Left Hanging: Suicide in Bridgend

In England and Wales there are roughly 5000 suicides in roughly 60 million people per year. This would until recently have led to around 2000 hangings per year; 34 hangings per one million people per year, 3.5 per 100,000 people per year.

Bridgend in South Wales has a population of 40,000. The greater Bridgend area has a population of 130,000. There should be 18 hangings per 100,000 people over a 5 year period, 24 per 130,000 per year.

In recent years however in both the US and UK there has been a rise in the number of hangings so that this mode of death now accounts for 50% of cases. If this applies in the Bridgend area, we might expect 28 hangings per 130,000 over a 5 year period, roughly 6 per year.

There were in fact 79 hangings in Bridgend between January 2007 and February 2012. The hangings continue unabated, so the true figure may be in the 90s. This means there have been 16 per year – an excess of 10 or more hangings per year.

There have likely been a lot more self-destructions than this in Bridgend. Coroners have considerable discretion and recently a great deal of encouragement to use narrative, open or death by misadventure verdicts rather than to record a verdict of suicide. To record a suicide verdict they should be satisfied that the person intended to kill themselves. One of the primary indicators of intent is a suicide note. In the Bridgend cases, there have been few suicide notes. This has made it easy for coroners to manage perceptions of what might be going on.

Having a narrative or open verdict can be extremely important for families. I have written reports in over 20 inquests arguing that it would be appropriate to return a narrative rather than a suicide verdict, in the case of people whose suicide has been triggered by an antidepressant.

But this use of narrative verdicts has produced a situation where suicide figures are close to worthless. The British suicide rate is comprised of cases recorded as suicides along with a proportion of narrative, open or other verdicts, with the proportion chosen down to bureaucratic whim. We do not have a self-destruction rate and absolutely no idea as to how many verdicts, either suicide or narrative, are linked to antidepressant or other drug intake.

A website, AntiDepAware, was recently set up to track deaths by suicide or misadventure that are related to antidepressants. It has logged over 1600 UK suicides involving antidepressants of which 43% were recorded as suicides by the coroner, 26% as narrative verdicts, 19% as open verdicts, 5% as death by misadventure and 7% as accidental.

While the suicide rate has become ambiguous, it is not possible to conceal the number of hangings.

Bridgend has had an unusual number of hangings. An apparently odd feature is that these hangings have involved a lot of kneeling. The fact that many victims have been found hanging but with their feet on the ground or close to kneeling has given rise to speculation about internet or other cults, and about serial killing rather than self-destruction.

I had been exposed to relatively few SSRI suicide cases when Linda Hurcombe came to me telling me of her daughter Caitlin, who after 6 weeks on Prozac hung herself using her horses’ lanyard (see Let Them Eat Prozac).

Soon after that with colleagues I ran a healthy volunteer study designed to test how antidepressants work. In this study, two completely normal women while taking the SSRI sertraline (Zoloft) became suicidal. One of these two had vivid imagery of hanging herself.

Around this time too I got involved in the Miller case. Matt Miller was a 13 year old boy who had just changed schools and was feeling nervous. His parents prompted by the teacher brought him to a doctor who put him on Zoloft. Seven days later he hung himself in the bathroom between his parent’s bedroom and his bedroom.

Pfizer, the makers of Zoloft argued that this was not suicide but auto-erotic asphyxiation gone wrong. As evidence, they pointed to the fact he was not suspended several feet above the floor but had his feet on the ground, almost kneeling. They went so far as to scour the carpet in the bathroom to collect potential evidence for seminal stains.

It was Yvonne Woodley’s case in 2010 that explained the hanging issue to me – something that anyone with an interest in the area could in fact have found from Wikipedia.

Yvonne Woodley was a 42 year old woman who was having marital difficulties. She presented to her doctor with sleep problems. The doctor viewed her as being under stress, and as posing absolutely no suicide risk. She gave Yvonne citalopram. A week later the doctor noted that Yvonne was more agitated and there were fleeting thoughts of suicide – so she doubled the dose of citalopram. After a suicide attempt, she doubled it further and a short while afterwards Yvonne hung herself.

She hung herself in the attic of her house. Given the kind of person she was, the rest of her family found it unbelievable that she would have hung herself in the house with her two daughters downstairs but a common feature of SSRI suicides is the apparent lack of concern for the effect on others.

The fact that Yvonne was close to kneeling enabled the coroner to return a narrative rather than a suicide verdict. The pathologist explained that when people are weighing up the possibility of hanging themselves, wondering about it, they might put a rope in place and test themselves against it. If they do this, it is in fact very easy by putting pressure on the carotid sinuses that are in the side of the neck to slip out of consciousness and falling forward to end up asphyxiated. If you have begun with your feet on the ground you can end up kneeling or close to kneeling.

The First Cases in Bridgend

Dale Crole, 18, Found hanged 5 January, 2007; David Dilling, 19, Found hanged in his home, February, 2007; Thomas Davies, 20, Found hanged from a tree, 25 February, 2007; Allyn Price, 21, Found hanged in his bedroom, April, 2007; James Knight, 26, Found hanged at his home; 17 May, 2007; Leigh Jenkins, 22, Found hanged, June, 2007; Zachery Barnes, 17, Found hanged from a washing line, August, 2007; Jason Williams, 21, Found hanged at home, 23 August, 2007; Andrew O’Neill, 19, Found hanged at home, September, 2007; Luke Goodridge, 20, Found hanged, November, 2007; Liam Clarke, 20, Found hanged, 27 December, 2007; Gareth Morgan, 27, Found hanged, 5 January, Natasha Randall, 17, Found hanged, 17 January; Angie Fuller, 18, Found hanged, 4 February; Kelly Stephenson, 20, Found hanged on 14 February while on holiday; Nathaniel Pritchard, 15, Kelly’s cousin, found hanged, died 15 February.

Reports in the Media

Jenna Parry was the next person to die. She was found hanging, almost kneeling. Her death triggered the list above and this account in the Independent in February 2008:

“Bridgend was yesterday mourning yet another addition to the alarming number of suicides in the area, after a 16-year-old girl was found hanged in a wood five miles from the town.

Police insisted there was no link between the 17 deaths in the past 13 months and no evidence of a suicide pact or an internet cult.

Jenna’s death came just days after two cousins died after apparent suicide attempts. Kelly Stephenson, 20, was found dead in a bathroom during a family holiday. Hours earlier she had learnt that her 15-year-old cousin, Nathaniel Pritchard, had hanged himself. The two lived a few doors away from each other in Bridgend…….

Following the deaths, a suicide prevention strategy has been announced for Wales. The Welsh Assembly has said it wants a 10 per cent reduction in suicides by 2012.  [As of 2012, the rate has in fact gone up despite the many abilities of coroners and bureaucrats to lower it].…

However, despite the spate of suicides around Bridgend – a county with a population of 130,000 people – police have said there is nothing to link the deaths….

[The coroner] Mr Morris criticized the media’s reporting of the deaths. “The media reporting is influencing young people in the Bridgend area.

“I have noticed an increase in sensationalist reporting, and the fact that Bridgend is becoming stigmatised. The link between the deaths isn’t the internet – it is the way the media is reporting the news.”

Fourteen deaths in Bridgend are logged on AntiDepAware. There are nine hanging verdicts in which antidepressants are mentioned. There are no hanging verdicts where antidepressants or other prescription medications are ruled out.

What’s happening? One contributory factor to these deaths is coroners. I have been writing to UK coroners for 15 years making the case that they should note where people have been on antidepressant or other drugs at the time of death. The list of drugs now linked to suicide and homicide up to and including school shootings includes anticonvulsants, weight loss pills, some asthma medications, some analgesics, some contraceptives, some medication for acne, a number of antibiotics, medications for malaria, in addition to antipsychotics and antidepressants. See below.

But coroners often do not record drug intake, unless the person has actually died from a drug overdose. In the case of Liam Clarke above he had had some cannabis, and alcohol and was on antidepressants. The coroner decided that the alcohol he had had affected his judgement. Coroners are under no obligation to explain their thinking on a matter like this and are rarely if ever challenged. There is little doubt that antidepressants can lead to a craving for and increased consumption of alcohol – did this happen in Liam Clarke’s case?

Many of the cases listed above were on antidepressants but we only know this because the police or families mentioned it at the inquest and reporters from the media then reported it. Unless the antidepressant or other pill was the cause of death by poisoning coroners typically don’t mention medication.

In Bridgend, the coroner seemed to play down the role of antidepressants. In one of the inquests involving antidepressants, he refers to “lack of anything in the system that would have altered his judgement”. In others he makes similar comments.

Gary Speed, the former manager of the Welsh soccer team, is Wales’s most famous recent suicide. A common feature in the extensive reporting of his death was that family and friends found it baffling. The coroner opted not to reveal if there were prescription drugs in his system. Why?

The Role of the Media

The idea that the media reporting of suicides might cause copycat suicides in Britain stems in part from the work of Keith Hawton in Oxford. As a result students in Cardiff University, which is near to Bridgend, are steered to regard the report in the Independent above as sensationalist. Other countries have more striking suicide cohorts – Japan being the most famous – and in the case of copycat suicides by pairs of lovers jumping into Mount Fuji there is a good case for thinking the media might fuel events.

But equally decent and proper media reporting may do just the opposite and bring to light what is going on. There is probably more chance that a good journalist, or someone who has lost a family member or a friend to suicide, is going to solve this rather than bureaucrats or experts brought in to work out what is going on. In this case neither the experts nor bureaucrats linked to this case seem interested to respond to emails from me.

Having coroners refuse to keep a public record of drug intake and browbeat the media into keeping silent seems like the worst of all possible worlds.

We have an excess of 60 hangings to explain in Bridgend. The number is growing by the month. If some have happened by accident as outlined above, it needs a public education campaign through the media to alert people to the risks.

Some of these suicides may be copycat. In the same way school shootings may have a copycat component to them. But a copycat needs an original or several original examples to get them going. The distress that leads to school shootings or clusters of hangings needs an original exemplar to shape it into more shootings and hangings – an original event to open this door to others.

There are obvious factors to explain some clusters like a pair of well-known Japanese loves committing suicide together by jumping into Mount Fuji. In the Bridgend case, if we are going to invoke a chemical – a medicine – the scale of the problem almost suggests that some factory in the Bridgend area must be pumping out some chemical that is having the same kind of effect as drugs like Cymbalta or Pristiq. This might seem improbable. But looking at the list of drugs that cause suicide and homicide, below, the improbable begins to look possible. It almost looks probable that this array of drugs will give rise to a cluster like this somewhere if not in Bridgend.

What to Do Next?

The problem of drug induced suicide and homicide is not vast like climate change or famine in Africa. You can make a difference. As things stand your Human Rights are being infringed.  The supposed rights of some unspecified group of people to use (doctors) or take (patients) without having to be deterred by warnings that these drugs can cause suicide or homicide are being used to justify the deaths of people that you know that could be avoided with proper warnings. This is a breach of the Human Rights Act.

The drugs listed below are not listed as a matter of personal judgement. They are either drugs that companies are obliged to state can cause suicide or for which there is convincing evidence that they have in fact caused suicide. There are likely many more drugs that some government officials and company personnel know cause suicide but about which they keep quite.

1. Some coroners are wonderful. Others are misguided. You do not want to assume your coroner knows what they are doing. You need to establish if they are bringing biases to bear on the issue. You have a right to interview them before an inquest.
2. Drug regulators deal in the wording of advertisements. Public health is not their brief. If you are waiting for a regulator or a drug company to suggest a drug may have contributed to a death, you will be waiting for ever.
3. These problems are rarely solved by outside experts. Communities need to take the issues into their own hands and to this end the media are their allies not the enemy.
4. Contribute details of any deaths by someone’s own hand, accidental or on purpose, to AntiDepAware. Contact [email protected]
5. Be aware that the following drugs and likely many others can all cause suicide and in many cases homicide. The statement cause here is based on compelling challenge-dechallenge-rechallenge cases – see Doxycycline causes suicide – or clinical trial data or legal requirements for companies to agree their drug can cause suicide for instance

Drugs that can Trigger & Cause Suicide or Homicide

 

Anti-Infectives
Mefloquine	Lariam
Doxycyline	Doryx
D-cycloserine	Seromycin
Fluoroquinolones	Levaquin, Cipro
Oseltamivir	Tamiflu
Contraceptives
Drospirenone	Yasmin
Drospirenone	Yaz
Cyproterone   and ethinyl estradiol	Dianette
Anti-Smoking
Varenicline	Chantix
	Champix
Buproprion	Zyban
Anti-Asthma
Montelukast	Singulair
Roflumilast	Daxas
Zafirlukast	Accolate
Anti – Acne
Isotretinoin	Roaccutane
Doxycycline	Doryx
Antihistamines
Diphenhydramine	Benadryl,   Sominex
Chlorphenamine	Chlortimeton
Cyproheptadine	Periactin
Urinary Drugs
Duloxetine	Yentreve
Tamsulosin	Flomax
Finasteride	Propecia
Dutasteride	Avodart
Anti-Nausea
Prochlorperazine	Stemetil,   Compro
Metoclopramide	Maxolon,   Reglan
Antihypertensives
Clonidine	Catapres
Doxazosin	Cardura
Guanabenz	Wytensin
Guanfacine	Tenex
Hydralazine	Apresoline
Methyldopa	Aldomet,   Aldoril, Dopamet
Prazosin	Minipress
Statins
Atorvastatin	Lipitor
Fluvastatin	Lescol
Lovastatin	Mevacor
Mevastatin	Compactin
Pravastatin	Pravachol
Rosuvastatin	Crestor
Simvastatin	Zocor
Stimulants
Methylphenidate	Ritalin
	Focalin
	Metadate
	Concerta
Amphetamine	Dexedrine
	Adderall
	Vyvanse
Benzodiazepines
Lorazepam	Ativan
Diazepam	Valium
Alprazolam	Xanax
Chlordiazepoxide	Librium
Bromazepam	Lexotan
Oxazepam	Serenid,   Serax
Cloabazam	Frisium
Medazepam	Nobrium
Clorazepate	Tranxene
Clonazepam	Klonopin
Antidepressants
Citalopram	Cipramil,   Celexa
Escitalopram	Cipralex,   Lexapro
Duloxetine	Cymbalta
Fluvoxamine	Luvox,  Faverin
Fluoxetine	Prozac
Paroxetine	Paxil,   Seroxat, Deroxat, Aropax
Sertraline	Zoloft
Venlafaxine	Effexor
Desvenlafaxine	Pristiq
Mirtazapine	Remeron
Trazodone	Desyrel
Buproprion	Wellbutrin,   Zyban
Amitriptyline	Tryptizol,   Elavil
Imipramine	Tofranil
Nortriptyline	Allegron,   Aventyl
Desipramine	Pertrofran,   Norpramin
Clomipramine	Anafranil
Dosulepin	Prothiaden
Lofepramine	Gamanil
Doxepin	Sinequan
Trimipramine	Surmontil
Anticonvulsants
Phenytoin	Epanutin
Sodium   Valproate	Epilim,   Depakene
Divalproex	Depakote
Carbamazepine	Tegretol
Oxcarbazapine	Trileptal
Lamotrigine	Lamictal
Gabapenin	Neurontin
Pregabalin	Lyrica
Leviracetam	Keppra
Topiramate	Topamax
Tiagabine	Gabitril
Felbamate	Felbatol
Antipsychotics
Chlorpromazine	Thorazine,   Largactil
Perphenazine	Fentazine
Trifluoperazine	Stelazine
Haloperidol	Haldol
Flupenthixol	Fluanxol
Pericyazine	Neulactil
Sulpiride	Sulpitil
Molindone	Moban
Aripiprazole	Abilify
Olanzapine	Zyprexa
Risperidone	Riserpdal
Ziprasidone	Geodon
Quetiapine	Seroquel
Paliperidone	Invega
Zotepine	Zoleptil
Iloperidone	Fanapt
Amisulpiride	Solian
Tetrabenazine	Xenazine