His family was concerned. Wayne Mason’s job at Claxton Engineering was exacerbating his mental health struggles. His GP had signed him off work.  The company had referred Wayne for counselling as bosses were “worried about him.”
Wayne was found dead at work on 17 March 2022. He was supposed to be on sick leave at the time.

There was no lack of concern in the months ahead of Wayne Mason’s suicide. There was just no effective, joined-up strategy to protect him.

A statement by his sister Stephanie Mason, read to the November 2022 inquest into his suicide, stated her brother had continued to go to work “unchallenged” and that his mental health issues were partly caused by work stress but “nothing was put in place to prevent him going to work.”

Dr Myles Duffield, Wayne’s GP who had signed him off sick seven days before his suicide, told the inquest: “I didn't want him anywhere near work.” But Wayne, 49, continued to go into his Great Yarmouth workplace.

The inquest heard Claxton bosses had been concerned about Wayne and referred him for counselling a few weeks before his death.

It hadn’t been enough.

What suicides?

After Wayne Mason’s suicide Claxton set up a ‘Wellbeing Crisis Team”. It was the right thing to do. Samantha Goward, assistant coroner for Norfolk, said she was satisfied that since Mr Mason's suicide death, Claxton had undertaken a “thorough investigation” which resulted in a lot of work being done to improve the systems in place for dealing with employees with mental health difficulties.

MENTAL TRAGEDY  Wayne Mason’s family, employer and GP were all concerned he was struggling. He killed himself at work in March 2022 while signed off sick.

Claxton had been well-intentioned but had got it wrong. There are worrying reasons employers, even good ones, are falling short – and official torpor is top of the list.
Work-related suicide isn’t ‘a thing’ in the UK’s official workplace health and safety system, a shortcoming that keeps the issue off employers’ priorities list.

The Health and Safety Executive’s (HSE) operational guidelines (OG) for inspectors are extensive and detailed, covering issues from fairground attractions, to cattle incidents and cyber security. But HSE has no equivalent operational guidelines on work-related stress - despite stress, anxiety and depression now being faraway the greatest cause of work-related harm and at unprecedented levels.

MAKING WORK SUICIDES COUNT
Six simple measures could make action to recognise, record and prevent work-related suicides more effective; count them, define them, assess them, investigate them, prioritise them, and compensate them. More

There are indications work-related suicides could be following the same trend. A Glasgow Caledonian University (GCU) analysis released on 1 December 2022 found the suicide rate for construction occupations in England and Wales in 2021 was 34 per 100,000 in employment - the highest rate since analysis of the data began.

The comparison of Office of National Statistics (ONS) suicide numbers by Standard Occupation Code (SOC) revealed the rates of suicides in construction in England and Wales rose from 26 to 34 per 100,000 in the seven years to 2021, a 30 per cent increase.

HSE continues to eschew reporting requirements. Enforcement action on work-related stress remains virtually unheard of. A search for work-related ‘suicide’ or ‘stress’ in case summaries on HSE convictions database since 2010 identified no entries. The terms were also absent from summaries of prohibition and improvement notices issued by HSE over the last five years.

It shouldn’t be this way.

HSE’s enforcement management model (EMM) notes the “purpose of enforcement” includes to “ensure that dutyholders take action to immediately deal with serious risks; promote and achieve sustained compliance; and ensure that dutyholders, who breach health and safety requirements, and directors and managers who fail in their responsibilities, may be held to account.”

But suicide, the most devastating possible consequence of poorly managed stress at work, remains off HSE’s enforcement to do list. It only recently added a short webpage on suicide prevention to its website.

Instead of inspection, investigation and enforcement, HSE plumped for a voluntary Working Minds campaign, launched in November 2021, to promote ‘partnerships’. It “encourages” employers “to take steps to support employees.”

So long, partner

Liz Goodwill, head of mental health policy at HSE, said: “When we launched Working Minds a year ago, we were under no illusion that stress, anxiety and depression were on the rise in the UK. Our aim was to ensure psychosocial risks are treated the same as physical ones, that employers recognise their legal duty to prevent work-related stress to support good mental health in the workplace, and that they have the tools they need to achieve this.”

WORK CRITICAL Hospital doctor Vaishnavi Kumar struggled with a “hypercritical environment” at work before her suicide in June 2022, her family said.

But a year after the campaign kicked off, workplace stress, anxiety and depression had risen still further, up 11 per cent, with record numbers affected. There is good reason to be concerned that partnerships alone don’t cut it, even in settings where a good level of awareness could be assumed.

Birmingham Queen Elizabeth Hospital doctor Vaishnavi Kumar received an ‘empowerment award’ in June 2020, and was “commended for her ability to unite teams, support to junior colleagues and dedication to patient care.”

The junior doctor took her own life on 22 June 2022, aged 35. An inquest heard she felt ‘belittled’ at work.  Her father Ravi Kumar, also a doctor, told Birmingham Coroner's Court his daughter felt the hospital was a “hypercritical environment to work in.”

Recording a verdict of suicide, assistant coroner Ian Dreelan said that Dr Kumar had previously contacted a mental health service in 2019. He added she self-referred again more recently, “citing work stress and a recent family bereavement as contributory factors.”

The coroner concluded contributory factors including an underlying medical condition and “the family bereavement she had suffered and the work stress she had experienced and mentioned to a clinician when she sought help.”

Invisible victims

Despite both Wayne’s and Vaishnavi’s suicides having clear links to work, neither death features in HSE’s work-related fatality figures. The regulator has refused repeated calls to make work-related suicide reportable under its RIDDOR reporting regulations (Hazards 155), which require reporting of everything from accidents to zoonoses.

The regulator’s single suicide webpage stresses in bold “Suicides in the workplace are not RIDDOR reportable”.

HSE website, accessed 17 December 2022

Despite the official blind-eye, coroners' inquests, evidence reviews and surveys in the wake of the Hazards ‘Say no to work suicides’ campaign are uncovering alarming evidence of a substantial but unaddressed toll.

Suicide charity R;pple, in survey results published in October 2022, reported 1-in-4 employees admit to having suicidal thoughts at work. R;pple said its findings, based on responses from 2,001 UK adults, exposed the need for mandatory suicide prevention requirements on employers, “entrenched in their existing health and safety policies.”

Launching a Working 9-Alive campaign, the charity said that whilst fire drills and marshals are common practice for workplaces, and fire action signs having been a legal requirement since 2007, “the UK, unlike many other countries, does not monitor, investigate, regulate, or legally recognise work-related suicides – with a person 62 times more likely to die from suicide (1-in-88) than in a fire (1-in-5,447).”

R;pple found that around a quarter of employees (23 per cent) don’t benefit from any mental health policies in their workplace, and almost two-fifths (38 per cent) feel that their workplace mental health policies could be better.

A further fifth of employees (20 per cent) see their workplace mental health policies as a “tick box” exercise.

ACTION! Send an e-postcard to HSE demanding it recognise, record and take action to prevent work-related suicides. www.hazards.org/hsesuicide

Preventable grief

Welsh government lawyer Owain Vaughan Morgan had not suffered depression until 2020, Pontypridd Coroners' Court was told.  But in January that year, he was promoted to his first managerial role.

He found the job difficult and stressful with long hours and struggled to work from home when the pandemic started. This resulted in a nervous breakdown in May 2020, and left him suffering panic attacks and shaking at his computer. Owain was prescribed anti-depressants and signed off work. His mental health reached crisis point on 23 February 2021, when he made an attempt on his life and was admitted to hospital.

On 13 April 2021, Owain’s wife reported him missing to police after he left home that morning. He was found dead the next day in woods.

Coroner Gaynor Kynaston, recording a verdict of suicide at the October 2022 inquest into his death, told the court the 44-year-old had “acute” mental health problems related to work stress and low self-esteem.

In France, all work-related suicides – an official definition gives a broad interpretation of work-linked deaths – are investigated by the safety authorities. [See: HSE in the slow lane on workplace suicides].

Not here.

Toxic workplaces

It is an opportunity for prevention squandered in the UK. Suicide investigations could unearth evidence of a toxic workplace and spur efforts to improve working conditions.

The August 2020 suicide aged 21 of trainee firefighter Jaden Francois-Esprit (pictured below, with his mother) followed alleged racist bullying at work and spurred a London Fire Brigade (LFB) commissioned review.

The November 2022 report of the review led by Nazir Afzal, a former chief crown prosecutor, found “dangerous levels of ingrained prejudice against women”, while colleagues from minority backgrounds were “frequently the target of racist abuse.”

Jaden’s mother, Linda Francois, said her son’s short time in the London Fire Brigade – he had joined the service at 19 – had “completely destroyed him.” Linda, a 55-year-old NHS worker, said her son became increasingly distressed about racism and bullying at Wembley fire station, where he was based.

Jaden had raised his concerns and made 16 transfer requests to work at other stations in the six months before his death, but these requests were not accepted. He was planning to leave the service when he hanged himself at home.

Commenting on the findings of the damning report, FBU regional organiser for London, Gareth Cook, said: “The LFB report makes for difficult reading. The reported incidents of racism and misogyny are extremely alarming. There is no place for such behaviour or attitudes within the fire and rescue service or within our trade union.”

He added that “the review highlights that morale and engagement in London Fire Brigade are low – 40 per cent are frustrated in their job. Staff shortages, poor workforce planning, no leave availability, poor work-life balance and low recognition are cited.

“The review also finds there is a need for increased trauma specialism and mental health awareness. For us these findings of poor morale and a need for better mental health structures are highly linked.”

Following the inquest into Jaden’s suicide, a 22 February 2021 Prevention of Future Deaths report from senior coroner Mary Hassell to LFB Commissioner Andy Roe noted: “In my opinion, action should be taken to prevent future deaths and I believe that you have the power to take such action.”

Growing pressure

HSE is becoming increasingly isolated in its insistence that suicide should not fall within its reporting, investigation and enforcement remit.

In a 30 September 2022 report, MPs called for suicides at work to be reported in the same way as occupational accidents and work diseases. The All Party Group Parliamentary Group (APPG) on issues affecting Men and Boys made the recommendation at the conclusion of its inquiry into male suicide.

The APPG report, Tackling male suicide: A new ‘whole system’ Approach, noted: “Suicide, whether inside or outside of work, does not currently trigger a RIDDOR to HSE for disclosure in the construction industry, when clearly it should do.” One of 15 recommendations in the report is: “Suicides at work to be disclosed as a RIDDOR (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations).”

In July 2022, HSE’s own expert group reported it would be ‘beneficial’ if work-related suicides were reportable. The regulator had asked its independent Workplace Health Expert Committee (WHEC) to consider the occupational factors that may contribute to the risk of suicide.

Work-related suicide, WHEC’s evidence review paper, found that suicide risk “varies strongly between occupational groups in the UK, with the highest risk found amongst workers in low skilled, and some skilled, positions.” But it added in the UK “there are no systematic methods of taking an overview of employee suicides in an organisation or workplace. It would be beneficial to establish a way of recording relevant data.”

The report noted: “While there are clear differences in risks of suicide between occupational groups in the UK, current means to identify high risk organisations and workplaces are weak.”  The report also called for greater collaboration between HSE and coroners on work-related suicides.

A September 2922 policy brief on good practice on mental health at work from the UN’s International Labour Organisation (ILO) and the World Health Organisation (WHO) noted: “Psychosocial risks at work are associated with negative mental health outcomes, including suicidal behaviours.” It called on governments to “mobilise the collection of evidence on the prevalence of risks” on workplace mental health problems, and to “establish regulatory processes.”

Other countries, notably the US and France, have clear definitions of work-related suicide and official reporting duties on employers.

It took an independent report following Jaden’s suicide to expose the racism and sexism blighting a fire service. A coroner stated the employer should do more to prevent future tragedies.

Wayne’s family, GP and engineering employer were all concerned for his welfare, but he still ended up killing himself at work while signed off sick.

Owain, a lawyer, had never suffered mental health problems until he was promoted to a more stressful job, killing himself 15 months later.

And while Vaishnavi’s NHS employer gave her an award for ‘empowerment’ of others, she was undermined by criticism of her work before she took her own life.

A requirement on employers to report suicides to HSE would focus attention on possible problems in the workplace. That is far from the rule at the moment.

A 2021 Leeds University study, which examined 12 work-related suicides, concluded: “Employer-led investigations were only carried out in 4 of the 12 suicide cases studied (33.3 per cent). The organisational/managerial factors that have caused or exacerbated a suicide are therefore not consistently investigated, reported or regulated and may continue to pose a health and safety risk to other employees.”

A requirement to report would send an early and serious signal to employers that addressing conditions that damage mental health could save lives.

Only the safety regulator, HSE, is stopping that happening.

• APPG on issues affecting men and boys. ‘Third enquiry: Male suicide’, 30 September 2022.
  
• Work-related suicide, Evidence Review Paper, HSE Workplace Health Expert Committee (WHEC), WHEC-18, July 2022.
  
• Work-related suicide: a qualitative analysis of recent cases with recommendations for reform, Sarah Waters and Hilda Palmer, University of Leeds, July 2021.
  
• Mental health at work: Policy brief, ILO/WHO, 28 September 2022.

Making work suicides count

Six simple measures could make action to recognise, record and prevent work-related suicides more effective.

• Count them Make work-related suicide reportable under the RIDDOR regulations and improve communication between the Health and Safety Executive (HSE) and coroners on potential work-related suicide notification.
  
  
• Define them Suicides caused by or clearly related to work need to be clearly defined. This could include suicide at work, in work clothes or using work equipment or materials, referrals to occupational health or HR for mental health problems, a history of mental health-related sick leave, a pattern of stress-related problems affecting co-workers, evidence from personal documentation, coroners’ inquests, GPs and other health professionals, or family or suicide notes implicating work factors.
  
  
• Assess them Investigating and addressing suicide risks should be part of workplace stress risk assessments and stress management strategies.
  
  
• Investigate them Work-related suicide and suicide ideation should be included explicitly in HSE’s inspection guidelines. There should be HSE operational guidelines for inspectors on work-related stress, including work-related suicides. Work-related suicide should be added explicitly to the Work-related Deaths Protocol defining cooperative arrangements between HSE, police, prosecutors and other investigating and statutory agencies.
  
  
• Prioritise them Suicide meets the requirement for inclusion in HSE’s Matters of Evident Concern and Potential Major Concern (Hazards 155). The Operational Circular to inspectors should be applied to suicides, and trigger HSE investigations into work-related suicides, suicide patterns or evidence of suicide ideation (suicidal thoughts)
  
  
• Compensate them. Deaths from work-related suicide should, in line with other fatal work-related conditions like mesothelioma, be eligible for government compensation. Legal guidance should clarify to courts the potential for work-related suicide causation in civil compensation cases.

HSE in the slow lane on workplace suicides

The report to HSE from WHEC, the regulator’s own independent expert committee, gave examples of reporting requirements on work-related suicide in Japan, the USA and France.

“The Japanese have terms for both death from overwork (‘karoshi’) and work-related suicide (‘karojisatsu’), each of which is defined in law, largely in relation to excessive hours of overtime work.

In the United States, suicide is considered a fatal occupational injury where any of the following is true:

• it occurred at the workplace while the deceased was there for work activity;
• it occurred away from the workplace, while the deceased was engaged in work activity; and
  
• death was related to the deceased’s work status (eg. a suicide at home that can be definitively linked back to work).

In France, since 2000, a suicide has been presumed to be work-related and subject to further investigation where any of the following is true:

• it occurred in the place of work or on the journey to and from work;
  
• it was officially recognised as a workplace accident;
  
• there was circumstantial evidence of a link to work (a suicide letter or witness statement);
• a work implement or tool was used (including firearm or medication);
  
• work clothes were worn.”

It adds: “Any suicide that occurs in the workplace in France is investigated as a workplace accident; the burden of proof is on the employer to prove that the suicide is not work-related. Even in cases where a suicide takes place outside of work, it is still investigated as work-related where the employee (in an attempted suicide) or the family can prove a causal link to work.

“Hence, around one in five employee suicides reported to the authorities in France is officially recognised as being work-related.

“Attempted suicide may also be recognised as a workplace accident; since 2007 this includes an attempted suicide by an employee who was on sick leave following depression that was linked to deteriorating working conditions or the behaviour of his/her employer.”

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DEATH WISH

Bosses knew certain staff were really struggling. Coroners said the job played a big role in their suicides. We all know work stress can push you over the edge. Hazards editor Rory O’Neill says it’s time the Health and Safety Executive recognised and acted on it too.