 'failing a generation'

British universities say they risk "failing a generation" unless students get better mental health care.

A Universities UK report found some students risked "slipping through the gaps" due to a lack of co-ordination between the NHS and universities.

The most up-to-date statistics show 146 students killed themselves in 2016. At Bristol, three students have died suddenly in the past month alone.

An NHS official said local services should collaborate with universities.

Henry Curtis-Williams, a photography student, took his own life in 2016, aged 21.

"He had lost weight, he had dark shadows under his eyes, he was clearly in crisis," said his mother Pippa Travis-Williams.

"He changed from being that super-confident person to [becoming] just a shell of a person."

The number of deaths in 2016 was higher than the 134 students who killed themselves in 2015 - which in turn was the highest total since 2006.

Universities UK said that over the past five years, 94% of universities had seen a "sharp increase" in the number of people trying to access support services.

Some institutions noticed a three-fold increase.

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The report said data on students was rarely shared fully between universities and local health services, which could lead to students accessing "treatment and support with incomplete information, or not accessing it at all".

The report added students leaving their family homes to attend university often enrolled with a new GP.

They would then return home during holidays, meaning they were without their bespoke GP care for several weeks or months.

What is Universities UK suggesting?

• Universities and local NHS services should communicate more about students who may need mental health services
• Local services and universities should assess the need for mental health services for students in specific towns and cities
• Institutions should promote positive mental health, make reasonable adjustments for students with pre-existing conditions, and reduce the stigma of mental health
• Create "student mental health teams" with NHS providers to improve referrals to specialist services

Barnsley bans sugary drinks in 'sugar-free borough' bid

Sugary drinks have been barred from sale at Barnsley Council in a bid to make the town a "sugar-free borough".

The authority launched its food strategy after its public health department identified smoking, excessive drinking and poor diet as major problems for the town.

Council staff said food habits were the "most challenging" things to change.

A full food plan is expected to be adopted by the authority later in the year.

As well as cutting out full-sugar drinks from sale and removing vending machines from council buildings, the cafe at the council's Westgate Plaza headquarters now gives a calorific value on its sandwiches, the Local Democracy Reporting Service said.

The council is working with prospective tenants of the new Market Food Hall, which is currently under construction, with the aim of introducing similar labels.

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Takeaways are being encouraged to offer healthier meal choices and to introduce simple measures like salt shakers with smaller holes, or healthier fats for frying.

Diane Lee, head of public health, said the authority wants Barnsley to become a "sugar-free town."

She said: "Our long-term goal is for all food sold to have its calories displayed, every sandwich in every shop.

"That's a long way off, but it's about giving people the information to lower their sugar and calorie intake."

The council said Barnsley has fewer overweight children than the national average, and public health staff will monitor future results in the hope that it is the start of a positive trend.

Work is being done to maximise school meals' nutritional value and to address "holiday hunger", when children from impoverished backgrounds do not get a good diet once school dinners stop for the holidays.

The town has already adopted a scheme to give weekly healthy food vouchers to families.

Seeds of hope: The gardens springing up in refugee camps

Syria is green," says Aveen Ismail. "But here it was like a desert until we started growing plants and trees."

The 35-year-old fled Damascus with her family in 2012. She now lives in the Domiz Camp in Northern Iraq, where roses, lemon trees and marigolds have sprung up amid the concrete and dust.

"Creating a garden was a way for us to heal and remind us of home," she says.

Alfonso Montiel of the Lemon Tree Trust has sat down in many of the tiny green spaces at the camp.

"You'll see in some cases it's full of roses," he says. "The first question you ask yourself is, why not food?"

Flowers, says Montiel, give a sense of the passage of time. "It gives them a sense of hope. It gives a sense of control of their environment."

The Lemon Tree Trust has been working in the refugee camps of Northern Iraq for the past three years, running garden competitions to encourage residents to create gardens, and providing seeds and plants.

Domiz, one of the largest camps in Kurdistan, is home to 30,000 refugees, most of them from Syria.

"The Syrians - one of the things they pack when they leave is seeds," says Montiel. "They want seeds from their own plants, from their own spaces, from their own families."

Echoes of history

Gardeners in the camp grow seeds and plants brought to them from Syria by brothers, uncles and cousins. The community has come together to build raised beds, which are planted with vegetables and flowers.

More recently, residents of the camp have helped choose plants and flowers for the Lemon Tree Trust's first refugee-inspired garden at the RHS Chelsea Flower Show. Sami, who has a PhD in botany, played a big role.

"He walked from Syria for ten days holding both of his boys, one on each hand, into the camp," says Montiel. "He was a principal collaborator in choosing the plants with Tom [designer Tom Massey] and thinking about the design. This is truly a garden inspired and developed with the help of the refugees themselves."

The garden has already proved an inspiration for Sue Biggs, the director general of the Royal Horticultural Society. When she heard about plans for the garden, she was reminded of a chapter in history 100 years ago when the RHS sent seeds to British citizens who were prisoners of war in the Ruheleben internment camp in Germany, to help them survive the hardships.

London Mayor Sadiq Khan plans TfL 'junk food' advert ban

Junk food advertising could be banned across the entire Transport for London (TfL) network, City Hall has announced.

The Mayor of London, Sadiq Khan, says he wants to tackle the "ticking time bomb" of child obesity in the capital.

If the proposal is approved, adverts for "unhealthy food and drink" will be banned on the London Underground, Overground, buses and bus shelters.

The scheme is backed by child health experts but the Advertising Association said it would have "little impact".

The junk food advertising ban forms part of Mr Khan's London Food Strategy, which has been published for consultation.

TfL's director of TfL's transport strategy Lilli Matson said it had a "large advertising estate with a diverse audience", and is supporting the mayor's attempts to make London healthier.

Mr Khan wants to "reduce the influence and pressure that can be put on children and families to make unhealthy choices".

He said: "I am determined to do all I can to tackle this issue with the powers I have and help Londoners make healthy food choices for themselves and their families.

"That is why I am proposing to ban adverts for harmful junk food from our entire Tube and bus network."

Mr Khan intends to ban adverts for food and drinks high in fat, salt or sugar.

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 spokesman for the mayor's office said if the ban comes in "everyone will be affected, whether it's the biggest fast food chain or the most niche", and their products will be assessed against the nutrient profiling model developed by the Food Standards Agency.

Companies could, he added, choose to swap their adverts for burgers or fizzy drinks for "healthier products within their range, such as salads or bottled water".

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Analysis: Karl Mercer, political correspondent

The burgers may be banned, the fizzy drinks may fizzle out, but have we seen the last of adverts from companies who make their money selling such things to Londoners? The truth is, probably not.

It seems the mayor is trying to have his (low-calorie) cake and eat it.

Perhaps aware that high sugar, fat and salt ads bring in around £13m for TfL he says his new ban will not apply to companies - just to their less healthy products.

Advertise with us, he'll say, as long as you're pushing your healthier wares.

That could cut the expected losses to TfL, but how does the policy fit into a wider business plan that sees shops at stations selling unhealthy snacks? Or kiosks on the Tube selling chocolates and crisps?

"We can all indulge occasionally," the mayor told me.

Advertisers will now have to decide how occasionally they wish to indulge when it comes to the big sell on London's Tube and buses.

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Chef and health campaigner Jamie Oliver - who has said London "now has the most overweight and obese children of any major global city" - described the proposal as "bold".