Preventing people from taking their own lives is everybody's business and talking to someone who's suicidal can never make things worse.
That's the message from the National Assembly's Health, Social Care and Sport Committee as it publishes its wide-ranging report on suicide prevention.
There were 360 registered deaths from suicide in Wales in 2017, the highest figure since 1981, but it's thought that official statistics may under-represent the true scale of suicide.
The Committee makes a series of recommendations focusing on better parity between mental and physical health services, improved follow-up care for those discharged from hospital, and introducing a national training framework for suicide prevention. It says that the Welsh Government should consider the introduction of meaningful targets if it's serious about achieving parity between physical and mental health
The Committee calls on the Welsh Government to recognise male suicide as a national priority while also urging it to implement specific recommendations around improving and protecting the mental health and wellbeing of children and young people in Wales as set out in the Children, Young People and Education Committee's Mind Over Matter report (PDF 3.3MB).
But while the Committee believes better and consistent services are urgently needed to help those affected by suicide, it also believes more effort is needed to raise awareness of suicide among the general public as well as frontline staff.
Dr Alys Cole-King from Connecting With People told the Committee:
"It is absolutely not the preserve of specialist services. We need to democratise suicide prevention, in that everybody has the right to know how to keep themselves safe and to know how to keep those around them safe."
The Committee was shocked by the lack of support available for those bereaved by suicide. It has been suggested that for every death by suicide, an average of six people are deeply affected and those bereaved by suicide are known to be at higher risk of taking their own lives.
Members learned that there isn't a consistent approach to bereavement support across Wales, with a few organisations offering support in different areas but with little public money to support them.
Help is at Hand Cymru is a support resource developed by the National Advisory Group on suicide and self-harm prevention. The Committee was told the information was effective and helpful, but that not enough people, including amongst the medical profession, knew it existed.
There is also a disparity in the way physical and mental health issues are treated. Referrals for physical issues or symptoms often have waiting times attached to them to ensure a speedy standard of care. But there are no such performance indicators for mental health or bereavement issues meaning people don't often receive the support they need when they need it.
Dr Kathryn Walters, a Consultant Clinical Psychologist at the British Psychological Society, referred to the death by suicide of a young patient who was due to receive dialectical behaviour therapy six to eight months before they died, but the clinician who would have been their one-to-one therapist went off sick and no cover was provided.
"They couldn't access it, and I do find myself wondering if someone were referred for chemotherapy whether they would find themselves in the same position.
"And the difficulty, I guess, is we're always in the position that it's hard to say unequivocally what we have prevented from happening in mental health services.
"It's back to that complexity. But it does distress me that we struggle so much. There are services where people go on maternity leave and there just isn't cover, and I'm not sure that exists in the same way in physical health services."
Dr Dai Lloyd AM, Chair of the Health, Social Services and Sport Committee, said:
"Suicide is everybody's business, that's the key message we've heard; that's the message we all need to remember and share.
"It can affect anybody and there isn't a community in Wales where people haven't been touched by suicide.
"We all have our part to play in reaching out and offering support to those in need. We know that if someone is having suicidal thoughts, receiving support from someone else can make a big difference.
"We shouldn't rely on medical professionals or the emergency services to provide that support, we can all help by offering an opportunity to talk.
"We need to raise awareness of the small things we can all do and spread the message that talking to someone in distress won't make the situation worse."
The Committee makes 31 recommendations in its report, including:
- The Welsh Government and other public bodies, including local health boards and local authorities, should make specific funding available for suicide prevention to ensure that it is sustainable in the long term
- A suicide prevention training framework should be adopted and implemented across all public services in a similar way to the framework for domestic violence, where training requirements are specified depending on the role;
- The Welsh Government should take the lead in promoting existing materials, such as the 'See. Say. Signpost.' training resource as part of a campaign to raise public awareness and embed the message that suicide is everybody's business and can happen in any community at any time;
- that the Welsh Government take urgent action to ensure that all GPs in Wales are aware of and understand the GMC guidelines on sharing information and the consensus statement agreed by the UK Department of Health, Royal Colleges and other partners.
- The Welsh Government must take all necessary steps to ensure parity between mental and physical health services. This should be tied to 'A Healthier Wales', and the Welsh Government must ensure that its plans for the development of health and social care services give the same priority to mental health and wellbeing as to physical health; and,
- that a target be introduced for waiting times for psychological therapies to ensure that those in need receive this support within a suitable timescale. Accessing appropriate therapy early can provide the intervention that's needed and prevent someone from requiring crisis care at a later stage.
The report will now be considered by the Welsh Government.
If you or someone you know is affected by suicide or is having suicidal thoughts you can contact the Samaritans on 116 123 or email jo@samaritans.org. You can also find out more information about Help is at Hand Cymru here.