Why is a free-to-caller service important?
Update 22 September 2015: Samaritans 116 123 is now FREE to call in the UK and ROI.
Suicide and status
The differences in suicide rates by age and gender are frequently discussed, but what is usually overlooked is the dramatic difference in suicide rates dependent on socio-economic status.
The poor and disadvantaged in our society are far more likely to die by suicide than the affluent. There is ‘social gradient’ in suicide risk: those in the lowest social-economic position have the greatest risk of suicide, with risk reducing with each step up the social ladder.
Socio-economic position can be defined by occupation, social class, educational attainment, income, housing type and even car use. Whichever indicator is used, people at the bottom of the ladder are at higher risk of suicide.
There is a well-established link between unemployment and suicide. Living in a deprived area contributes to suicide risk. Suicide tends to increase during economic recession, particularly where the impact of recession is not offset by welfare safety nets.
Approximately 90% of individuals in developed countries dying by suicide have a mental health problem. The ‘social gradient’ also applies to mental health problems.
Studies demonstrate higher rates of mental health problems associated with low income:
- insecure housing
- limited education
- recent unemployment
- low status
- high-demand or low-control work
- child abuse or neglect
- poor neighbourhood conditions
- and low social support.
Almost whichever difficulty one considers – mental or physical health problems, harmful substance misuse, crime, poverty, social exclusion, worklessness, insecure or poor working conditions, as well as suicidal behaviour and suicide – these are more likely to be experienced by people in lower socio-economic groups.
They are also likely to have a more negative impact, because people in lower socio-economic groups have fewer resources to cope with such difficulties.
The impact of the recession
It is probable that the current recession will affect the suicide rate, and there is evidence emerging that this is the case.
The people who are likely to be at higher risk of suicide during recession are those who were already suffering from poverty prior to recession;
- those with pre-existing debts
- those who have recently lost their jobs or who become unemployed for some time
- those who are affected by a downturn in business; people who depend on clients for their livelihood
- those with insecure, precarious, poorly paid or insufficient work; those in low-status occupations
- and those with few educational qualifications who are disadvantaged when seeking employment in a competitive job market.
Distinctive to the current recession are the simultaneous cuts to public spending and social welfare systems: to social security benefits, benefits for sick and disabled people, and any introduction of universal credit.
Thus, in the context of extremely hard financial times and increasing economic stress, especially for those at the bottom of social ladder, there is simultaneously a rolling back, rather than investment in, welfare safety nets; as well as political and public discourse which is at best unsympathetic and at worst potentially vilifying of the poor and socially excluded.
This is likely to exacerbate people’s material, social and psychological distress.
The fact that the poor live shorter lives, live with physical and mental health problems and are more likely to die by suicide, are inequities that demand a response by services such as Samaritans.
The cost of calling us
The cost of calling Samaritans has been raised as a barrier to accessing the service by people that use our service. Some people say they are prevented or discouraged from telephoning Samaritans in times of need because of the cost.
In particular, our callers raised as a worry the cost of calls from payphones or mobile phones – including that at the point of crisis they may not have any credit on their phone, and have no access to a landline.
Statistics show those in the lowest income group are more likely to have access to a pay-as-you-go mobile, rather than a landline or the internet.
Because callers are charged for calls, and because of our use of an 0845 number, Samaritans service may exclude those most in need and at excessive risk of suicide – those with low incomes, and experiencing poverty and social exclusion.
However, it’s also important to consider that helpline use depends not only on costs but also on the way the service is promoted and targeted, and the quality and value it delivers to users.
How we must change
So the answer is obvious is it not? We simply must move to providing a service which is free to our callers...
In order to do this in a sustainable way we must first make sure we understand the impact a free-to-caller number has on the pattern, volume and nature of our calls.
Without that knowledge we cannot know for certain that such a service is sustainable in the long term.
There are already estimates which predict a 10-15% increase in costs to the charity for running such a service, if all our five million plus calls were made free via a free-to-caller number.
So what’s next?
We are about to embark on a project which will enable us to test the impact of a free-to-caller service on our ability to reach new audiences and help us understand the demands it places on our organisation’s capacity.
Equipped with this knowledge we will bring together government, funders and telecommunications agencies in a partnership to develop a long term sustainability plan. We call this project ‘Freecall’.
Freecall will be a major step forward in Samaritans’ strategic development. The project will help us target groups at greatest risk of suicide and give the organisation the information it needs to build a strong business case for a sustainable, full rollout of Freecall across the whole UK.
Joe Ferns, Executive Director of Policy, Research & Development
Clare Wyllie, Head of Policy and Research