International Suicide Prevention Week
Resumed debate.
We move straight to the next item of business, which is a continuation of the members' business debate on motion S2M-1578, in the name of Duncan McNeil, on international suicide prevention week.
Motion debated,
That the Parliament acknowledges the importance of International Suicide Prevention Week from 5 to 11 September 2004 for raising awareness of this cause of death; recognises that more people die as a result of suicide than from traffic accidents; commends the work being done by Choose life, Scotland's strategy aimed at reducing suicides by 20% over the next 10 years; welcomes the introduction to Scotland of Applied Suicide Intervention Skills Training, helping develop more effective approaches to both identifying and assisting those most at risk of suicide, and looks forward to this suicide-reduction work continuing at a national and local level.
It is a slightly unusual privilege to read in the Official Report that I rose to start my speech at 17.21 yesterday and am still continuing it nearly 24 hours later. I rather hope that that record will not be beaten, even though it was dictated by the rather unusual circumstances.
I congratulate Duncan McNeil on bringing this important subject to Parliament. I share his disappointment that the debate has been fractured. However, I am sure that the fact that it spreads over a long timescale will cause it to be read with particular interest. I will not speak at quite the length that I originally intended to because we have two members' business debates to conduct tonight.
One of the important things about suicide is that it comes in a variety of forms, not all of which politicians or anyone else can reasonably expect to have influence over. One form that is troubling the modern world is what I would term political suicide. It is not a new phenomenon, as anyone who has stood on the heights of Masada will know. Several thousand years ago, the community there committed mass suicide, apparently by choice, when confronted by the horrors of being overrun by a hostile mob. One has sympathy with that community. In 1968, Jan Palach immolated himself in Wenceslas Square as an expression of his personal despair at the quashing of the Prague spring. Of course, the Czech Republic is now a member of the European Union.
More sinister and worrying today is murder by suicide, whereby many young people are persuaded to commit suicide in order to murder others. I make this important little point before I move to the meat of the matter: we want Scotland to support real and locally appropriate democracy as the only way forward throughout the world. That is an important part of the prevention of political suicide, which happens in environments in which there is a democratic vacuum that provides no opportunity for the proper expression of political views.
Individuals are at the heart of this debate on international suicide prevention week. Of course, a number of factors can drive people to commit suicide. People who are physically ill can be driven in their extremity to take their own lives—perhaps when they are suffering from a terminal illness. That is not good for anyone—perhaps, for the person concerned. I hope that there will be many more opportunities throughout Scotland for people who are terminally ill to receive the appropriate pain management that means that they are less likely to take that extreme measure, which affects their families and friends.
Probably at the core of the matter is whether we offer the appropriate support to people who are mentally disturbed and whether we detect and catch such people early enough to ensure that they receive the support that means that they do not feel driven to commit suicide as a way out of their despair. Of course, there can be subtle interactions between mental and physical illness: a school classmate of mine had the grave misfortune to have a serious intestinal problem that required him to have a colostomy bag, the physical effects of which affected his mental state. He committed suicide.
Finally, there are people who commit suicide out of the blue—we do not know why. In my own family we experienced that seven years ago and to this day we do not know why that family member committed suicide.
We cannot help everyone who might commit suicide, but I hope that international suicide prevention week will help to raise the profile of the problem and reduce the numbers of people who do so.
I too congratulate Duncan McNeil on securing this important debate.
It is so sad that something as preventable as suicide kills more young men than road accidents do and remains the main cause of death for men aged between 15 and 44, as Duncan McNeil said yesterday. It is particularly sad for members of the Scottish Parliament, because people in Scotland are twice as likely to kill themselves as people in the rest of the United Kingdom.
I welcome the work that the Scottish Executive is doing on the matter. The investment of £12 million over three years directly to support national and local efforts represents funding that can achieve tangible results. I also admire the Executive's commitment to prevention and cure, because by acting to reduce the risks that might lead to suicidal behaviour, while working in the longer term to enable people to recover and deal with issues that might contribute to that behaviour, the Executive is approaching the matter in the right way. As the motion says, the choose life strategy aims to reduce suicides by 20 per cent over the next 10 years. Although such a reduction would represent a welcome start, Scotland's suicide rate would still be 50 per cent higher than the rate south of the border. There can be no doubt that Scotland has a particular problem. It is therefore surely incumbent on the Scottish Executive to take whatever further action it can to reduce the number of suicides.
To be proactive is always better than to be reactive but, sadly, not all suicides are predictable. We often hear that people who have taken their own lives appeared happy on the outside. It might be difficult for professionals to identify such people, but we must all strive to create a society in which people do not feel that they have no alternative to suicide. It is important to recognise that prevention might not always be possible, but there are actions that we as a society can take to help to prevent suicide, particularly in situations in which suicidal behaviour is perhaps predictable, for example in relation to the priority groups that are identified in the choose life strategy.
As is often said during our debates on mental health, one in four of us will develop mental health problems at some point in our lives. That is why it is vital to have joined-up thinking to ensure that people are given appropriate levels of support at the very earliest stage possible.
Sadly, I am aware of the anguish surrounding deaths by suicide—both through representing constituents and through personal experience. The feelings of helplessness and guilt are overwhelming and make losing a loved one even more difficult to deal with. It is vital that we ensure that all agencies are working together to provide the kind of co-ordinated care and support that ensures that vulnerable people in our society feel that there is somewhere they can go for help. It is concerning that people with mental health issues often have to wait excessive times for appropriate treatment. It is important that we remember that national health service waiting times are a problem for issues of the mind as well as for issues of the body.
In its own way, this debate is important in tackling suicide in Scotland. We must use every opportunity to raise awareness of the scale of the problem. We can only hope that highlighting the issue will assure people who may be at risk that they are not alone. Although I agree that more can always be done, a lot of help is available. That help is available not only for young people; we should not forget that a quarter of all suicides are among the elderly.
I am delighted that this issue has been chosen for the first members' business debate in the new Parliament building. Highlighting the help and support available is vital in suicide prevention. However, we must realise that there is no easy answer. People become suicidal for various reasons. If we could cure bullying, unemployment, homelessness, substance misuse and mental illness in one fell swoop, we would, but it is not as simple as that. However, I congratulate the Executive on the work that is being done and I thank Duncan McNeil for bringing this matter to the chamber.
I thank Duncan McNeil for securing the first members' business debate on the first and second day in this new Parliament building.
In the first session of the Parliament, I spoke during a members' business debate on suicide, and I had my own members' business debate on men's health. We must continue to consider both those important issues. Janis Hughes mentioned the suicide rates in Scotland compared with those in England; I would mention the suicide rates in the Highlands, where the rate of female suicides is very similar to that in the rest of Scotland, but where the rate of male suicides is much higher.
I agree with the objectives set out by the Executive at national and local level, especially the raising of awareness, early intervention, more effective care and support, the improvement and increasing of the provision of services, the removal of the stigma that men feel about seeking emotional support, the offering of effective and sympathetic support to family members and sensitive media reporting.
Over the summer recess, I had several meetings with Dr Cameron Stark, a public health consultant in Highland NHS Board with special responsibility for addressing the high suicide rate. I also met many families who had lost a loved one to suicide. Most recently, I met John Burnside, who lost his son Richard—or Titchy, as he was known. I learned a lot from those families, and—although, as Janis Hughes said, every suicide case is unique—some common elements come through. I listened to a mother who begged that her son be taken into prison because she knew that that was where he would get the help he needed. I have also listened to families who are still begging for help to save someone in their family from suicide. However, when people seek help for depression and mental health problems, they will often receive a costly prescription rather than someone to listen to them. When they seek help for drug and alcohol problems, the help is either not there when they need it or not sufficient in relation to the care and support that they need. Even when alcohol and drug problems start to be addressed, many of the underlying mental health problems have to be faced. At that point, people often say, "I had to face my demons." Help is desperately needed, and rarely there.
People are not always treated with the respect and dignity—which were mentioned by the First Minister yesterday—that they deserve. In fact, it can be a humiliating and degrading experience for many. Over the recess, I am sorry to say that I saw the police acting with more compassion and sensitivity than some—although not all—health workers. I commend the NHS in much that it does, but I also commend the police.
For many people, debt problems are a serious issue and they do not know where to turn for help.
As Janis Hughes said, families are left with the burden of asking themselves whether they should have noticed the signs and done something. There are so many questions and it often takes months or years to get the answers. In social work, the constant turnover of staff and shortage of social workers mean that such support can take much longer to appear than would be expected.
When people are taken into psychiatric hospitals, they sometimes find little to do all day and are left to their own devices to pass the day as they can. Hospitals should offer intensive therapy, care and support, not just bed and breakfast with the prescription pills thrown in. A patient who was admitted to Newcraigs hospital has compared that experience with her recent experience in Castle Craig hospital, where she was admitted to tackle her alcoholism. In Newcraigs hospital, there is nothing to do all day. In Castle Craig hospital, patients rise for breakfast at 7 and then undertake a full programme of therapy and events that goes on all day. Given the shortage of hospital beds, I ask the minister whether we can provide more intensive therapy when patients are admitted.
I am grateful to the Mental Welfare Commission for Scotland, which met several families in Inverness last week—a meeting that they said was positive and productive and at which action points and timescales were agreed for the issues to be addressed. It is by listening to families and their experiences that progress can be made. The suicide awareness group in Inverness is a leading catalyst for change, working with NHS Highland, the Mental Welfare Commission for Scotland, the Scottish Association for Mental Health and other organisations. The group has been inundated with inquiries not just for solace but for help to prevent suicides.
The choose life strategy says that suicide is preventable, and the first step towards reducing the number of suicides is to raise awareness of the subject and to encourage people who feel suicidal to speak up and seek help. We should all remember how we may respond to that cry for help and think about how we can be part of increasing awareness and understanding of suicide and how we respond to constituents and families who come to our offices.
In conclusion, as convener of the cross-party group on funerals and bereavement, I raise again the question of unresolved grief and whether attempted suicides in psychiatric hospitals should be audited. I commend John Burnside, who lost his son two weeks ago, for speaking out about the curse of alcohol. I hope that the matter will be addressed in forthcoming legislation.
I, too, congratulate Duncan McNeil on securing the first members' business debate in the new Parliament building and on his choice of a very important and serious matter. It is unfortunate that technical problems meant that the debate has had to be conducted 24 hours after he made his introductory speech.
As Janis Hughes and Mary Scanlon have said, suicide is a Scottish problem. I believe that it is a cultural problem for us, as it is strongly linked to low self-esteem, which we have both as a nation and as individuals. I recall, as a young girl growing up in Edinburgh, that showing off was probably the cardinal sin. We seem to believe that God will bring us down if we think too highly of ourselves. That attitude is often displayed in the way in which we consider our football team, our athletes and, I dare say, even our Parliament. We tend to assume that, because something is Scottish, it is going to be second rate and, unfortunately, I think that people believe that of themselves. That is part of the legacy of our Calvinist tradition that can be very damaging to us as a nation, as we tend to sell ourselves short. It can also be damaging for individuals. It contributes not just to our high suicide rate, but to many of our other health problems.
As Mary Scanlon said, earlier this year there was a spate of suicides in the Highlands. There was a similar terrible series of suicides in the Annan area of my constituency last year. It was almost like an epidemic, as if suicide was catching. Nobody understood why several people—mainly young—in a pretty Border town such as Annan and the surrounding area committed suicide within a short time. That included two people who killed themselves on the same weekend and, on two consecutive weekends, two people who hung themselves from the same tree by the river. That absolutely shocked the community.
Later that year, I spoke with the mother of one of the young men who took their lives. It turned out that he had been the victim of bullying. She came home after a night out to find him hanging in the hall. She was a lone parent; he was her only child. She had gone out that night with no inkling of his mental state—he had seemed perfectly cheerful when she left. When she came home, he was dead. Naturally, she has found it extremely difficult to reconstruct her life, and her mental health and resources have been put under incredible strain.
As others have said, the causes of suicide are complex and individual. However, recent statistics show that young people—especially young men—and the elderly, as Janis Hughes said, are the most vulnerable. At stages in people's lives, they may feel especially uncertain of their role and whether it has value. A young person who may have relationship problems, who cannot envisage what their future could be or who has financial problems or problems with drug or alcohol abuse may question the value of their existence. An older person whose family has grown up and moved away, who has perhaps lost their lifelong partner or close friends, or who suffers from chronic ill health that will only deteriorate may also have difficulty in seeing any point in struggling on.
Such individuals may not show obvious signs of depression. They may feel unable to talk to anybody about their feelings of despair and may be ashamed of those feelings. That shame only adds to their lack of self-esteem. Sometimes, close friends or relatives can guess that something is going very wrong with their loved one but feel that they cannot get through to them or cannot obtain professional help. On other occasions, suicide seems to come out of the blue leaving those who are closest to the victim blaming themselves for not noticing the signs. That is why it is crucial to talk openly about mental and emotional health issues and about suicide prevention without prejudice or stigma. We must reject the old notion that people who attempt or commit suicide are cowards or selfish. Those people are in despair. They have lost all sense of self-worth.
That is why it is important that the issue is not seen just as a health problem. It is important that our education system in its broadest sense builds self-confidence and self-esteem in our children and young people. That is linked to developing a more flexible curriculum that enables young people to build confidence in themselves and in what they can do, and to moving away from an education system that is about failure to one that is about success. If we cannot do that, our people will continue to take their own lives, whether deliberately by pill, knife or rope, or inadvertently by drugs, drink, alcohol, bad diet or lack of exercise.
I realise that my time is short, so I will not go over what others have said. Others have highlighted the tragically high suicide rate among young men and its possible causes and, of course, the statistics show that young women make unsuccessful suicide attempts, so the methods that are used could be considered. I suspect that it is easier to access shotguns, for example, in the Highlands and in other rural areas, and young men often use that method.
We should not forget the high suicide rate among men who are over 65—not just older people in general. Compared with women, many more men who are over 65 commit suicide. According to Age Concern Scotland, the most common cause is depression, which is often brought on by social isolation. A challenge to which our health and social services should rise is to ensure that old men—especially those who have been widowed—do not feel that there is no future.
I ask the minister how we can best support families who have been bereaved by suicide, whether it is the suicide of a child or a parent. As Janis Hughes said, bereavement through suicide can cause a different reaction from other types of bereavement because families feel more shock and guilt and they blame themselves more. They feel anger—sometimes justifiably—at the health services if mental health problems have led up to a suicide, and they may feel isolated because they feel that their acquaintances are judgmental, perhaps especially in small communities.
It is worrying that statistics show that one suicide in a family makes it more likely that another suicide will follow in that family, perhaps through guilt or because—especially for young people in that family—suicide becomes a possible way out of difficulties. We should examine that issue and support should be given to other family members for that reason.
We probably need a variety of support methods. Some people will depend on their family, friends, general practitioner, minister or priest and, in the right circumstances, self-help groups can play a part. Voluntary organisations also have a tremendous part to play—Mary Scanlon mentioned voluntary organisations in the Highlands that do so. However, they need backing with funds and training to ensure that they are not too narrowly targeted. I ask the minister: who is working with children and young people who are bereaved by suicide, so that they do not choose the same route for themselves?
Presiding Officer, I apologise for not being here at the start of the debate. As you know, a photo call of committee conveners was arranged at very short notice. Unfortunately, I lost my way when I was returning to the chamber and no one could give me the right directions.
I congratulate Duncan McNeil on securing this debate and, if no one has done so already, I wish him many happy returns. This evening's members' business debate is extremely valuable in raising the profile of an issue that desperately needs our attention. The presence of such dramatic figures as those for Scotland would be cause for concern in any nation. I will not be the first MSP to have dealt with the tragic outcome of a suicide case, and with cases from which it may be possible to learn from mistakes that might have been made.
I have learned from the case of 17-year-old James Hanlon, who died following his decision to discharge himself from a psychiatric hospital after he had been diagnosed with some type of psychosis and had historic prolonged use of cannabis. His parents were not notified of that act of discharge, despite his long history of mental illness, and he went home to take his own life. They have made representations to me, as their MSP. They say that, regardless of his age, some other person should have been notified that he had been discharged from the hospital. To this day, they believe that he was placed in an adult ward because there is a shortage of adolescent beds and that the current approach of psychiatry does not seem to be able to deal with a person who uses, or is addicted to, cannabis or some other substance and who has a psychological condition.
When I spoke to the family yesterday to tell them about this important debate, they were able to tell me that 22 mothers, all of whom had lost a young son, were present at a support meeting that they had attended the previous night. Almost without exception, those sons had used cannabis. We need to consider such examples to see whether they can tell us anything about what we could do better.
At the Gartnavel royal hospital in Glasgow, there are 16 beds that cover the whole of the west of the Scotland—the hospital does not serve only Glasgow—so there is a need to redesign the service for people aged 16 to 25, to recognise the high incidence of mental health issues among young people, who are vulnerable to suicide. We now have some specialist services to deal with the onset of psychosis in that age group and I am pleased to say that there are some developments in Glasgow, but we need to continue to invest in those developments. We know that suicide is a complex public health issue and that it is often mistakenly viewed as a single stressful event. The majority of suicidal people want to live, and research shows that some give warning signs. As a society, we must learn more about those signs; we must learn more about the why, and what we can do about it.
This is an important week for our Parliament, and this has been a valuable debate. Saving lives and giving people hope for the future is fundamental to achieving the Scotland in which we all want to live.
The motion that is before us today was lodged by Duncan McNeil, the MSP for Greenock and Inverclyde, and it says much for his commitment to facing up to the challenges that exist in his constituency and throughout Scotland. I sincerely congratulate him on helping us to send such a pertinent message at such an important time for Scotland.
Suicide is a devastating event that affects many people in our communities. Every death by suicide is a tragedy that robs our country of a life that has not yet reached its full potential. Our efforts to prevent suicides and cope with the aftermath of a suicide are a vital part of our efforts to address inequalities in health, to improve the health of the people of Scotland both physically and mentally and to achieve greater social justice and inclusion for vulnerable people.
I want to take a moment to mention a leaflet called "After a Suicide", which has just been produced by the Scottish Association for Mental Health with some financial support from the Scottish Executive. However, it was possible to produce the leaflet only because it received so much input from families who have suffered from just such a tragic event. I will ensure that the leaflet, which contains much useful experience and advice, is made available to every MSP.
Our suicide prevention strategies across Scotland have increased substantially over the past two years, following the launch of our choose life national suicide prevention strategy in December 2002. Local and national agencies are working hard to put in place a sustainable infrastructure of local action, planning, support, advice, training, research and evaluation work that will help us to meet the target of reducing suicides across Scotland by 20 per cent by 2013.
We are already beginning to see the early green shoots of success. Last year, there was a 12 per cent drop in Scotland's annual suicide figures, which are now the lowest they have been since 1991. However, I do not want to suggest that we are complacent. It is, of course, too early to determine whether that drop in annual figures for the whole population can be sustained over the longer term or whether the decrease is a result of more attention being paid to suicide prevention. National suicide figures rise and fall for a variety of reasons, so we will arrange a detailed analysis of the figures and trends in the near future.
I repeat that we are certainly not complacent. We are really only beginning the task of suicide prevention as one part of our public policy approach to improving Scotland's emotional and mental health and well-being. The work of our national programme for improving mental health and well-being has made a good start; as chair of its national advisory group, I am pleased with its progress to date. One example is our internationally recognised anti-stigma see me campaign, which is beginning to challenge negative attitudes to mental ill-health. We are promoting greater public awareness of positive mental health and have embarked on the ambitious programme of mental health first aid training that I launched last year. More than 900 people have now taken part in the national pilot of the MHFA course and we are now developing the course for a national roll-out next year.
Furthermore, the work of the breathing space advice line also continues. This free and confidential service will have achieved full national coverage by the end of the year
However, let me take a few moments to concentrate on our specific efforts with regard to suicide prevention. Every local authority in Scotland now has a dedicated suicide prevention action plan as part of its community planning partnership work. We are investing more than £9 million over three years to help to support those plans at local level. Moreover, every area now has a dedicated suicide prevention group and a choose life local co-ordinator. Last year was very much about getting plans in place, identifying local priorities and making decisions about where best to invest resources and efforts. I heard the pleas that Duncan McNeil made yesterday for us to examine how our efforts are being received. We expect these plans to have a significant impact over the next two years and we have commissioned a national evaluation of the choose life strategy, which will report on progress by this time in 2006.
When it gathers new information and audits existing information, will the Executive also listen to families to find out how often help was sought by the suicide victim; whether such help was for drug, alcohol, mental health or self-harm problems; how often that help was not available; and how those circumstances contributed to their deaths?
We have many professionals in the field who work with us and who are striving to find the answers to those difficult questions, which will prevent so many tragic losses in Scotland. However, I suggest that no one can tell us more than the families who have experienced such tragic events, so it would be wrong if they were not an integral part of our work to prevent suicide in Scotland. I am happy to assure the member that families' experience will be fundamental to how we shape our efforts on this matter in future.
At national level, we have a dedicated choose life implementation team that is led by Caroline Farquhar. The main focus of recent action has been on establishing a national suicide prevention training strategy. The work is based on the successful applied suicide intervention skills training—ASIST—programme that was developed by LivingWorks Education in Alberta, Canada. To date we have trained 48 people from all over Scotland to be ASIST trainers and by March next year the figure will have risen to 150. I was delighted to be able to meet some of the trainers from Canada and the international LivingWorks network who trained our first set of trainers in May 2004. I am extremely impressed by that training work—so far 790 people in total have received the training. I was pleased to hear from those greatly experienced professionals that they are impressed by the approach that is being taken here in Scotland. They believe that our approach is groundbreaking and they are encouraged by the work that we are doing.
In this week—national suicide prevention week—there will be a burst of activity both in ASIST and in suicide awareness talks, which aim to raise awareness of the subject in every part of Scotland. We are also making efforts to target particular groups of people; for example, the choose life team has developed strong links with the Scottish Prison Service, the Samaritans and Childline and is providing funding to those organisations to support their efforts to prevent suicide. In particular, the SPS has received £500,000 and much of the focus is on reducing self harm, which is predominantly a female issue in our prisons.
Only by making those community-based efforts will we achieve our goals. Only by making suicide prevention a community issue that is owned by everyone will we be able to save lives. That requires sustained national and local effort of the type that is being carried out under choose life and all the other related initiatives. Our aspiration is that all that work should achieve real and lasting benefits for Scotland as a place that cares about and delivers better mental health for all.