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S E V I L How we can act effectively to reduce suicide in Wales #4steps

FOUR STEPS TO SAVE LIVES

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More than 6,000 people die by suicide every year in the UK. Each year in Wales between 300 and 350 people die from suicide – about 3 times the number killed in road accidents. In Wales, the suicide rate for men is at its highest since 1981. Male suicides in Wales rose by 23% between 2012 and 2013. Latest figures show that suicide is the leading cause of death for 20–34 year olds. While causes of suicide are complex, we do know that there are factors which increase the risk for specific groups and individuals. These factors include deprivation, being a man and alcohol misuse. Reducing suicide requires a wide range of agencies to work together nationally and in local communities, to give people the best chance to turn their lives around when they are struggling. We need an approach which promotes mental health and wellbeing, timely support, public awareness and which reduces inequality. We have welcomed the second phase of the Welsh Government’s Suicide and Self Harm Prevention Strategy and Action Plan, Talk to me 2. The existence of such plans, and their effective implementation, is vital for efforts to reduce suicide. However, we need to act more strongly and consistently across Wales to tackle rising suicide rates. The work required to make this happen supports other policy ambitions to increase the resilience of communities, to increase public awareness and to improve access to mental health services. Samaritans exists to reduce the number of people who die by suicide. That means Samaritans should be there when and in the way that we are needed, including making sure that our support is free to people who call us. Together we can make a significant difference to the rate of suicide and find ways to respond to people in distress. We must work together, locally and nationally, to achieve real change in Wales.

Sarah Stone Executive Director for Wales

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Christopher Mill Samaritans Trustee from Wales

How we can act effectively to reduce suicide in Wales

Four steps to save lives

1 Promote mental health and wellbeing and tackle inequality

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2 Act locally in Wales

3 Tackle alcohol misuse to reduce suicide

4 Help us to make Samaritans telephone service free

g and Promote mental health and wellbein tackle inequality We need to take a broad approach to reducing suicide. This means taking action to increase emotional resilience and understanding of the need to seek help among the whole population. This approach should be balanced with targeting groups that are at especially high risk. Mental and physical health should be given equal weight in public policy. Mental Health measures should include: Raising public awareness of how to improve mental health and wellbeing. Better information about mental health services, swift assessment and access to treatment. Improved availability of treatments and services including talking therapies. Investment in research on mental health. Recognition that people with serious mental health problems are a high priority group, particularly at the point of discharge from hospital or crisis centres. These mental health measures should be broadly applied but should also target high risk groups and settings, taking specific actions appropriate to them. Men in mid-life Male suicide rates in Wales are at their highest since 1981. We need to open up a dialogue in which men feel more able to talk about mental health and suicidal feelings. We especially need to target men in mid life living in situations of socioeconomic deprivation. Welsh Government should challenge mental health stigma by supporting and co-ordinating campaigns specifically targeted at men.


Young People not in education, employment or training The Thematic Review of deaths of children and young people through probable suicide for 2006–2012 found that many of the children and young people either had restricted educational achievement or were not in education, employment or training. Those over 16 years of age received little or no support from any services. Welsh Government should explore mechanisms to ensure that children and young people between the ages of 16 and 18 are supported in education or training, which includes work based training. Older people and loneliness Older people are especially vulnerable to loneliness and isolation which can have a serious effect on mental and physical health. Half of those over 75 in the UK live alone and 1 in 10 experience intense loneliness. One of the barriers to tackling this is difficulty in identifying those who are most at risk. Welsh Government should explore the potential of loneliness maps where local services and local authorities work collaboratively to use existing data to predict where the most lonely and isolated residents live, allowing limited resources to be targeted at people and places that need them most. Prisoners Prisoners are 6 times more likely to take their lives than an average person in the UK. In recent years the numbers of self-inflicted deaths in custody has increased. Prisoners should be consistently assessed for suicide and self-harm risk at points of particular vulnerability. There are certain times when prisoners are most vulnerable: on admission to custody; in times leading up to sentencing or parole decisions; before or after transfers; during pre-release periods; and at times when prisoners hear distressing news from family and friends. It is important that prisoners always have access to support. Access to Means There is evidence to suggest that lives can be saved by the use of a variety of measures including the installation of Samaritans signs, physical barriers, nets and telephone lines at high risk locations for suicide. Welsh Government should consider putting in place a requirement to involve a range of agencies to consider proposed designs at the feasibility stage. The risk of suicide at these assets would need to be determined at project inception stage to determine reasonable provision at each site.

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Act locally in Wales Suicide is the result of many different factors which interact in complex ways. Suicide prevention therefore requires the action of many agencies across sectors. This is why suicide prevention strategies and action plans are a key component in reducing suicide. We welcome the second phase of Wales’ suicide and self harm strategy and action plan ‘Talk to me 2’. There needs to be a clear framework for implementation of this. We need to act locally to make sure the most effective ways of reducing suicide are in place across Wales.

How we can act effectively to reduce suicide in Wales

Measures should include: Regional multi-agency suicide prevention fora should be mandatory and established consistently across Wales. They should create and work to local action plans and there should be a clear expectation of when these will be in place. They should be clear, comprehensive and sit within the context of the national plan. A systematic approach to a local ‘suicide audit’ which includes the collection of data about suicides. Frontline staff should receive suicide prevention training. Improved follow-up support for people attending A&E after self-harm or a suicide attempt. Safety measures at high-risk areas for suicide. Local specialist suicide bereavement counselling and support groups. Local services should ensure that effective signposting for listening and advocacy services are in place.

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icide

Tackle alcohol misuse to reduce su

Misuse of alcohol makes people, particularly men, 8 times more likely to kill themselves. As many as 65% of suicides are related to excessive drinking. Alcohol misuse reduces inhibitions and makes acting on suicidal thoughts more likely. Young people under 24 are particularly vulnerable to thoughts of suicide, suicide attempts and completed suicides under the influence of alcohol. The Thematic Review of deaths of children and young people through probable suicide, 2006–2012 strongly recommended that access to alcohol for children and young people should be restricted. Measures should include: Introduce a minimum unit pricing (MUP) policy in Wales There is extensive international evidence showing that MUP policies are effective in reducing alcohol consumption, alcohol related harms and alcohol related deaths. The introduction of MUP in Wales would target the most deprived areas, where alcohol-related mortality rates are more than three times higher than in the least deprived areas. Increase public awareness of the mental health effects of alcohol Whilst most people are aware that drinking too much alcohol is bad for us, many are unaware of the long term effects. In particular, evidence shows that people who consume high amounts of alcohol are vulnerable to higher levels of mental health problems. Young people, men, and socially isolated and/or deprived individuals are high risk groups and as such, measures should be taken to ensure effective and targeted campaigning. Frontline staff should be provided with suicide prevention training There should be particular emphasis on providing suicide prevention training for frontline staff, specifically for those working in addiction services and for others, such as police officers and health professionals. Alcohol treatment and mental health services should work closely together on suicide prevention, which encourages joined up approaches and a more established understanding of the link between alcohol and suicide.


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Help us to make Samaritans telepho

ne service free

More than five million people in the UK and the Republic of Ireland get in touch with Samaritans every year. In 2014, Samaritans’ volunteers in Wales and the Marches responded to nearly 260,000 calls for help. When you are struggling to cope, you need to know that someone will be there to help you when you need it most, without having to worry about the cost of the call. Research shows that call costs deter some people from using our service, particularly those from lower income groups, who are more reliant on mobile phones and expensive pay-asyou-go tariffs. Suicide rates are often highest in socio-economically deprived communities so this means that some people who really need our service cannot afford to access it. It is Samaritans long-standing ambition to have a free-to-caller telephone number. Samaritans has been awarded such a number for providing services of ‘extreme social value’. However, while the number is free to callers, for Samaritans the cost implications are unsustainable. As a result, we cannot promote this number in the UK until we are certain that we are able to sustain it, now and into the future. We are working with major telecoms companies to find ways of making the number more affordable to Samaritans, with good progress. What we need now is a commitment from the Westminster government to help us cover the remaining costs of making our free number available across the UK, so that everyone can afford to call us when they’re going through a difficult time. What can you do in Wales? Support Samaritans in Wales and the wider work we do to make our telephone service free to callers. Help us to promote help seeking for listening and advocacy in Wales. When we are successful in securing freecall, help us to promote and sustain the service in Wales.

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