The next item of business is a debate on motion S4M-08800, in the name of Michael Matheson, on suicide prevention.
We have an ample sufficiency of time this afternoon so I am able to give the minister a generous 13 minutes. I am able to be similarly generous to other members.
14:46
I am pleased to open the debate on behalf of the Scottish Government.
As the motion says,
“significant progress ... has been made in recent years in suicide prevention”.
In 2012, there were 762 deaths by suicide in Scotland. We all want that number to be lower but the 2012 figure nevertheless represents a welcome decrease on the number of suicides in 2011. In 2012, as in each of the previous two years, we saw one of the lowest levels of suicide in Scotland since 1991. The three-year rolling average rate shows that, between 2000 and 2002, and 2010 and 2012, there has been an overall downward trend in suicide rates, with an overall decrease in Scotland of 18 per cent.
That progress reflects the priority that I believe the Scottish Government and the Scottish Parliament have given suicide prevention and mental health in the work that they have done since devolution. The Parliament has given attention to suicide prevention and to the wider mental health policy agenda for a significant number of years, and that has been widely recognised by many people outwith Scotland.
The motion also says that
“there is still work to be done to reduce suicides further”.
In December 2013, we published our new “Suicide Prevention Strategy 2013-16”. The intention is to build on previous work, while setting out commitments and actions for the next three years.
I will talk about what has been achieved already and the firm basis on which we have built our new commitments. I will also talk about how we developed our new suicide strategy and the importance of basing practical actions on established and emerging evidence to benefit people who are at risk of suicide and those who care for them.
As members are aware, “Choose Life”, a 10-year suicide prevention strategy and action plan, was published in 2002. At the end of 2012, we formed a working group to consider our future strategy and action on the prevention of suicide and self-harm. With the working group and a reference group, we developed an engagement paper to support progress on developing a new strategy for the prevention of suicide and self-harm. From February to May last year, several engagement events took place across the country at which stakeholders, including interested members of the public, had the opportunity to feed in their aspirations for a new phase of suicide prevention action in Scotland.
The engagement paper prompted discussion on a range of key issues at the engagement events and in the many written responses that were received. Those responses helped to inform the preparation of our new strategy on the prevention of suicide—I will say a little bit more about that later.
First, it is worth reflecting on some of the progress that has been made in suicide prevention over recent years by people working in a range of sectors across Scotland. As I said, in 2012, as in each of the previous two years, we saw one of the lowest levels of suicide in Scotland since 1991, and since 2000 to 2002 there has been an overall downward trend in suicides, with an overall decrease of 18 per cent. That means that we have achieved most of the planned reductions in suicide rates as set out in the choose life strategy.
Looking to the future, I mentioned that our engagement paper prompted discussion on a range of key issues, both at the engagement events and in the many written responses that we received. The comments received were considered by my officials, the working group and the reference group.
Through those deliberations, we have developed a robust new suicide prevention strategy for Scotland. I had the pleasure of launching the strategy last month when I addressed the annual stakeholders forum, which was organised by NHS Health Scotland’s choose life programme team. The strategy contains 11 commitments across five themed areas: responding to people in distress; talking about suicide; improving the national health service response to suicide; developing the evidence base; and supporting change and improvement.
Our purpose in the strategy is to focus on a number of key areas for future work that we believe will continue the downward trend in suicide in Scotland that we have seen over the past 10 years. We want the strategy to deliver better outcomes to people who are suicidal and who come to services; to their families and carers; and to those who are not in contact with services. We also want to ensure that we improve our knowledge of what works in this complex field.
We acknowledge that there is a broader focus on activities that are not directly related to suicide prevention but which, if taken forward effectively, will contribute to reducing the overall suicide rate. Such activities include building resilience and mental health and emotional wellbeing in schools and in the general population; working to reduce inequality, discrimination and stigma; and promoting good early years services.
All that work is undertaken in the context of being vigilant about improving mental health; supporting people who experience mental illness; and preventing suicide. The strategy continues the trend in previous strategies of focusing on where the evidence leads us. The strategy echoes key messages—learned from practice and research—that suicide is preventable; that it is everyone’s business; and that collaborative working is key to successful suicide prevention.
Members may recall that the engagement paper covered prevention of suicide and of self-harm. However, after taking into account the views that were received in the engagement process and the deliberations of the working group and the reference group, we have taken the approach that our strategy should focus on suicide prevention. Although it covers self-harm as a risk factor for suicide, it does not specifically deal with support for people who self-harm as a coping mechanism.
We will undertake separate work this year on supporting people at risk of self-harm, including those in distress. That will link with the commitment in the mental health strategy to develop an approach that focuses on improving the response to distress. As many members will know, we are working with NHS Tayside and other partners to develop a shared understanding of the challenge and the appropriate local responses that can engage and support people who are experiencing distress, and to provide support for practitioners.
I mentioned the importance of following the evidence. A growing evidence base has emerged in recent years that suggests that there are practical actions that we can take to reduce suicide. For example, improving the NHS response to suicide, which is one of our five themes, is based on evidence from a range of sources such as the Scottish suicide information database, or ScotSID, and the national confidential inquiry into suicide and homicide by people with mental illness.
As well as pointing to the actions that can be taken in the NHS setting to support people who might be at risk of suicide, ScotSID has thrown up challenges that we need to look at further. For example, those who died by suicide tend to have had fairly extensive contact with a range of healthcare services, including general practitioners, accident and emergency departments and acute hospitals. ScotSID also throws up the fact that, at the time of death, many people are receiving some form of medication that is used in the treatment of mental illness. We have therefore set out commitments on ways in which the NHS can focus on effective treatment that brings benefits to patients.
Analysis from the confidential inquiry has already informed safety improvements for patients, prioritised attention to follow-up for patients after discharge from hospital and supported a focus on actions to tackle problems around drinking and drug use. We have a strong, internationally recognised research community in Scotland, which stands us in good stead as we move forward with the aim of continually improving the evidence base on suicide and on how we can support people who are at risk.
Like the choose life strategy, the new strategy has a strong focus on services, but it is not intended to replace existing population-based health work that many people and agencies have been doing to help prevent suicide in Scotland. We expect many of the elements of the suicide prevention action plan that is set out in the strategy to continue alongside the work that is already taking place as part of the choose life legacy. Indeed, one commitment in the new strategy is that NHS Health Scotland will continue to host the choose life programme. The national programme will, among other responsibilities, continue to provide leadership and direction to local choose life co-ordinators. We are committed to working closely with NHS Health Scotland, the see me campaign and other agencies to develop an engagement strategy to influence public perception about suicide and the stigma surrounding it.
The way in which we talk about suicide is important. We know that talking openly about suicide in a responsible manner saves lives. We have adopted that approach through the choose life campaigns—“Suicide. Don’t hide it. Talk about it” and “Read between the lines”—and we will continue to campaign in that way during the period covered by the new strategy. It is also important to continue to challenge the media misconceptions that sometimes still arise about suicide and suicide numbers and rates in Scotland.
Suicide prevention remains a significant challenge, but progress over the past several years has been encouraging. We are proud of what we have achieved collectively so far in Scotland in improving the population’s mental health and services for people who experience mental illness, and in significantly reducing the suicide rate. Our new suicide prevention strategy reflects the high priority that we attach to that agenda. The strategy reflects a changing landscape, but we still need to ensure that we have the right commitment and energy to implement it and to continue to make progress. The strategy builds on existing successful suicide prevention work and sets out new commitments that are based on emerging evidence on the risk factors that are associated with suicide.
I look forward to seeing further progress being made in the coming years. I know that practitioners and others across numerous services and agencies will continue to approach the work with the dedication and commitment that they have shown in recent years. I am confident that we in the Parliament have a shared objective of continued improvement in suicide prevention in Scotland, and I have no doubt that all members will want to support our aim of achieving that objective.
I move,
That the Parliament recognises the pain experienced by families and friends who have lost loved ones through the tragedy of suicide; notes the significant progress that has been made in recent years in suicide prevention, with an overall decrease of 18% in the suicide rate in the last decade, and in supporting people who have been bereaved through suicide; agrees that there is still work to be done to reduce suicides further, and therefore welcomes the publication of the new Suicide Prevention Strategy 2013-2016, which builds on previous and continuing work and establishes the priorities and actions for suicide prevention over the next three years in support of a healthier and fairer Scotland.
14:59
Suicide affects far too many families and communities throughout the world. It is reported that an astonishing 1 million people commit suicide every year. That is one every 40 seconds—more than all the world’s murders and wars combined. There are, of course, many reasons why people decide to take their own life but, whatever they are, the fact that 1 million avoidable deaths take place through suicide every year is a truly shocking statistic.
I echo the sentiments of the minister and the Scottish Government that much work needs to be done. Therefore, I welcome the new suicide prevention strategy that the Government is introducing. I hope that it will build on the good work already being carried out by the likes of the choose life programme and various other programmes in which local authorities, health boards, communities and many other agencies are involved.
Prevention is the key to all activity and informs the new national strategy. However, in forming any prevention strategy, we must be fully aware of the facts and figures so that we can target resources effectively. For example, we need to know why men are nearly three times more likely than women to take their own life. We need to understand that the most vulnerable group is men between the ages of 35 and 44. However, men aged 25 to 34 and 45 to 54 also appear to be highly vulnerable.
I find the socioeconomics of the matter stark. There is a very strong correlation between suicide rates and levels of social and economic deprivation. Between 2008 and 2012, the age-standardised rate was more than four times higher in the most deprived 10th of the population than in the least deprived 10th.
I have to say that, with income levels falling, welfare changes and the general thrust of austerity, desperation can and does creep into people’s lives when they are on the breadline. The Samaritans report “Men and Suicide: Why it’s a social issue” points to an increased risk as income goes down, as well as to an increased risk in groups with poor education and among unskilled manual workers and social housing tenants.
I will make one other point on statistics. I note that the figures in the motion and the Government’s new strategy state that there has been an 18 per cent reduction in the suicide rate in the past 10 years. However, I looked at local authority figures prior to the debate and it appears that there is a difference between the headline figure in the strategy and the local authority figures. Perhaps, in his closing speech or after the debate, the minister could clarify the difference between what is in the strategy and the figures that local authorities produced. I make that not as a political point but as a point of clarification.
Beyond the statistics, we need to focus and refocus on prevention and on targeting people and groups in the communities where they live. As members would expect, there are many sources of information and analysis on the subject. The report to which I referred—“Men and Suicide: Why it’s a social issue”—highlights a number of points, but the socioeconomic dimension jumps out. We need to address the fact that suicide figures are significantly higher in the communities that I mentioned.
As a general rule, the poorer someone is, the more likely they are to self-harm. At a basic level, if someone lives in poor housing, has a very low income, is under financial pressure and does not have support systems around them, and if their life seems devoid of hope, it is unsurprising but nevertheless upsetting that they might take the appalling option of suicide.
For other people, major events or changes in their life are the trigger. That could be job loss, relationship breakdown, the death of a friend or loved one or a change in physical health or mental wellbeing. The Samaritans report points to a number of factors that contribute to the high figures. The main ones are whether they are male, their background, personality traits and emotional literacy and mid-life challenges. Those are issues that any strategy must recognise and address.
Of course, we must draw people out to enable them to share their feelings and concerns. I am sure that we would all recognise that we Scots are not the best at talking about our personal difficulties. We may be free with our moans about the weather, the national football team, physical ailments or the after-effects of a good night out, but we are much more reticent when it comes to our inner feelings, emotions and what is going on inside our heads. We do not tend to share those feelings. Often, the last people we are willing to share our troubles with are the very people who can help us most: the people we live and work with and the people we love and care most about. There are many attractive things about our national character but that is a part of it that we have to change quickly because, for far too many of our fellow Scots, those troubled feelings, which are often caused by major events or experiences in their lives, cause them to self-harm or suicide. Of course, we need to develop platforms to help people to open up, and I hope that the Government's strategy helps to ensure that that will happen.
I want to finish by giving voice to someone who has been affected by suicide and who is a relative of one of the 3,904 suicides in Scotland over the past five years. This person, who is a friend of mine, told me this week about his family’s experience, and I said that I would relay what he said to the Parliament.
He said that the issue of mental health problems needs to be publicised more on television and online and in newspapers, magazines and the general media. He said that such awareness raising is important but that brief, infrequent adverts are never going to be enough. The first port of call must be to ensure that ordinary people—family and friends—can spot the signs that there are problems and know what they are. More awareness raising through the media would help, and I am grateful that the strategy points to greater use of social media.
He also said that the health service must get away from attempting a quick fix by prescribing pills for mental health conditions such as depression rather than taking a longer-term approach, and that mental health services have to be more effective and accessible. That is still not happening. It takes months for a client to see someone and, when they manage to do so, the number of sessions that they are allowed is restricted.
He also said that his family had great support from the charity Touched by Suicide Scotland, which runs eight self-help groups and works in five different council areas. It has expressed frustration at the different ways in which it is treated by local authorities. Some are very supportive but others appear to completely fail to recognise the support needed by individuals who are bereaved by suicide.
On awareness training, the charity urges us to go much further and make the focus of training much wider than previously, when it has been mainly on health service staff. Of course, GPs, nurses, health visitors and so on need training, but we also need to train housing officers, benefits staff, advice workers, shop stewards, bar staff and people who work in bookmakers, bingo halls and the like, because they will come into contact with people who may be at risk of self-harm. I hope that, under commitment 2 of the strategy, training will be considered for those groups of workers.
Touched by Suicide also expresses concern about support for children and young people who are at risk of suicide and says that not enough is being done in schools and colleges. It says that, if a child is at risk of suicide and is classed as priority, the quickest timescale for them to be seen by someone is within five days, which can often be too long. It raises concern about funding being a big problem for small organisations that support people who have been bereaved by suicide. If they support people in different areas, they often have to submit multiple applications for funding in each of the geographical areas that they work in.
Five years ago, when I was a councillor, six constituents in my ward took their own lives in an 18-month to two-year period. Six lives wasted, six families shattered and communities devastated. I hope that the strategy has the impact that it is designed to have. I speak regularly to the friends and family of those six people. They never forget, and they never stop saying one word: “Why?”
15:09
It is customary in most debates to begin by welcoming the issue that has been brought to the chamber for discussion. However, for far too long people have shied away from discussing suicide. It has been seen as something not to be talked about because of a sense of awkwardness or difficulty in accepting how an individual’s life has ended.
It is also probably right to say that the situation was even starker in previous years, when families in particular felt acute embarrassment, indeed shame, if a family member took their own life. No support networks, such as that of the excellent Cruse Bereavement Care Scotland, were in place to help families to cope with their loss, and the stigma of suicide was prevalent in society. Even a survivor of suicide—someone whose attempt had failed—was not given the necessary help that is available today.
In July 1958, Lionel Henry Churchill from Cheltenham was found in bed with a bullet wound in his forehead, having tried to take his life following the death from natural causes of his beloved wife. He lived, but instead of the medical treatment and care that he needed, he was sentenced to six months’ imprisonment. It is remarkable to consider that, until just over 50 years ago, suicide, or “self-murder” as it was called, was a criminal act in Britain.
Thankfully, we have moved on from those times but we still have a long way to go. That is why I very much welcome the Scottish Government’s suicide prevention strategy. As we have heard, the strategy was developed after many discussions with a large number of stakeholders. It was launched last month and puts in place measures for the next three years, focusing on five areas of importance.
I return to my opening remarks and stress the value of talking about suicide, not only to deal with the after-effects of the death of a loved one but as a first step to stop someone seeing suicide as the only option. I am encouraged to see that, in a prominent suicide spot in the centre of my city, Aberdeen, a phone number for the Samaritans is available so that anyone contemplating the act can speak to someone about their intention before it is too late.
The theme of discussion is at the core of the strategy and I believe that it is central to breaking the taboo of suicide. By discussing suicide in a responsible manner, we can save lives. I pay tribute to NHS Scotland and its choose life action plan for developing the “Suicide. Don’t hide it. Talk about it” campaign some years ago. The campaign directed people to listening charities such as the Samaritans, and to breathing space, which is now in its 10th year as a national phoneline service. Next week marks breathing space day 2014, whose message is “Stay connected”. I was interested to learn that the campaign is aimed not only at those who are vulnerable or at risk of suicide but at everyone, by asking us to keep in touch with friends or family by picking up the phone or, for those more adept at it, sending a text message. I encourage everyone to take that advice by taking time out on 1 February to talk to a loved one.
The strategy highlights the benefit of communication through social media and the wider internet in promoting the key message of suicide prevention. However, it also refers to the possible negative impact of such media, especially on those who are most susceptible to and likely to have suicidal tendencies. In that respect, I am sure that I speak for many who have concerns about web-based chat rooms and webcams, Facebook, Twitter and all the other online outlets that are available, particularly to teenagers and young adults, who use them the most.
The relatively new problem of cyberbullying can have tragic and devastating consequences. Figures obtained under freedom of information legislation by my colleague Ruth Davidson just before Christmas showed that in the past three years more than 500 pupils throughout Scotland had been victims of cyberbullying; the actual figure may be higher. Anonymous comments, threats, lies and hurtful insults online can lead to low self-esteem and, very sadly, in extreme cases, to suicide. We will all be aware of the tragic case last summer of the Fife teenager who took his own life after internet bullying and blackmail. I wonder what measures could be put in place to ensure that a terrible event like that does not happen again. Although I accept that the strategy cannot cover all areas, I ask the minister whether he can provide more detail about how he thinks the strategy’s preventative approach to suicide fits in with tackling the specific problem of cyberbullying.
Elsewhere in the strategy document, theme D looks at how we can develop an evidence base to give the NHS and all the other agencies a better understanding of why certain people are inclined towards suicide. I very much welcome that approach, as preventing and thereby reducing incidents of suicide requires on-going analysis, research and the evaluation of information from ScotSID and the national confidential inquiry into suicide and homicide. I particularly welcome the Government’s decision to examine the effectiveness of treatment for patients who experience mental distress and to investigate further the effects of drug and alcohol abuse as potential precursors of susceptibility to suicide.
The document draws attention to the fact that in Scotland almost three quarters of suicides were men, of whom 48 per cent were in the age range 35 to 54. For theme D to succeed, analysis needs to be undertaken that identifies other areas that have a causal link to suicide in addition to depression and mental ill health issues as factors. Financial or job worries, relationship breakdown, stress, bereavement and so on can all contribute to suicidal feelings in men in that age range. I would like to see more focused scrutiny of specific groups in which there is a preponderance of suicide.
To give just one example, the minister will be aware that in the past 30 years there has been a higher than average rate of suicide in male farmers and farm workers in Scotland, with 86 deaths between 1981 and 1999, in comparison with 60 in fishing and its associated industries over the same period. Various factors can be cited for those statistics, such as changing farming practices, economic difficulties and geographical isolation. Farmers’ specific needs and, often, their remoteness from support networks and medical treatment hinder early diagnosis of depression and mental illness. Measures to prevent suicide must be examined.
In his introduction to the strategy document, the minister rightly pays tribute to all those who have worked in suicide prevention, which has resulted in a downward trend in suicides over the past 10 years in Scotland. However, he ends on a note of caution—that we cannot be complacent—and says that “commitment and energy” are still required if we are to continue to make progress. I most definitely agree with that, and I commend the minister and his team for their work so far.
Many thanks. We move to the open debate. We have ample time for interventions and I look forward to those things happening.
15:17
Most of us who speak in this debate probably know or know of someone in their community—perhaps even in their family—who has committed suicide. The loss of a loved one is devastating enough for any family to cope with, but to discover that the loss came about as a result of suicide must pile on more anguish to those who remain. Families who suffer that sometimes blame themselves and wonder whether they could have been more vigilant. Could they have spotted any warning signs and done anything to prevent it? With the natural grief over the loss of a family member comes the additional stress of asking whether a loved one’s suicide was preventable.
Cases that I have been aware of over the years often had something in common, which was the total surprise of the family: there seemed to be no indication or warning signs of what was to happen. Therefore, any strategy to reduce the number of suicides in Scotland must offer some guidance to help families spot the potential dangers, and I recognise that the new strategy does that in several ways. Although we often rely on our dedicated professionals in the health and mental health services to assist us with this problem, families can play a vital role in noticing a family member’s changing patterns of behaviour. I will talk about that in more detail later.
If we look at some of the statistics, as the minister did in his opening speech, we see that there were 762 probable suicides in Scotland in 2012—about two every day, which is quite a sobering thought. In the 2012 statistical report covering suicide information, three quarters of suicides were males and about half were aged between 25 and 54. People who lived in the most deprived communities in Scotland were three times more likely to commit suicide than those in the most affluent parts of our country. Interestingly, two thirds of those who committed suicide were in employment and over half had had mental health prescriptions dispensed to them in the 12 months prior to their death.
In comparison with the rest of the United Kingdom countries, Scotland’s male suicide rates are significantly higher—73 per cent higher—and female rates are almost double. Both have remained above the western European mean since the early 1990s. Despite the gloomy figures, there is encouragement as the trends are markedly downwards; as the minister said, the overall figure has fallen by about 18 per cent in the past 10 years. Indeed, the figures are at their lowest level since those days in the early 1990s.
Much of the good work started in 2002 with the choose life programme, which was recognised as a leader in the field. The steady decline in suicide rates from that time is a testament to the success of the public awareness approach that was adopted. The introduction in 2008 of suicide prevention awareness training for NHS front-line staff has built on that success. The strategy that we are talking about is a natural progression of the approaches that have been working over time.
We do not need to look too far to identify some of the probable causes of suicide, with mental illness, alcohol and drug abuse, poverty, family break-ups and financial problems all playing some part. As the minister said in December 2013, we have made progress, but we need to keep reaching out to those who are at risk and focus our attention on where the evidence takes us. Suicide is preventable and we can reduce the number of tragedies that families face each year.
I was interested to listen to this morning’s Radio Scotland programme on depression as part of its mental health season, in which several callers expressed the need for people to be able to talk to someone at any point in a day when depression strikes. What are the possible warning signs? I have mentioned families who said that they did not notice any changing patterns of behaviour with their loved ones. I am aware of a local case in which a person simply left home one day, with no apparent signs of what was to come, and did not return.
Neil Findlay mentioned some of the causes of suicide. Perhaps some of the symptoms were those that were kindly posted on one of the NHS choices websites, which provides very useful help to families. They included feelings of hopelessness; episodes of sudden rage and anger; reckless acts with no apparent concern for the consequences; feeling trapped; starting to abuse or more frequently use drugs or alcohol; noticeable weight changes due to changes in appetite; people becoming increasingly withdrawn from friends, family and society; an inability to sleep, or sleeping all the time; and—this one might occur to families—someone suddenly beginning to put their affairs in order by sorting out possessions or making a will.
It is sad, but families might recognise those symptoms only after the event because in our busy day-to-day lives we may not think anything of such potential warnings. That is not to say that those are all causes to set the alarm bells ringing, but the advice from the NHS is to engage a person and encourage them to talk about how they are feeling and to share any concerns with a GP or a person’s care team, particularly if they are being treated for a mental health condition.
I expect that other members will develop the key elements in the strategy, but the particular emphasis on more direct engagement with families and carers, more work to tackle stigma and discrimination and deploying technology to provide people with more helpful information will, I hope, improve matters even further in the coming years.
The Scottish Government’s strategy for preventing suicide develops and builds on the very successful choose life programme that has seen a significant drop in the awful statistics. The public have been closely involved in developing the strategy further and I am sure that more gains will be made. Helping families and health workers to spot potential warning signs and providing the support mechanisms for those who are at risk will go some way towards reducing further the number of suicides, which, as the minister said, are entirely preventable.
15:24
I am grateful to members who have shared their knowledge on the subject but, like Nanette Milne, I, too, am not content that we need to discuss this issue and recognise that we do so with great sadness. It would be far better if we as a nation did not have to face the on-going experience of suicide as has been described. In that sense, we face a tremendous battle.
It has been alluded to that we have faced nearly 4,000 such deaths in Scotland over the past five years. I am sure that each of those deaths has left behind heartbreak and a legacy for those who have been involved. In that context, I welcome what the minister said and the strategy that has been outlined in “Suicide Prevention Strategy 2013-2016”.
The introduction to “Suicide Prevention Strategy 2013-2016” lays out definitions of self-harm, suicidal behaviour and suicide. Members’ experiences and observations identify that among the priorities that we face is focusing on the early signs of behaviours that could eventually lead to suicide or an attempt at suicide. Those who have engaged in self-harm and suicidal behaviour deserve our support at an early stage, and there should be early intervention of some value if we are to go further in reducing the suicide rate.
I think that we all accept that it is not only suicides themselves who are the focus of our concerns. Around every such event, families and friends are left to question how it occurred, and our society is left bereft of the contribution that could otherwise have been made. Indeed, in many circumstances, witnesses are left behind devastated by the experience.
Many statistics have rightly been mentioned. Almost every day somewhere in the United Kingdom, someone steps on to a railway line and commits suicide. That has an obvious impact on not only their family and friends but the poor train driver who was in the train on that date. The ramifications of each of those circumstances are severe and for all of us to consider.
Some of us who had no knowledge of those circumstances earlier in life often heard that the act was selfish and required more consideration. Suicide leaves behind chaos, guilt—we heard about that earlier—in families that feel that they have some responsibility in some way, and a notion of blame needing to be asserted. Thankfully, we have, I think, come to understand that the whole circumstance is based essentially on illness, pressure and an inability to see a way forward. For many, that is not understandable, but nevertheless it is so prevalent that we can come to know that human beings can feel that the only way forward is to take their own life. I do not think that we can too often consider and try to respond to the sadness and impact of that.
On the circumstances that lie behind suicide, there is, no doubt, as Willie Coffey mentioned earlier, a propensity in Scotland to commit suicide, particularly among males, that is not seen elsewhere in western Europe. Obviously, alcohol and substance abuse have some impact. We are all aware of the levels of alcohol and substance abuse in Scotland. Joblessness and poverty have been mentioned, and bad debt is a factor. Hopelessness and sometimes homelessness lie behind suicide. Our thanks are no doubt due to NHS Scotland, the Samaritans, Breathing Space, the Salvation Army and many third sector groups that work tirelessly in that regard.
For the future, education is obviously of great significance in the strategy when it comes to understanding some of the early signs and recognising the pressures that individuals face. Talking about the issues and getting things out there into the public domain are increasingly important. Knowledge in the workplace is also important, because signs can be seen there. Workers should be educated to know that colleagues are under pressure; steps can then be taken.
The issue is very sensitive. Signs can be misread, but it is far better to take steps to help each other than to step aside and say in the Scottish way, “Let’s not be nosey about our pals’ interests or our neighbours’ futures.” We should step in and at least show kindness and an interest.
Also, social events in Scotland such as football matches, where male sensitivities are put aside, and pop concerts and the like are places to advertise the fact that there is a problem, which is almost unspoken until one experiences it at first hand. Identification is an important issue.
Equally important, as has been alluded to, are the real-time responses. I, too, listened to the radio this morning, and it became self-evident that when people need help they need it immediately and they need someone to speak to. Although the Samaritans are a great support, more needs to be done in that regard. I am sure that the minister will give thought to that.
Mention has been made of the use of sport and recreation to get people out into the open air and involved in groups. Although that is not part of an NHS strategy, one hopes that the minister can give us some insight into the co-operative work that is going on in the partnerships that we always talk about to deliver alternative solutions to our problems.
Monitoring and constant reassessment of the strategy will be significant in the years ahead. I am pleased to hear that there is no complacency regarding the falls in numbers and that they are not, in themselves, being seen as the achievement of success. One life saved is something that we should laud and be pleased about, but we want to try to save all these lives for the future. In that context, I welcome the 11 commitments that are outlined in the document and encourage the minister to do more as the evidence presents itself.
15:34
I pay tribute to the organisations out there that are doing a huge amount of work in tackling mental health stigma and in trying to prevent suicide—organisations such as the Scottish Association for Mental Health, the choose life programme co-ordinators and volunteers across the country and the Samaritans, who have been mentioned quite a lot in the debate. Many of us recently had the privilege of meeting Samaritans from throughout Scotland who are doing immense work, in my community in Aberdeen and elsewhere.
In its briefing for the debate, SAMH asks a number of questions that I have asked myself in a previous guise as a local councillor. It asks the Scottish Government how it will ensure that local authorities and community planning partnerships are held to account for the suicide prevention work that they are obliged to carry out under single outcome agreements. SAMH calls for more transparency from local authorities and others in pointing out what they are doing. I think that that is required. I am convinced that a lot of good work is going on, but it is a subject that we do not talk enough about. We talk about relatives and friends who die of natural causes, but folk often do not talk about those folk that they have known who have taken their own lives. We must get much better at doing that.
We also have an obligation to challenge behaviour. Far too often in society—in the media, in particular—we see a stigmatisation of mental ill health. We have seen headlines galore, over many years, using language that should not be used to describe folk with mental health problems. All of us here and beyond should challenge such behaviour. We now have the new media—the social media—which Dr Milne talked about, and we see a huge amount of bullying and horrid language there.
Before the debate, I looked at some recent cases of suicide. Dr Milne mentioned the young man from Dunfermline who, after being blackmailed after using the internet, could see no way out other than to take his own life. There are countless stories out there, but one that I was really struck by had the headline, “Ballet girl was ‘hooked on Tumblr where users encouraged her to harm herself’”. That is beyond my ken—why would anyone do that? However, it is obvious that such behaviour goes on. That girl took her own life. We should look at ensuring that social media sites are not used to bully folk and to leave them with what they think is very little option, and I think that we can do that.
A BBC Scotland report from 22 June 2012 had the headline, “Social media ‘could cut suicide’”. It said that, in a study by the University of Stirling in 2009,
“one in five school children said the internet, including social networking sites, influenced their decision to self-harm.”
It went on to say:
“Now the researchers say the possible dangers posed by new media could be counteracted if the sites provided support for vulnerable young people.”
In that report, Professor Rory O’Connor of the University of Stirling’s suicidal behaviour research laboratory is quoted as saying that
“The reasons for adolescent suicide and self-harm are multiple and complex. My colleagues and I see that the challenge is ensuring that new media provide support for vulnerable young people, rather than helping or encouraging self-destructive behaviours.”
I am pleased that organisations such as SAMH and the Samaritans now have a presence on Twitter, Facebook and other new media sites, because I think that that can be immensely beneficial. Interaction with such organisations on new media sites is often helpful for people who may have some dark thoughts.
The difference between the suicide rate among the poor and that among the more affluent members of society has been mentioned. Mr Coffey said that the suicide rate in the most deprived areas was more than three times higher than the rate in more affluent areas. One of my main concerns is welfare reform and the austerity measures that are being implemented under the direction of the Westminster Government. As many other members probably do, I regularly have folk come to me who feel despair, isolation and a lack of self-worth, because of the changes that have been thrust on them. We need to take cognisance of the impact of the welfare reforms on people’s mental wellbeing, and we must ensure that we do the right thing in that regard by doing all that we can to help folk who have been affected in that way. In my opinion, the best way of dealing with that would be to halt the austerity measures and to stop the worst impacts of welfare reform, and I hope that that will be possible in the very near future.
15:39
Dr Sir Thomas Browne created the word “suicide” meaning “to kill oneself” in the 17th century, but it has always been with us.
The early Christian church exalted self-sacrifice and martyrdom, yet by the middle ages the church would dissuade people from committing suicide by preaching damnation, and people who had committed suicide were often denied a Christian burial, hung in chains, impaled on a stake or disembowelled. Thankfully, the modern faith and secular worlds are much more enlightened in their approach to suicide.
My own family has suffered from suicide. My great-grandmother drowned herself in the River Shannon, and an uncle burned himself to death in his car. A cousin in the 1960s often came home from school to find his mother attempting self-destruction by putting her head in the oven or standing on the window ledge; at 10, he found her strangled by the washing line. In this debate, therefore, I will focus not on the wish to die of the terminally ill or of those who are in permanent pain without quality of life, which I believe will be debated another day, but on the suicide of despair by people who see little hope in their own life now or ever.
Suicide can destroy the future because of a failed exam, a broken relationship or a loss of home or job that someone cannot see past but which the passage of time would surely have resolved. Studies show that the children of suicides are more likely to kill themselves, as are members of the immediate family and close friends, inflicting, as some have argued, a posthumous homicide. In the past 45 years, there has been a 60 per cent increase in the incidence of suicide worldwide. As Neil Findlay pointed out, between 800,000 and 1 million people kill themselves in the world every year now; every one of them is, of course, a tragedy.
Scotland has not been immune from the global trend, as we have heard in the debate. The latest study from the Prince’s Trust revealed that a third of young unemployed people had considered suicide and that 9 per cent felt that they have nothing to live for. Furthermore, the rate of suicide is three times higher in the most deprived populations of Scotland than in the general population. The decline in living standards is therefore something that must be considered as we look at the matter and attempt to establish a strategy towards preventing suicide.
We have heard in the debate of suicide’s devastating impact on families and communities and of efforts to tackle the issue, but it is important to remember that specific groups in society are more at risk of suicide, and it is wise to focus on assisting those groups where possible. Of course, not all groups who suffer from suicide are deprived. As Nanette Milne said, there is a higher instance of suicide among farmers; there is also a higher rate among doctors, nurses and veterinarians. One might consider that access to the means of suicide is another reason for it.
Veterans of the armed forces form another group whose rate of suicide is higher than that of the wider population, for reasons that include difficulty in adapting to life outside the forces, living with the trauma of conflict or suffering from mental and physical problems related to time in service. I am therefore pleased that Scotland is the first nation in the UK to appoint a veterans commissioner to work with charities, local authorities and health boards to identify public services that might provide greater support to veterans. That commitment will complement the £1.4 million annual funding from the Scottish Government for specialist mental health and community outreach services provided by Combat Stress to help veterans who need support.
As deputy convener of the cross-party group in the Scottish Parliament on adult survivors of childhood sexual abuse, I know that people with a history of childhood sexual abuse have a greater likelihood of suicide. The “Beyond Trauma” study by Dr Sarah Nelson of the University of Edinburgh focused specifically on the mental health needs of female survivors, half of whom revealed that they had tried, sometimes repeatedly, to kill themselves. In an NHS Lothian needs assessment of adult male survivors of childhood sexual abuse, it was found that male suicidal behaviour was even more acute than that in female survivors, with most male survivors having attempted suicide—again, often on several occasions. Very often, survivors of childhood sexual abuse not only have to live with their experiences but they struggle with addictions that are developed as a result of them. As is pointed out in the suicide prevention strategy, substance abuse often increases the likelihood of an individual attempting to take their life, making that group, too, particularly vulnerable.
Often, the best way for survivors to rebuild their lives is to discuss their experiences, understand what happened to them, know that they are not alone and rediscover their self-esteem and trust in others. Organisations across the country support survivors of childhood sexual abuse and carry out vital work to help those who are most in need tackle their problems as a result of trauma. I am pleased that Survivor Scotland was allocated £1.65 million from the Scottish Government between 2012 and 2014 to fund a variety of projects to continue that invaluable work, as individuals who are at risk of suicidal behaviour require continued support to ensure that they do not end their lives.
A couple of years ago, I chaired a Samaritans and University of Edinburgh seminar here in the Parliament on the media impact of suicide. The National Union of Journalists attended the seminar and it must be commended for its serious approach to suicide prevention, encouraging as it does journalists to report suicide sensitively, as sensationalist coverage or reporting that appears to glorify or romanticise suicide can lead to many more copycat suicides.
Although suicide clusters thankfully remain rare, they can have a devastating impact on local areas. To see that, we need only cast our minds back a few years to the tragic events in Bridgend in south Wales, where dozens of teenagers and young adults committed suicide in the space of a few short years. At the time, many people blamed sensational and excessive media coverage of those tragedies for the increased number of suicides. In 2010, the police asked the media to cease reporting on them in an effort to deter copycats, and eventually the trend subsided. The continued dialogue between the NUJ and the Scottish Government is welcome, as are efforts to ensure that there is sensitive reporting on mental health issues and suicide through the publication of practical guidelines and journalist training.
I am glad that Mr Gibson talked about the inroads that have been made in relation to reporting. There are a huge number of responsible journalists out there. However, one thing that is little discussed is the way in which folks with mental health difficulties are often portrayed in entertainment programmes such as “The X Factor”. Does Mr Gibson agree that we should challenge the producers of those television programmes as well as the print media?
I have never watched that programme so I find it difficult to comment on that one in particular, but all stereotypes involving people with mental health issues should certainly be challenged if we are to have a much healthier society.
I have taken a great interest in this most tragic of subjects during my time in the Parliament. It has been encouraging to see the work that each and every Administration since devolution has done to reduce the number of suicides in Scotland, and to see such strong cross-party support for that work. It is clear that it is essential to take a comprehensive, far-reaching and national approach to suicide prevention, and I am pleased that all members are able to unite to provide the best outcomes for those individuals and families who most need our support.
15:46
I, too, welcome the publication of the Scottish Government’s new “Suicide Prevention Strategy 2013-2016”, and I commend the minister for providing us with this opportunity to debate its contents.
Suicide is an incredibly sensitive issue and one that must be treated as such by all of us across society. As Willie Coffey has already said, I dare say that most of us in the chamber will know of someone who has either committed or attempted suicide. I know of more than one, unfortunately, and Kenny Gibson mentioned a few of his family members. It is hard to articulate just how much the friends and relatives of those concerned can suffer in the aftermath. It is important that we drive down the number of suicides in Scotland and that any framework that is put in place to achieve that aim is fit for purpose.
The latest strategy follows on from “Choose Life: A National Strategy and Action Plan to Prevent Suicide in Scotland”, which was published in 2002, and it certainly builds on some of the successes of its predecessor. The 18 per cent reduction in suicides in Scotland and the fact that all probationer police officers and 50 per cent of front-line NHS staff are now trained in suicide prevention techniques provide a good platform on which to build.
I have highlighted in previous debates on mental health that it is vital that we end the spectre of patients being condemned to long-term repeat prescriptions for antidepressants without regular reviews of their response to the treatment. The strategy highlights how important it is that we make a concerted effort to change that, as it notes that,
“at the time of death, many people are receiving some form of medication used in the treatment of mental illness.”
Perhaps something as simple as a review of their medication with a change to the dosage or the drug may have made a difference to their mood.
The minister will be well aware of the successful pilot that was held in Glasgow in which participating practices reviewed those who were on antidepressants for more than two years. It led to 28 per cent of patients having a change in their therapy and an 8 per cent reduction in prescribing costs. Reviews can make a difference, but I appreciate that the use of antidepressants is essential in many cases.
I was delighted to come across commitment 7 in the strategy, which reads:
“We will work with the Royal College of General Practitioners and other relevant stakeholders to develop approaches to ensure more regular review of those on long-term drug treatment for mental illness, to ensure that patients receive the safest and most appropriate treatment.”
I welcome the inclusion of that important commitment in the strategy and I would be grateful if the minister provided in his summing-up a timeframe for engaging with stakeholders on working towards those much-needed reviews.
In 2008, the Scottish Government published “Equally Well: Report of the Ministerial Task Force on Inequalities”, which makes recommendations on tackling health inequalities. It said that one of the challenges that faced the ministerial task force was that
“Those living in the most deprived”
10 per cent of
“areas of Scotland have a suicide risk double that of the Scottish average.”
I appreciate the mention of farmers and vets by Nanette Milne and Kenny Gibson. It is without doubt that the incidence of suicide among such people is high because they have access to the means of committing suicide.
I was disappointed that health inequalities merited only one fleeting mention in the suicide prevention strategy. The link between inequalities and greater rates of suicide is acknowledged in “Equally Well”, and it merits greater inclusion in the overall discussion on preventing suicide.
Timely access to psychological therapies has a role to play in treating those with mental illness more effectively, and I hope that it would have the knock-on effect of reducing the number of suicides further. I therefore welcomed the target of access to psychological therapies within 18 weeks of referral as a positive step. However, I caution that, for someone who is suffering from mental anguish, 18 weeks is a long time to wait. Many such patients have of course suffered for some time before their referral. The minister should not limit his ambitions to 18 weeks.
The target is due for delivery by December, so this is not the time to move backwards. In September, there was a 3 per cent drop in the number who are being treated on time. One fifth have to wait more than 18 weeks for treatment, so the Scottish Government cannot rest on its laurels yet.
The head of psychological services in one health board told me that, alongside its counterparts in other areas, that board is constantly making the case for greater investment in mental health services. Yesterday, I visited Midpark hospital in Dumfries, which I know that the minister visited in 2012—I saw his signature in the visitors book. NHS boards are experiencing increasing demand for such services because of the economic downturn and—perhaps more positively—because the public are becoming much more aware of the services’ availability.
I hope that we might be beginning to see some erosion of the stigma that has plagued mental health. The Scottish Government needs to continue to address that. It will also have to address the clear disparity that exists across Scotland in access to clinical and other applied psychologists. It cannot be right that, per head of population, NHS Greater Glasgow and Clyde and NHS Fife have twice the number of psychologists that NHS Forth Valley has. If the health improvement, efficiency and governance, access and treatment—HEAT—target is to be met later this year, access must be addressed urgently.
Suicide is difficult for those who are left to comprehend. I am glad that we are making progress with a decrease in suicides, and I look forward to much more progress in the near future.
I call Christine Grahame, who has a generous six minutes. After that, I will be happy to call James Dornan.
15:53
I compliment the Parliament on discussing mental health and suicide prevention. In my long time in the Parliament, we seem to have raised those issues many times, which we have gone some way towards destigmatising. We have provided funding to the voluntary sector, which I will discuss later. It is refreshing to be in a debate that has been mostly—apart from a wee hit or two from Jim Hume—devoid of party politics and point scoring, which is as it should be.
I welcome the Government’s suicide prevention strategy, which continues the earlier work on harm reduction, early intervention and destigmatising. I recognise the work that my colleague Kenneth Gibson has done, which he is humble about. In 1999, when I had no idea what he was talking about, he raised the issue of high suicide rates among young men. He has pursued the issue for years, and it is only those of us who have been in Parliament for 14 years who recall that. Kenny Gibson has kept to the subject, as others have done, for a very long time, and I compliment him on that, because we are catching up with him.
I want to focus on the third sector, which is important and informed because of its grassroots contribution, as is illustrated in my constituency, where face-to-face help is provided. That is important, because there can be clever websites and clever things to do, but sometimes people just need someone right in front of them, with a cup of tea, to talk to and to listen to them. No website can provide that.
I also want to talk about the role of education in the campaign—raised by many members, but begun by Nanette Milne—for the responsible use of social media, which definitely has an increasing part to play.
Penumbra in my constituency promotes mental health and wellbeing, aiming to prevent mental ill health for people who are at risk. It provides support and practical, accessible help, based in the community and right in the middle of Galashiels in big offices, which destigmatises the issue right away. The premises are cheery, with well-painted, fresh rooms and coffee and tea. That says something about mental health issues, which—if we are honest—we all know affect many people, including many friends and relations, at some time in their lives.
Health in Mind provides befriending services, offering six-monthly matches, operating initially in Midlothian and the Borders. Clients get six months with a befriender matched to them, to get them out and about, busy, out of the house and out of their cocoon. It helps them to get confident again with the outside world and to build their self-confidence and self-esteem, which can be so easily vanquished.
For anyone, redundancy can take away self-esteem with the click of their fingers, as can a broken relationship, when all the cockiness and self-esteem that they once had disappear. It can happen to anyone. The befriending services help to rebuild people’s confidence so that they can cope with what many of us cope with every day without any problem—although we could all be there.
New Horizons, founded in 1993, is an informal meeting place and self-help group where people help one another to get through their problems. It even leads to romance. It led to a marriage—I met the couple who had met there and then married.
As a side issue, the bedroom tax affects people with mental health problems. One of the members at New Horizons told me that she cannot share a home because of her mental health condition but that she was being asked to have someone else in the spare room or be taxed on it.
Together, those charities play a collective role not only with one another but by contributing to the planning of mental health services across the Scottish Borders. In Midlothian, we have midspace, the online mental health and wellbeing information service for people who want to know where to go for services. It points them in different directions for treatment and care. Other members have mentioned SAMH, which in my area is focusing on employability, which is important.
While I am on the subject, let me point out that it is extremely difficult for somebody with mental health issues to disclose them to an employer. They do not want to put it in a form or mention it; they can say that they have had chicken pox, but they will not say that they have had a breakdown at some point in the past, because they fear that they will be written off and not be able to pursue their career any more. There are still issues with employers.
Not all who may commit suicide are mentally in a position to access services, as I have said; neither are they identified by the system earlier on. Out of the blue, somebody can commit suicide triggered by redundancy, the end of a relationship, failing an exam or not getting the marks that they thought they would get. There can be no warning.
I move on to the role of education. We have dealt with that, to some extent, in relation to social media, where there can be venomous bullying and distressing attacks on Facebook or in blogs and tweets. As has been said before, there have been highly publicised examples of individuals who committed suicide substantially as a consequence of online comments. We know that it is the bad things that are said about us that we keep reading.
The nasty things are the ones that we cannot get out of our heads in the middle of the dark night when we remember a horrible comment that we have read. Do not look at those comments on the internet about me, by the way. They are there; they are there about us all. The nasty ones are the ones that we keep picking at, so if someone is vulnerable, they are the ones that they will remember. They bite into our souls.
Lewis Thelwall, aged 19, of Port Talbot was bullied to his death because false rumours were put on the internet about him. He was vulnerable so he took the comments to heart and killed himself.
In Fife, 17-year-old Daniel Perry became involved, in his innocence, in a scam. He was threatened with blackmail. People—anonymous users—on the social media website ask.fm actually urged him to kill himself. The same website had been linked to other youngsters’ deaths. He was sent messages saying:
“you need to let a blade meet your throat”.
Who are these people that put such things online? Daniel was warned that he would be better off dead if he did not transfer the cash. Of course, he took the warnings to heart and he hid everything from his family. The thing is that his mother said:
“He was not the type of person who let things get him down”.
Presiding Officer, I was told that I had a generous six minutes. Do I still have time left?
Yes.
I ask the minister, who has indicated the issues that he is dealing with, why the ministers for education and children are not also involved in the mental health strategy. I want education to be included in the suicide prevention strategy. I know that some schools deal with Facebook, sexting and tweeting and all that, but others do not.
I know that we all think that we are clever clogs at technology but we are way behind youngsters. Why are we not in schools and looking at responsible use of the internet? That has implications for those who put things on the internet, because they will be there for ever—when they go out to look for a job, the things that they have said and done online will still be there—and it has consequences that other people might regret for the rest of their lives if they are party to actions that lead to someone else taking their life.
I therefore ask the Minister for Public Health to advise in his summing-up whether he is discussing these particular issues with the ministers responsible for education and children.
16:02
I was not going to take part in the debate but, with your indulgence Presiding Officer, I will make a short contribution.
Some members have already raised the point about a preponderance of males aged between 35 and 54 committing suicide. If it is not altogether understandable, we can see why people in that group might feel the most pressure. People reach an age at which they feel that they should have achieved something. They might well have done so, but in their minds they have not and they feel disappointment and pressure. That pressure might not come from outside; an individual might feel inside that he should have done something that he has not managed to do, despite the fact that he might be a very successful businessman or successful at something else.
Other people do not see that pressure that those people are feeling. Christine Grahame talked about Daniel Perry’s mother saying that he did not let things get to him. Often, other people do not know who we are. It might look as though we are coasting through life and everything is hunky-dory, but it could take just one thing to trigger a devastating action.
I do not think that those who are left behind are part of the Government’s suicide prevention strategy. Suicide might be a tragedy for a small group of people, but it can have a larger effect. I know of someone who found their friend who had committed suicide by using a hose on an exhaust pipe. Three days after he had gone missing, his friend found him. It happened a long time ago now, but the vision lives with his friend to this day. He has suffered mental health issues that were based on the stress that finding his friend caused.
Although it is important to have some sort of prevention strategy, suicide is sometimes not preventable—sometimes we just do not see it coming—and those who suffer because of the act of the person who has committed suicide need to be protected.
It is great to see the Government dealing with the stigma of mental ill health, and I congratulate the Government on the suicide prevention strategy and the work that it has done up to this point.
Many speakers have mentioned online attacks. It used to be that, when someone slagged someone else off, they slagged them to their face, or they might have sent a poison pen letter. An individual can now be publicly ridiculed for no reason whatsoever, and they do not even know who the people are so there is nothing that they can do. They cannot defend themselves against it. People retweet things and jump on any bandwagon. That individual then feels as though they are being assailed from all sides. They feel helpless and they feel useless and that is when they get to the stage of considering suicide.
It is important to note that the strategy will help in many ways, but it will not help in every way because people cannot always tell. Families can look after somebody and they are the ones who think that they know that person the best, but they are the ones who are the most shocked when that final action is taken.
I have seen a number of people who have suffered from this. Kevin Stewart talked earlier about people coming to see him. In the past six months, I have had a number of people coming in to my office who have attempted suicide and have talked about attempting it. One 17-year-old girl had tried to kill herself three times in the space of six to eight weeks, so it is not just us middle-aged and elderly men who are committing suicide or attempted suicide; it is people in the young group, too. They are finding the pressure of life so difficult—they might be finding it difficult to get a job or to get that boyfriend or girlfriend they think they have to have to be cool. We need to keep in mind that it is small things that can trigger those huge actions.
I welcome the strategy. Everybody has to play their part in this: everybody has to look at their own family and to watch their own friends. If they see a change in a family member’s or friend’s behaviour, they need to take note of it. Somebody earlier on—I think that it was Neil Findlay—mentioned the macho issue and how Scots males are not very good at interacting with each other about our emotions. Sometimes we have to put that aside and just take a chance. If we think that somebody does not look right, we have to ask the question—we have to ask them what is wrong. If we do not, sometimes what happens is that we live to regret not asking them—we find that it is too late.
We now turn to closing speeches. I remind members who participated in the debate that they should be in the chamber for closing speeches.
16:07
This is one of these debates to which we contribute as politicians wishing that we knew more about the subject—much more about the subject than any one of us probably does. Therefore, our contributions are all circumscribed by that fact.
To my surprise, we last touched on this topic—I can remember the debate quite clearly—on 24 January last year, when we spoke about mental health issues. I thought that the debate was much more recent than that. There were excellent speeches in that debate from many who have not contributed today—we heard then from Fiona McLeod, Malcolm Chisholm, Richard Simpson, Mary Scanlon, Dennis Robertson, Mary Fee and David Stewart.
In that earlier debate, when we were talking about mental health issues more generally, suicide became a feature of our discussion and at that point the SAMH two too many campaign was mentioned. Even though we are having this debate against a background of a falling number of those who are taking their own lives in Scotland, the two too many campaign illustrates that, each and every day, two people in Scotland take their own lives. In total, that is 14 deaths in every 100,000 against a European average of 16 deaths in every 100,000.
As Neil Findlay said, if we roll it all up into a global figure, the number of people who commit suicide is astonishing. It is not the norm but the exception, but it is against that background that we are seeking—through the strategy that I think all of us are very happy to support—to effectively understand why people commit suicide and to seek to reduce the number further.
Historically and in different cultures there have been different attitudes to suicide, but in Scotland it is a long time since it was a heroic act to defend a nation’s wellbeing in war or since we had any correlation to some sort of old imperial Japanese code of conduct. I have to assume that, for most people, the decision to commit suicide is a bleak, cold and lonely one that is almost always taken for reasons about which our despair should match that of any unfortunate soul who contemplates such an end.
Let us understand the context that we will not eliminate suicide—I agree with James Dornan on that—but that we should pursue policies and actions that will continually militate against the reasons that drive people to thinking of it. In Michael Matheson’s foreword to the strategy document, he sums up the issue by saying simply:
“Every suicide is a tragedy that has a far reaching impact on family, friends and the community long after a person has died.”
That is the general point that every member understands and which is at the heart of the tragedy.
During the debate, all sorts of reasons why people commit suicide have been advanced. As Kenny Gibson said, although he chose not to talk about it today, some people who are faced with some sort of medical prognosis decide that suicide is the right course. Others are driven by a breakdown in relationships or a radical change in fortunes, which might well be relationship driven or to do with careers or finance.
Some people are driven to suicide because they are different. On that issue, as a country, we can take considerable pride in the way in which our culture has changed, certainly since I was young. At that time, if someone was disabled, they could be the subject of ridicule or, if people were gay, that was to be disowned and denied, or worse. There were all manner of other social stigmas that drove people to suicide. As a society at large, we have moved on considerably and, I hope, not so many of those stigmas are now apparent.
Neil Findlay talked about Touched by Suicide, social groups and what we can do to assist people to be better able to develop the skills that will allow them to intuitively recognise those who are at risk. Nanette Milne talked about the impact and potential consequences of the web, which Kevin Stewart and Christine Grahame also touched on.
I am not being flippant when I say that my sons certainly receive lots of comments for being the sons of a Tory MSP, and they have learned to cope with that. It is incredible how many young people find themselves the subject of bullying that is driven by the actions of their parents or the perceptions of their parents. That has a wholly corrosive effect on some young people, but they can have a great reluctance to discuss that in the family, because they feel that in some way they are protecting their parent from what has been said about them. On some dreadful occasions, that has driven young people to suicide.
I understand—I do not think that this is a Westminster myth—that, for a great number of years, the sons and daughters of newly elected MPs received a letter from the son of a previous MP about the difficulties that they would face and the pressures that they would be under because their parent had entered elected politics. Mr Carlaw’s sons can obviously cope, but many families cannot. That is yet another area in which some folks do not realise the damage that they are causing.
Potentially, within what Mr Stewart says is the germ of an idea that goes way beyond politicians. Children who have suffered might well be a source of information or support to others who find themselves in a similar situation.
Willie Coffey said that members will know of people who have committed suicide. I had not reflected on that until he said it, and I suddenly realised that my grandmother’s sister, of whom I was enormously fond and who had a great influence in bringing me up as an infant, committed suicide. In fact, I was not told about that until I was in my 30s.
I also realised that another relative died in circumstances that I have never been able to determine and that I imagine were suspicious. They were of that age and time that Nanette Milne mentioned when nobody wanted to discuss suicide or admit to it. Also, a friend’s wife committed suicide quite unexpectedly—she was the last person one would imagine would do that. The tragedy was that her husband then developed and died from lung cancer and left three adopted children. That is the sort of personal tragedy with which people are left to deal later on.
The minister obviously enjoys the support of all parties and all members, and we welcome the strategy. In his closing remarks, I would like him to tell us how he will ensure that there is a sustained effort to give focus to implementing the commitments in the strategy, to energise people and to ensure that the results are assessed. I would also like him to tell us how he will ensure the one-to-one-contact and the engagement that, together with the practical actions, underpin much of his strategy. That will obviously be beyond the strategy, but I would like to see further evidence of it contributing to additional reductions by which we all hope to see measurable progress.
I have advised Parliament that I expect all members who have participated in debates to be present for closing speeches. I regret to note that Graeme Pearson is not present and I have not received an explanation.
16:16
Like many other members, I find it difficult to imagine what drives people to suicide or, indeed, the anguish of family members who are faced with the suicide of a loved one. Therefore, I welcome the debate, because we are taking those issues seriously.
I also welcome the impact of the choose life strategy, which was published back in 2002. Although it is disappointing that the targets have not been fully met and, as Willie Coffey told us, our suicide levels are still much higher than other European levels, we must take heart that movement is in the right direction. Therefore, I welcome the new strategy that follows on from choose life and hope that it will have similar impacts on the number of suicides in Scotland.
Many members spoke about issues that are pertinent to the debate, but one of the more important ones is the one about which Kevin Stewart talked at length: the stigma that is connected with mental health issues. That stigma still exists, despite numerous campaigns in the area. How can we encourage people who are desperate and need help to seek and receive that help if we do not remove that stigma? It is really important that we do that. Kenny Gibson also mentioned the work of the NUJ in reporting suicide, which is helpful in that regard.
Many members spoke about groups that are involved in helping people. I also pay tribute to them: the breathing space service, SAMH, the choose life campaign, Touched by Suicide Scotland and, of course, the Samaritans, which is one of the groups that everyone thinks about when we talk about suicide. They provide a lifeline for those who are suicidal, and they work round the clock to be there to listen to people. Many of those groups also work outside the statutory services, which makes them much more approachable when we consider stigma and the fear that it puts into people about approaching mental health services.
Neil Findlay mentioned the Samaritans report “Men and Suicide”. Perhaps we have missed the point that gender stereotypes put men at greater risk of suicide; they put greater pressure on men to cope, to be strong and to provide leadership. As James Dornan said, there is an onus on men to have “achieved”, by a certain time in their lives. They perhaps compare themselves with their peers and find themselves wanting.
Men also have difficulty discussing their emotions. Women are much better at discussing emotions and reaching out for help. In men, the gender stereotype says that that is weakness, which builds barriers for people to seeking help from their peers and loved ones.
We heard from Neil Findlay and other speakers about the incidence of suicide being much higher in areas of deprivation. That should not be surprising, because living in areas of deprivation where there is no hope of improvement must eventually grind people down to a point at which they see no point in going on.
Jim Hume made a really good point when he talked about suicide and “Equally Well”. We need to consider the issue as part of health inequalities. Health inequalities takes in many health issues, and suicide is one of them, which is relevant when we are considering financial pressures and the like.
We also need to look at other groups of people. I think that it was Nanette Milne who talked about the predominance of males in agriculture. Farmers and farm workers are a group of people who perhaps do not have a lot of social interaction, because they work in rural areas where they do not meet people. It is important that we reach out to them.
Graeme Pearson talked about signposting help for men at male-dominated events, such as sporting events. That is really important, but it is also important that we encourage people to speak about the issues.
Another important group is young people. We all know about the issues of transition in mental health services when people move from children’s services to adult services. That is a difficult time and we need to ensure that the services are in place to help them through that. There are added pressures on young people; young people have always been under pressure, but as things move on, especially with regard to social media and the like, the pressures change. Yesterday, YoungMinds published research about the pressures that young people feel they are facing. Half of them said that they felt that they had been bullied, which is a frightening amount. Part of that bullying is, of course, being done through new social media. Christine Grahame talked about the difficulty that that causes and suggested that there is a need for education in that area. I say that we need to take that a step further and hold to account the platforms that publish the material. If we were to do that, there would be a greater chance that those platforms would police their pages to ensure that people do not come under pressure from the bullies. That is something that we might need to look at in the future.
Other members talked about substance abuse being a trigger for suicide. That should not surprise us at all. Obviously, those who self-medicate by turning to alcohol and drugs for help are already suffering poor mental health. It therefore follows that they are at risk, so we need to think about ways of helping them through that, and of targeting that group.
Graeme Pearson talked about the impact of suicide on families, and the guilt that they feel about whether they could have done something or intervened. Families are hugely important in this issue. Recently, I attended a meeting of the cross-party group on carers, at which families of people with mental health problems talked about how they had been treated by psychiatric services. Patients had been told not to confide in their families and families were not given advice on how to support family members who were coming out of hospital and were suffering mental health issues. They had not been told that people coming out of in-patient services are at a greater risk of suicide, so they were ill prepared to help them. Patient confidentiality must of course be paramount, but it is not helpful if we end up stopping people reaching out to those who are best equipped to help them, and if we are not providing those families with the knowledge and understanding of what they can do to help.
In its briefing for today’s debate, SAMH talked about the community support networks that it is putting in place to provide support and information for people who are suicidal. That is a step in the right direction. It also talked about community engagement, and many people have spoken about training for people in work situations in which they might meet people who are thinking about suicide. However, I think that we should look at suicide prevention from a community point of view, so that we can address the training needs throughout our whole society, because we do not know when people might meet someone who is thinking about suicide.
On the subject of social media platforms, I read a story about someone who had tried to commit suicide and was trying to find the person who had intervened. That person was not a policeman or a health worker; it was just someone who had been walking past and who had stopped to speak to the person and persuade them not to take their own life, and had then gone on about their business. Obviously, at such a time of great distress, the person did not think of taking the other person’s contact details, but they now want to track that person down to thank them for changing their life by convincing them not to commit suicide.
I also welcome the fact that a self-harm strategy will be published. That is important because many of those who commit suicide have also self-harmed. A strategy will help to identify those who might commit suicide.
I will touch briefly on the interventions that are available when someone is attempting to commit suicide or is suffering a mental breakdown. The emergency service that tends to respond is the police, which is perhaps not the best service for someone who is in a difficult place. We need to put in place services that reduce the stigma, and which deal with people quickly—it is an area in which there should be no waiting lists—and with compassion.
One suicide is one too many. It is hard to imagine the despair that outweighs a person’s natural instinct to prolong their life and leads them to take their life and ignore the impact that it will have on their family and on the person who finds them. Although we wish that suicide was not a problem and that we were not debating it, we must do everything possible to support and reach out to those who are at risk.
16:26
I very much welcome the tone of the debate and appreciate the fact that all members support the motion. Over the years we have been able to share a common purpose in many social policy areas—not just suicide prevention, but the wider mental health agenda and key points in our drugs policy agenda. I am pleased that we have been able to continue to do that today.
I was struck by what Graeme Pearson said about the sadness of having a debate about suicide prevention, because any loss of life through suicide is a tragedy. However, as I said in my opening remarks, a key part of tackling issues around suicide is to talk about suicide, raise awareness of the issues and engage in a debate about how we can help to prevent suicide. I am sure that Graeme Pearson agrees that there is no better way to set an example than by having a debate of the tone and nature of the one that we have had in our national Parliament today. As Christine Grahame said, over the past 15 years Parliament has had a strong record of debating mental health policy and suicide prevention issues.
I have the pleasure of meeting delegations from other parts of the world who come to Scotland to look at policies that we are taking forward in the health portfolio. Last week, the Danish health minister came over to look at our patient safety programme and to consider what the Danes can learn from that. We have had delegations here to look at our mental health policy. Internationally Scotland is—believe it or not—viewed as being a progressive country in respect of its overall mental health policy and the approach that it has taken over the past 14 or 15 years. That is also the case with suicide prevention. It is recognised that the trend in Scotland over the past decade or so for a reduction in the number of suicides, against a rising number globally, means that Scotland is doing some of the right things. I think that that has happened because the Scottish Parliament has allowed devolution to put much greater focus on such issues than was previously the case. That is to the credit of the Parliament, previous Administrations and the present Administration.
I totally agree with the minister’s point about Scotland leading the way in strategies and so on. However, in a 10-year period, we have also seen an increase in prescriptions of antidepressants, particularly the new generation of selective serotonin reuptake inhibitors. Some people have been critical of that, but perhaps there is a link between the fall in the number of suicides and the fact that people have access to those antidepressants. Those who criticise the prescribing of them might do well to think about that.
In any mental health debate, the prescribing of antidepressants is inevitably raised. It is worth keeping it in mind that medication for mental illness is as valid as medication for coronary heart disease or for arthritis. It is a legitimate form of treatment, when it is appropriately used.
It is fair to say that recently there have been changes to prescribing practices for antidepressants, which has to some extent been because of concerns about how they were being provided to individuals. Sometimes they were prescribed for very short periods and sometimes for extended periods, when clinical evidence has not been so good, in terms of their use. Some of the most recent prescribing data show that clinicians are likely to have individuals on antidepressants for longer and at higher doses because clinical evidence now demonstrates that that is a much more effective way to get the benefit of that medication. When the statistics come out, it looks as if more people are receiving antidepressants for longer, but that reflects the change in prescribing practice. When we talk about such things we need to be very careful that we do not give the impression that use of medicines in treatment of mental illness is in some way secondary.
I want to address access to psychological therapies. Jim Hume raised the point that we should not limit our ambitions to a target of 18 weeks. It is fair to say that Scotland is the only part of the UK that has set such a target in order to drive improvement in access to psychological therapies. It is worth noting that in Scotland the average time for access to such therapies is not 18 weeks, but nine weeks. If a patient requires an urgent referral to a clinical psychologist or another type of therapy, the normal process is the same as the one that is used to refer someone to an orthopaedic surgeon. A person can have an urgent referral, so that they are seen quickly.
There has been an increase in the number of psychologists in the NHS in Scotland and there is a range of equally important therapies that patients can benefit from. There has been mention of physical activity, which can help a person’s mental health and wellbeing. We have the social prescribing aspect of the mental health strategy, which is the green pad: the idea of prescribing physical activity or something else that can help mental wellbeing, rather than medication. The mental health strategy is looking to encourage that and take it forward.
In his contribution, Neil Findlay outlined the scale of the international issue and the increasing problem of suicide around the globe. Between 800,000 and 1 million suicides a year take place around the world, which is why the World Health Organization has set a target to reduce suicides by 10 per cent by 2020. We want to ensure that our strategy helps us to play our part in reducing suicides overall. It is worth noting that in 2012, Scotland’s suicide rate fell below the world global monthly suicide rate, to 14 per 100,000, against the global rate of 16 per 100,000. We are moving in the right direction, but we have to do more.
Neil Findlay also raised issues around data in the strategy and data that he got from local authorities. The data all come from the General Register Office of Scotland and can be broken down into health board and local authority areas. There are some differences because in 2010 the WHO issued guidance that resulted in a change to the coding of particular deaths, which meant that some drug deaths are now classed as suicides. However, the GRO still produces two sets of data: one with the new coding and one with the old coding, which shows the 18 per cent reduction. That is why there is a difference in the data that Neil Findlay referred to, which are being measured against data that were collected over the 10 years of the choose life programme, which started before the GRO introduced its change after the WHO made its recommendations.
A number of members have also made reference to the impact that suicide has on families. I am struck, but not surprised, by the number of members who have been touched in some way by the suicide of a family member or a friend. In my opening speech, I made the extremely important point that suicide is preventable. The data show us that the vast majority of individuals who commit suicide were, prior to doing so, receiving treatment in the form of medication for a mental illness, or had been in contact with GPs, A and E departments or other services.
Will the minister take an intervention?
Let me just finish my point.
If those individuals are in contact with those services, why are we not picking up on their potential risk of committing suicide? It is absolutely key that we learn from that. Part of the pilot work up in Tayside is to look at how we can respond much more effectively to and follow up on individuals who present in distress at A and E departments but do not need to be admitted, or who are arrested by the police and are in distress, or when other agencies are involved. Therefore, an important piece of work for us to develop in the self-harm strategy is how we can be much more effective at picking up signs of distress, which is a key factor that often presents when someone is at risk of committing suicide.
Presiding Officer, do I have time to take Christine Grahame’s intervention?
I can give you about two minutes more.
Some members said that some suicides are not detectable and come out the blue. On suicides being preventable, will the minister—before he runs out of time—address the need to educate children and young people about their social media responsibilities? Perhaps we could have avoided some young people committing suicide had there been discipline in use of social media.
I understand Christine Grahame’s point that there are not always signs of distress prior to someone committing suicide. However, the evidence shows us that a very large number do show such signs, so we must ensure that we get much better at identifying and following up such individuals more effectively.
On cyberbullying, Kevin Stewart raised the benefits of social media in addressing stigma and educating and informing individuals about the services and the supports that are available. He also mentioned how people can use social media negatively—I am sure that we have all witnessed examples of that. There are programmes in schools—for example, the respect programme, which is about respecting individuals when using social media. It is important that we develop that work. I have no doubt that my colleagues in education will continue to progress such policies. I will certainly ensure that, in progressing the self-harm strategy, we consider how to build more of that into our approach and that we consider how cyberbullying, for example, impacts on someone’s mental wellbeing.
A number of members asked how we will progress the work. I am not a fan of big thick strategies. I like strategies that are task focused, time limited and measurable—hence the short nature of the suicide strategy. We are establishing an implementation group, which will be made up of a range of individuals from across the sector, who will be responsible for measuring and monitoring implementation of the 11 commitments in the strategy. I have limited the strategy to three years, so that it is focused and so that we can measure and evaluate its progress over that period. I reassure members that there will be no lack of energy on my part to drive forward the strategy. I have no doubt that the monitoring and implementation group will hold us to account in making sure that we are doing that effectively across all the agencies and with others who have parts to play.
I am very grateful for all the positive comments that have been made in the debate. I will keep Parliament informed of progress on the strategy.