On 20 February 2018, the Assembly will debate the Health, Social Care and Sport Committee’s report of its inquiry into suicide prevention.
Suicide is a leading cause of death in people under the age of 35, and the number one cause of death in men under 50. While there are certain groups of people who are at higher risk, it can affect anybody. Each death by suicide significantly impacts the lives of a wider circle of people. Despite this, the Committee heard, it is little talked about. The stigma that is still associated with suicide means that many people struggling with suicidal thoughts are reluctant to seek help and, when they do, their experience is often negative.
The report’s key message is that suicide is everybody’s business. Raising awareness among the general public, as well as those working in public services, will encourage help-seeking behaviour and a more compassionate response to people in distress.
“This is everyone's business. We can't leave it to people in white coats and people whose vehicles have blue lights. Your child may only have one chance to speak to somebody and that may be you.' We need to translate that message right across the country”.
Ged Flynn, Chief Executive, Papyrus
Suicide prevention, the Committee agrees, is ‘everybody’s opportunity’. Its report recommends that existing training resources - which aim to give members of the public the confidence to intervene when they’re concerned someone may be at risk of suicide – should be rolled out more widely. Examples highlighted include Network Rail’s Small Talk Saves Lives campaign, in partnership with Samaritans, British Transport Police and the wider rail industry, and the free, 20 minute online training See.Say.Signpost produced by the Zero Suicide Alliance.
The Committee also heard that improved training in mental health and suicide prevention would equip frontline service providers to respond sensitively and effectively when dealing with a person in emotional distress. Stakeholders suggested that suicide prevention training should be given the same focus as first aid/CPR, highlighting that GPs for example are far more likely to have contact with people who are feeling suicidal than with people in need of CPR.
The Welsh Government has accepted the Committee’s call for a training competency framework to be implemented in Wales, similar to that developed for England. A new, all-Wales suicide prevention website www.talktometoo.wales, launched at the end of January, will bring together information, support and training resources for the public and for professionals working in suicide prevention.
Access to services
It’s likely to be the case that any increase in help-seeking behaviour will lead to greater demands on mental health services. The ability of individuals across Wales to access the support they need is already a cause for concern. Stakeholders described high thresholds for accessing services as well as lengthy waiting times, pointing out that a person’s mental health can deteriorate significantly while waiting for an appointment. The Cabinet Secretary, Vaughan Gething, said:
“I wouldn't tell anyone in this committee, or outside it, that where we are is acceptable. For all the progress we've made, over a period of time, there's still much more to do. So, no, some of the waiting times are not acceptable. We are investing more, and we'll need to see if that investment deliver results that mean that people don't wait an excessive length of time for that support, whether it's going to be urgent at the crisis end, or at the more standard end, because all of those things matter to avoid problems escalating”.
A recurring theme throughout the inquiry was that mental health remains under-prioritised, and the Committee’s second, broader headline message is the need for greater parity between mental and physical health.
The Welsh Government accepts this point in its response (PDF, 578kb) to the Committee’s report, and states that its new mental health delivery plan for 2019-22 (expected to be published for consultation in the spring) will include ‘a substantive theme on parity between physical and mental health’.
Support for people following a suicide
The Committee heard from people with lived experience of suicide about the devastating impact it has on family, friends and the wider community. It’s also known that people who have been bereaved through suicide are at higher risk of suicide themselves.
Support groups, such as those run by Survivors of Bereavement by Suicide (SOBS) and the Jacob Abraham Foundation in Cardiff, can provide a lifeline to people struggling to come to terms with the death by suicide of a loved one. However there is limited access to such groups (which rely on self-fundraising) in Wales.
A key theme throughout the inquiry was the need for an improved, more consistent approach to ‘postvention’. This is action taken to support people who are bereaved or affected by suicide, such as family, friends, colleagues and peers.
As an immediate priority, the Committee said, the Welsh Government should develop and implement a Wales-wide postvention strategy for suicide, as called for in the 2018 mid-point review of the Welsh Government’s Talk to me 2 suicide prevention strategy. The Welsh Government says it will urgently review the postvention pathway now in place in England and will work with the National Advisory Group to adapt this for Wales.
Young people
The Committee was concerned about the growing burden of mental ill health among children and young people, and called for educational settings to play a greater role in developing children and young people’s emotional resilience and providing mental health support.
The Committee fully endorsed all the recommendations of the Children, Young People and Education Committee’s Mind over matter report on the emotional and mental health of children and young people (April 2018). In relation to suicide specifically, this report recommended that the Welsh Government works with expert organisations to:
- provide guidance to schools on talking about suicide and self-harm, to dispel the myth that any discussion will lead to ‘contagion’ (schools where there has been a suicide or suspected suicide should be prioritised);
- ensure that basic mental health training, including how to talk about suicide, becomes part of initial teacher training and continuous professional development.
Men
Males remain three times more likely to die by suicide than females. Men in mid-life are identified as a particularly vulnerable group. The Welsh Government’s suicide prevention strategy Talk to me 2 says:
“Men aged between 30 and 49 are now the group with the highest suicide rate and this appears to be an increasing issue for men in the most deprived areas of Wales.
The current economic climate may exacerbate the risk factors for this group making middle aged men priority people on whom to focus preventative efforts”.
Many men may not seek help in traditional ways or fit standard treatment criteria, and new approaches need to be developed. The Committee heard about existing initiatives including community/voluntary sector programmes (e.g. Men’s Sheds), mental health champions among sports or tv personalities, and provision of information/support in ‘non-mental health’ settings which men (including those who may be vulnerable) frequent, including for example job centres, citizens advice bureaux, and also sports fixtures (e.g. It Takes Balls to Talk).
The Committee calls on the Welsh Government to recognise male suicide as a national priority. The Committee says funding should be allocated to identify and implement innovative ways of encouraging help-seeking behaviour among men, and to roll out existing, successful initiatives more widely.
The Welsh Government accepts the Committee’s recommendation. Its response also highlights Time to Change Wales’ Talking is a Lifeline campaign (launching on 21 February 2019) which aims to address the stigma around men's mental health.
Going forward
It’s recognised that suicide prevention involves a co-ordinated, multi-agency approach, and the Committee’s report makes a total of 31 recommendations in a wide number of areas (in addition to the issues discussed above, these jnclude for example, information sharing about at risk patients, crisis care, reducing access to means, and responsible reporting of suicide).
The Welsh Government accepted all of the Committee’s recommendations, albeit some of these ‘in principle’.
Addressing the Talk to Me 2 national conference in Cardiff on 31 January 2019, the Minister for Health and Social Services also announced that additional funding of £0.5 million would be provided each year to support suicide prevention in Wales.
The Committee’s report makes clear that it intends to keep a close eye on progress in the areas for action it has identified. There is a great deal of work to do, the Committee says, however there are immediate steps which could be taken to support people to seek the help they need, and to encourage all of us to reach out when we’re aware that someone may be in distress.
Help and support
If you’re struggling to cope, need to talk to someone or feeling suicidal, you can contact Samaritans.
- Freephone 24 hours a day from any phone on 116 123.
- Welsh Language Line: 0808 164 0123 (7pm-11pm, 7 days a week)
- Email: jo@samaritans.org
- Website: Samaritans Cymru
Article by Philippa Watkins, Senedd Research, National Assembly for Wales
