Meeting date: Tuesday, November 21, 2017
Meeting of the Parliament 21 November 2017
Agenda: Time for Reflection, Topical Question Time, Minimum Unit Pricing of Alcohol, Suicide Prevention, Edinburgh Bakers’ Widows’ Fund Bill: Final Stage, Business Motion, Decision Time, Road Safety Week
- Time for Reflection
- Topical Question Time
- Minimum Unit Pricing of Alcohol
- Suicide Prevention
- Edinburgh Bakers’ Widows’ Fund Bill: Final Stage
- Business Motion
- Decision Time
- Road Safety Week
We move to the next item of business. I allowed both the statement and topical questions to run over quite a bit, so I am looking for as much consideration and time saving as possible. Members should keep their speeches to the allotted time where possible.
The next item of business is a debate on motion S5M-09000, in the name of Maureen Watt, on suicide prevention in Scotland.15:00
I am pleased that we have an opportunity today to discuss suicide and its prevention in Scotland. The Scottish Government attaches the utmost priority to this high-profile area.
Any death by suicide is a tragedy, with a deeply distressing impact on the families and friends left behind. I have met quite a number of people who have been bereaved by suicide. Unless we have been in that situation, we cannot understand fully what such a loss feels like, but we can all appreciate the extremely upsetting and traumatic effect of losing a loved one in this tragic way. Out of respect for those who have been bereaved, I hope that we can speak in general terms today, rather than about specific cases.
Suicide is an extremely complex phenomenon, with a wide range of determinant factors, including mental illness, being male, unstable relationships, deprivation, adverse life events, gender issues, substance misuse and contact with the criminal justice system. There is rarely any single identifiable causal factor related to individual deaths by suicide. That makes it extremely challenging to identify in advance the risk of any individual dying by suicide.
Over the past decade, there has been a 17 per cent reduction in the rate of suicide in Scotland.
Will the minister take an intervention?
As we debate the hugely important issue of suicide and its prevention, it is vital that we recognise the improvements that are being made. It is also important that we understand where more work is required. For example, the rate of suicide has reduced more slowly among people experiencing mental illness compared with the general population. That is an area in which we want to see improved progress.
Will the minister take an intervention?
Presiding Officer, you have just sent me a note asking me to curb my speech, and I have about four minutes over. If members wish to raise issues during their speeches, I will be happy to respond to them in my closing speech.
Our mental health strategy sets out our guiding ambition
“that we must prevent and treat mental health problems with the same commitment ... as we do with physical health problems.”
People should only have to ask once to get help fast. That ambition also applies to supporting people who are at risk of suicide.
Our existing suicide prevention strategy sets out commitments under five broad themes, which encapsulate the overall aims of the strategy: responding to people in distress, talking about suicide, improving the response of the national health service to suicide, developing the evidence base, and supporting change and improvement.
We cannot say with certainty that any single action has had a direct causal link to the reduction in the suicide rate. However, we have provided funding and policy direction for a number of initiatives that are designed to improve support for people at risk of suicide. For example, NHS Health Scotland’s national suicide prevention programme has been working nationally and locally to build skills through training, to improve knowledge and awareness of good suicide prevention practice and to encourage improved co-ordination between services.
We have provided funding to Samaritans, including a current grant to help Samaritans with the increased telephone charges that are being experienced as a result of its helpline now being free to access. Breathing space is a free telephone service for people who are experiencing low mood, depression or anxiety. It handles about 6,000 to 7,000 calls per month. Although breathing space was originally set up to respond to the fact that about 70 per cent of deaths by suicide are by males, it provides a valuable service that is accessible to everyone.
NHS living life is a free telephone psychological therapy service, which is available out of hours to adults who are feeling low, anxious or depressed. Like breathing space, the service is run for us by NHS 24. Last month, I visited staff who work on breathing space and NHS living life. It was good to learn how those early interventions can support people to deal with a range of mental health conditions. I announced £500,000 of development funding to improve the services that NHS 24 offers to people who are experiencing mental health problems.
In recent years, GPs and other clinicians have developed improved knowledge, recognition and treatment of depression and anxiety. At the same time, anti-stigma work by see me has vastly improved public understanding of mental health. People now feel more comfortable about coming forward for help when they need it, so more people receive appropriate treatment and support for depression and anxiety.
Members will know of our work with partners to develop the innovative distress brief intervention. The DBI is about equipping people with skills and support to manage their own health and prevent future crisis. The pilot is being developed in Lanarkshire, Aberdeen, Inverness and the Scottish Borders. National partners include Police Scotland, the Scottish Ambulance Service and NHS 24.
Those are all strong examples of our work with partners to help to reduce the rate of suicide in Scotland. That partnership approach is crucial to suicide prevention.
It is worth remembering the role that we can all play in listening to friends, family and colleagues who may need an empathetic ear to speak about worries or ill health. Last year, NHS 24’s breathing space team ran an awareness-raising programme called the year of listening. I was pleased to learn last week of a new initiative by Network Rail, Samaritans and British Transport Police called small talk saves lives, which encourages the public to support those who may be in emotional crisis around them on the railway network. Listening carefully and providing support can help people to feel a stronger sense of connection, which helps to support confidence and wellbeing.
We all agree that Scotland’s children represent our country’s future. Children and young people should have an understanding that it may not always be possible to enjoy good mental health and that, if that happens, support is available. Some local authorities provide school-based counselling. In others, schools use pastoral care staff and liaise with educational psychological services and health services for specialist support. Every school has a named contact in specialist child and adolescent mental health services, who can be contacted if they have concerns about a pupil. We continue to support Childline, which provides confidential advice and information to children and young people who are affected by bullying and related issues. That forms part of our wider attempts to improve the wellbeing of children and young people through curriculum for excellence.
We intend to publish a new suicide prevention action plan in 2018. To inform development of that plan, the first three in a series of pre-engagement events have been run for us by NHS Health Scotland, Samaritans and the Health and Social Care Alliance Scotland. Those events allow us to hear from people who have been affected by suicide and from those who directly engage with those affected by suicide, so as to help understand what might be done better or differently to reduce suicide and the impact that it has on those left behind. I look forward to seeing the report on those events in January. That will help to inform development of a draft action plan, which we will publish on our website as part of a wider engagement process in early spring 2018. We hope to publish a final version in late spring 2018.
Early emerging themes from delegates at the first few pre-engagement events include the scale and scope of training and support offered to healthcare and other professionals who engage with those who are at increased risk of suicide, and the importance of public health approaches to improve our willingness and ability to respond to those in distress, including awareness raising for everyone. While we cannot pre-empt what might emerge over the full engagement process, those are helpful pointers.
In recent years, we have had extensive stakeholder discussions, which have helped to inform the content of the mental health strategy and the development of the DBI. We will continue those discussions as we work towards a new suicide prevention action plan; we know from them that many stakeholders would like, for example, to see a reinvigorated focus on local suicide prevention action. Currently, each local authority area has a locally agreed suicide prevention action plan and most areas have a local suicide prevention co-ordinator, who can be a crucial element in driving forward effective suicide prevention action. We recognise the need for strong local action, which we will consider as part of the engagement process.
Nevertheless, there are already many examples of good local practice to support suicide prevention. For example, in North East Scotland, collaborative work between Aberdeenshire Council, Aberdeen City Council, NHS Grampian, Police Scotland, Cruse Bereavement Care and Samaritans has seen a reduction in the rate of death by suicide in Aberdeen and Aberdeenshire by 20 per cent and 10 per cent respectively over the past decade. In March 2016, as part of the local suicide prevention campaign, they developed an app to signpost help and advice sites to users who research ideas about suicide. In recognition of that work, choose life north-east won an innovation award and care for mental health award at this year’s Scottish health awards; some of my colleagues were there to see it.
I could go into other examples, but I will not as I need to be as brief as possible. In January, I will visit a partnership group of NHS 24, ScotRail, British Transport Police, FirstBus and others to look at mental health improvement and suicide prevention for employees and customers across a range of sectors. The next suicide prevention action plan can provide opportunities to share and replicate such examples of good practice across Scotland.
I note the Conservative and Labour amendments, which the Presiding Officer has accepted for debate, and I am minded to accept them. Most of all, I look forward to hearing members’ views on this important topic over the debate.
That the Parliament believes that every suicide is a tragedy, and extends its sympathy to all those bereaved in this devastating manner; supports the partnership and co-operation across the NHS, health and social care sector, Police Scotland, Scottish Ambulance Service, Scottish Fire and Rescue Service and the third sector, which have contributed to a 17% reduction in the suicide rate in the last decade; considers that Scotland can go further and learn more about this complex area; calls for individuals and local communities to be heard in the Scottish Government’s public engagement process to develop a new suicide prevention action plan, based on evidence, to continue the downward trend in suicides, and commends and reiterates 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.15:12
I am pleased to have the opportunity to speak today on an important subject that, unfortunately, is not spoken about enough.
The consequences of suicide are far reaching. When suicide is preventable, it is all the more heart-breaking for the families who are affected. I, like Maureen Watt, extend my sympathy to those people who have been bereaved in this traumatic way. I welcome any effort by parties to work collaboratively to create a successful suicide prevention strategy that seeks to learn from the good practice that we have seen so far and that looks honestly at where we need to improve. That is why I will support the Scottish Government’s motion today.
Since the early 2000s, we have fortunately seen a positive decline in suicide figures, which fell by 18 per cent in Scotland between 2002 and 2013. Thanks in part to the Scottish Government’s suicide prevention strategy that ran from 2013 to 2106 and focused on improvement in the NHS’s response, assisting people to talk about suicide and developing the evidence base, figures have continued to decline, but we should never be complacent. While remaining sensitive to the fact that suicide figures are prone to fluctuation year on year, we are united in our concern over the fact that suicide figures in Scotland rose by 8 per cent last year—the first such rise in six years.
Although suicide is a complex issue that can be difficult to fully understand, the deaths of 728 people in 2016—an increase of 56 on the previous year—should be taken as an early warning sign that we should act on quickly. That is why I have put forward an amendment to address the gap that exists now that the previous strategy has expired.
Evaluating what has worked so far and what could be changed for the better will be key to informing the new strategy. Charities working with the Government to inform the new strategy have commented on the need for consistency across local authorities, which is something that I support. While each local authority is responsible for the delivery of the choose life suicide prevention action plan, which allows for the tailoring of services according to local needs, there needs to be clear ownership and oversight of that.
The Scottish Association for Mental Health has called for greater transparency and accountability in the funding of suicide prevention activities, highlighting the fact that funding for those is not ring fenced. Through freedom of information requests, the mental health charity found that almost half of Scotland’s 32 local councils did not have, or failed to provide, information on their suicide prevention budgets and the associated workforce. Samaritans has echoed the call for clear reporting and physical leadership.
It is also important that we work towards furthering the use of the evidence base that was spoken of in the previous strategy as a means of targeting resources effectively. When it comes to demographics, for example, we know that people aged between 35 and 49 are disproportionately affected, with 47 per cent of suicides last year taking place within that age bracket.
We also know that, in spite of the suicide rate improving over the past decade in terms of numbers, men are still the group that is the most affected by suicide. In 2016, 517 out of the 728 suicides were male—211 were women—and in the United Kingdom, suicide is the single biggest killer of men under the age of 50.
That is why I congratulate the work of charities such as the Men’s Shed Association. By removing the stigma and creating a safe environment in which men can talk freely and at their will, the charities attempt to address the reasons why men, specifically, do not come forward—reasons that partly concern societal expectations of men’s behaviour and roles. I urge health services to consider how they can cater specifically for men in the future.
We also need to work with statistics from the Scottish suicide information database so that we can understand how people at risk of suicide move through the health system. Although a large number of suicides have had no contact with healthcare services in the months before their death, a national database report that was published this month showed that 70 per cent of them had had contact with those services within 12 months of their death and more than a quarter died within three months of visiting an accident and emergency department.
We also know that a quarter of people had at least one psychiatric in-patient stay or out-patient appointment in the 12 months before their death and that 59 per cent of people had at least one mental health drug prescription dispensed within the same timeframe. Those statistics are telling. They show us that there are opportunities to intercept people as they move through the health system. This is why it is important that NHS front-line staff feel confident about identifying those at risk and are able to provide the appropriate support. I therefore support calls from charities for all health professionals to be provided with suicide intervention training.
Working with all the emergency services is key as well, and I am pleased to see that mentioned in the Scottish Government’s motion. The Mental Health Foundation has called for the national roll-out of community triage, following a successful pilot in NHS Greater Glasgow and Clyde, which gives police officers direct access to mental health professionals to support their decision making and reduce inappropriate detentions of people in psychiatric distress or crisis.
I thank the charities that work tirelessly to help those who are at risk of suicide and to improve the public’s understanding of it. Charities have long understood the importance of innovative and specialist campaigns, and I support the Samaritans’ small talk saves lives campaign. It works with the British Transport Police and rail companies in the UK to reach out to those who are vulnerable to acts of suicide on the rail network. Based on the evidence of Samaritans-trained railway staff, the campaign’s video seeks to give travellers the confidence to act if they notice someone who they think might be at risk on or around the rail network simply by the use small talk—a skill that I think that all Scots have.
Recently, I was honoured to meet mental health charity campaigner, Josh Quigley who, after attempting suicide, completed a 1,500-mile cycle trip last year across 80 countries to raise awareness of suicide prevention and mental health. It is because of the collaborative work by charities, public bodies and individuals such as Josh Quigley that we are able to see real change.
To finish, I reiterate my support for the Government motion. This extremely important debate has enabled us to talk candidly about a subject that is all too often still considered a taboo by many. We have a cross-party consensus on the need to prioritise mental health, and it is only by working together that we can continue to bring about an improvement in preventing suicide. I look forward to continuing to work with the Scottish Government in order to drive forward effective policies to tackle mental health issues and ensure that a new strategy delivers successful outcomes.
I move amendment S5M-09000.2, to insert after “complex area”:
“; notes with concern that Scotland’s previous suicide prevention strategy ended in 2016 and that the new action plan will not be published until 2018”.15:20
Suicide prevention is a critically important issue, and Scottish Labour welcomes the opportunity to contribute to the debate. The motion before us is absolutely right to state that
“every suicide is a tragedy”.
On behalf of my colleagues, I extend our sympathy to everyone who has been bereaved as a result of suicide.
Uncomfortable though it is, this serious issue deserves debate and discussion so that we can continue to reduce the number of people who die by suicide. The motion notes that the suicide rate has gone down by 17 per cent over the past decade, which is welcome. However, the number of people who died by suicide last year was 728, which is an 8 per cent rise on the year before and the first such rise in six years.
It is true that the figures fluctuate from year to year, but when we are talking about people’s lives, we cannot be complacent. Each death by suicide is an utter tragedy, and the impact of each one of those 728 deaths by suicide last year will have devastating ramifications for many people for many years to come.
One death by suicide is one too many, so it is crucial that the Scottish Government brings forward another suicide prevention action plan in the coming months, although I share the concerns that have been raised about the fact that the Government allowed the strategy for 2013 to 2016 to expire without putting in place an updated plan. We in Scottish Labour will therefore be supporting the Scottish Government’s motion and the amendment in the name of Annie Wells, which recognises the concern that the previous strategy was allowed to expire.
I welcome the motion’s acknowledgement of the importance of collaborative working. We know that suicide prevention work can be successful only when agencies work together, and the forthcoming action plan must make that happen more effectively. As the minister mentioned, the Scottish health awards recently took place, and I had the pleasure of attending, alongside other colleagues in the chamber, to celebrate the amazing heroes who help to deliver our health service day in and day out.
Fortuitously, the minister and I were sat together at the event, and we both had the honour of watching the choose life north-east Scotland initiative win a well-deserved innovation award. I can think of no better example of the importance of collaborative working than the success of that project, in which collaboration between local authorities, the health board, Police Scotland, Cruse Bereavement Care and Samaritans in Scotland resulted in a 29 per cent reduction in suicides in a single year, and another 40 per cent reduction in the first three months of this year.
The spirit and success of that project must be captured in the new action plan so that that example of best practice can be rolled out across the country. Unfortunately, as we know only too well, there is still great variation in the success and availability of suicide prevention services across Scotland. Earlier this year, released a report entitled “Dying from Inequality”. It revealed the headline figures that I highlight in my proposed amendment to the motion, including the fact that those in deprived communities are three times more likely to die by suicide.
The report found that those who are experiencing socioeconomic disadvantage are more likely to experience negative life events and less likely to seek help. That partly explains why the suicide rate is much higher in deprived communities than it is in the least deprived communities. An understanding that low wages, insecure work and other factors such as unemployment are key contributors to the complex issue of suicide must therefore be central to the new action plan. Reducing the rate of suicide in Scotland cannot be achieved by investment in NHS services alone; it must be underpinned by a commitment to tackle poverty and inequality at all levels of our society.
I absolutely agree that we have to look at the wider causes. Would Monica Lennon include the austerity agenda that underpins welfare reforms in her list of factors that influence people’s mental health?
Suicide is the biggest killer of men aged under 50. Three quarters of those who die by suicide in Scotland are men. Focusing on how health services meet the needs of men, especially young men at risk, must be central to the new action plan if we are to tackle stigma. A suicide prevention action plan can be successful only if it is backed up with adequate resources, which means an end to cuts to local budgets and to austerity, wherever it derives from. The decimation and roll-back of services is heaping pressure on front-line staff and is making it more difficult for the signs of suicide to be spotted and taken seriously.
The publication of the Scottish suicide information database report last week revealed that more than two thirds of those who went on to complete suicides had some contact with health services in the year before they died, while more than one quarter visited an A and E department within three months of their death. As a nation, we must invest more in front-line services, resources and training to ensure that staff have adequate support to spot the signs of those in need and to provide appropriate intervention.
It is vitally important that any action plan should contain reporting and evaluating mechanisms. In March this year, in the context of the previous strategy, I raised that issue during First Minister’s question time. I was disappointed that that was not taken forward. The new action plan must have mechanisms that allow it to be robustly evaluated and monitored, with clear lines of accountability and a commitment to resources. Given the current crisis in mental health, I expect that the minister is making strong representations to the finance secretary ahead of the forthcoming budget. A reduction in the suicide rate can be achieved with a properly funded action plan and a focused effort on working collaboratively across services. I appeal to the Scottish Government to ensure that the forthcoming action plan reflects those shared ambitions.
I move amendment S5M-09000.3, to insert after “complex area”:
“; notes the link between suicide and socioeconomic disadvantage, with the suicide rate being three times higher in the most deprived communities; believes that suicide prevention should be rooted in efforts to reduce overall poverty and inequality; recognises that adequate funding of front-line services is vital to the success of local suicide prevention and that continuing austerity is harmful to this work; acknowledges calls for the new suicide prevention strategy to have robust evaluation and reporting mechanisms”.15:27
I refer to my entry in the register of members’ interests, as I am a registered mental health nurse. I hold a current registration with the Nursing and Midwifery Council and an honorary contract with NHS Greater Glasgow and Clyde. I particularly welcome the debate.
Almost a year ago to the day, on 19 November 2016, we observed international men’s day, the theme of which was “Stop Male Suicide”. Usually, when we debate gender inequality, women are the subject of most inequalities; however, when it comes to completed suicide, that is not the case. It is a multifaceted issue that cannot be blamed on one particular factor, but it cannot be denied that part of the problem may stem from society’s patriarchal attitudes. Some people still expect men and boys to play particular roles and to have typical traits and behaviours. So-called “real men” are strong and they never air their emotions, other than perhaps anger.
We live in a society in which it is still common for males to be told to “be a man about it” or to “man up”, rather than talk about their feelings. As a mum of three boys, I have encouraged them to challenge those stereotypes and to express their emotions. During my recent visits to schools in my constituency of Rutherglen, I have been heartened to observe how emotional literacy is being encouraged and taught. However, there can be no doubt that such gender-based attitudes can be damaging to men’s mental health. In every country bar one, the male suicide rate is higher than that of females, and there are three times as many male suicides as there are female suicides in Scotland and in the UK as a whole. Although women are more likely to attempt suicide, men use much more lethal means to self-harm, which results in a much higher rate of completed suicide. It is a sad reality that everyone who is present will probably know of a friend or family member who has been affected by male suicide. That is evidenced by the fact that suicide is the single biggest killer of men under the age of 45.
Over the past decade, the suicide rate in Scotland has fallen by 17 per cent. I am pleased to hear that the Scottish Government is determined to reduce the incidence further, but any Government would attest to the fact that there is no simple fix for the problem. It remains a fact that, if we are to tackle the high male suicide rate, men need to open up about how they feel, and we must help and encourage them through that journey. Changing attitudes and challenging the stigma that still exists around mental illness will not alone solve the issue; Governments have a major role to play.
As a mental health nurse, I have seen our mental health services grow from being hospital-centric, on the periphery of our NHS and often hidden away on the edges of towns and cities, to being seen as a priority. With the introduction of mental health crisis teams, out-of-hours mental health services and liaison psychiatry based in our acute hospitals, the Scottish Government is taking positive steps to tackle the issue. All those services provide support and treatment to people who are experiencing thoughts of self-harm or suicide.
Other programmes, such as the mental health first aid programme, have equipped non-mental health staff with the skills and confidence to ask questions about thoughts of self-harm and suicidality and have given them the knowledge of how to respond to people who are experiencing thoughts of self-harm and suicide.
We have made great strides in mental health care in recent years, and the Scottish Government is continuing to take positive steps to tackle the issue. This year, mental health investment will reach £1 billion for the first time. Since 2006, its funding has been increased by almost 40 per cent, and a further £150 million is being invested by the Scottish Government over the next five years to improve mental health services and find better ways of working.
As our Minister for Mental Health said, a draft suicide prevention strategy will be released next year. That is a major step forward, but that does not mean that our health and social care professionals are waiting for a strategy to act. Day in, day out, they use their professional skills to assess and manage risk and to help and care for those in mental distress.
Any suicide is a tragedy, and the effect on the person’s loved ones, friends and work colleagues remains long after the person has died. We owe it to them to work together to find a way to reduce the number of suicides. The Government and wider society must work together so that our sons, fathers, brothers and friends are no longer taken from us in such devastating circumstances.15:32
I welcome the opportunity to contribute to this debate on a subject that is not the easiest to discuss. It is apt that the Mental Health Foundation Scotland gave its publication the title “It’s time to talk about it”. We, in the Parliament, have the responsibility to lead the conversation.
It has already been mentioned that most of us here have some connection with or knowledge of people who have attempted suicide or even, sadly, taken their own lives. A few years ago, I coached a troubled young man who was talented enough to win a medal at Scotland level and managed to take his own life. Apparently, that was related to relationship issues. A national coach who, to the outside world, was highly successful and well liked shocked us all when he managed to take his own life. Apparently, that was relationship related, too.
Closer to home, I helped a close relative over a period of time to get past attempting suicide and back to living a more normal life. That was done through attendance at psychiatry sessions, work sessions and assessments, liaising with the police, getting the person sectioned and subsequently reintroducing them to normal home life. That was a positive outcome and a relief for all of us who cared for and loved them.
In all our deliberations, we need to be aware of the toll of this terrible condition on family and friends. We need to be aware of the constant worry and anguish, the impact on personal, family and working lives, and the impact that supporting a person in this situation can have on our own mental health. The condition has a huge impact beyond the sufferers themselves. That is why one of the Mental Health Foundation’s recommendations is most welcome and resonates strongly with me. It has recommended
“Support for individuals directly impacted by suicide”,
particularly family and friends.
We are addressing the topic of prevention, and I have read that one of the key elements is talking about our feelings, keeping in touch and asking for help. We men—the strong and silent types—do not do that, of course, because speaking about our issues somehow lessens us as men. We keep our mouths shut and deal with it in silence. The result is that the suicide rate for men is 2.5 times that for females. It may be about time to park our egos, chaps.
Seriously, though, tackling the stigma associated with poor mental health—as this debate is doing—and creating an environment in which people are comfortable to open up and ask for help must be the focus of all our efforts. Those communication channels and options are most challenging in our most deprived areas, where the numbers are stark. People living in the most deprived areas are more than three times as likely to die by suicide as people living in the least deprived areas. Furthermore, it has been shown that the vast majority—about 70 per cent—of those who have died by suicide had contact with healthcare services in the year prior to their death.
A topic that I get into my speeches at every opportunity is the importance of being active and eating well. According to the Mental Health Foundation, regular exercise can boost self-esteem and helps people to concentrate, sleep and feel better. The foundation goes on to say that one of the most obvious yet unrecognised factors for good mental health is good nutrition. If properly addressed and implemented, tackling diet and obesity is intrinsically linked to tackling poor mental health, as is drinking sensibly—a topic that was recently discussed at length in the chamber.
To further highlight that point, according to SAMH—and as I often mention—a factor in tackling poor mental health is inclusivity and physical activity. I have a poster in my office that says:
“Food is the most abused anxiety drug. Exercise is the most underused antidepressant.”
That was borne out for me in my jog with jogscotland and in the fact that SAMH co-funds jogscotland’s work on mental health.
It is also recommended that people should do something that they are good at. I love that. Part of the solution is to ensure that opportunities to participate in whatever engenders enthusiasm and self-esteem—whether that be music, art, drama or physical activity—are widely available, because those feelings are entirely the opposite to those that are displayed by people with poor mental health.
We know all the statistics. A man living in an area of deprivation who has had recent contact with healthcare services is most at risk of dying by suicide. We know who we should target to have the highest prevention success rate. We also know what steps can be taken to help the situation. As has been stated by SAMH and the Mental Health Foundation, inclusivity and activity as well as eating well are essential elements for good mental health. Therefore, it stands to reason that affording those opportunities to all—especially to those who are in the most vulnerable situations—is surely the most logical step that can be taken.
Suicide is a devastating condition that affects many more people than just the suffering individual. We know who is most at risk, we know where they are and we know that they are likely to have had some contact with healthcare professionals in the past 12 months—it is a classic Venn diagram. We also know the types of service that can be offered to prevent poor mental health from escalating. It will just take some joined-up thinking and a little bit of courage from the Government to create an environment in which that can happen.15:37
I remind members in the chamber that I am the parliamentary liaison officer to the health secretary.
Given the new 10-year mental health strategy, it is clear that suicide prevention is a high priority for the Scottish Government. It is good to see that the overall suicide rate has fallen by 17 per cent over the past decade, but we can always do more. It is vital that we continue to break down the stigma associated with mental health and work across political parties, services and public and third sector organisations to ensure that support and help are offered to those who need them.
We need to assess the multitude of reasons that lead to someone feeling so helpless. Those range from struggles with anxiety and depression to poverty, traumatic life events, bullying, domestic violence and addiction issues. The list is intricate and infinite. Indeed, there is a vast variety of reasons why someone would feel that they had no solution other than to take their own life, but the good news is that the majority of suicides are preventable. The minister mentioned the Network Rail initiative, which is a very good scheme.
There is a lot to be said for Monica Lennon’s amendment. There is no doubt that poverty and deprivation can impact on mental health or that policies impact on poverty.
I will not be the only MSP in the chamber today who has come across several situations in which constituents have expressed how helpless they feel and how they have no options left. Those situations are often to do with recent welfare changes and their perceived treatment by the Department for Work and Pensions. People should not be made to feel as though they are nothing more than a burden because of cuts to welfare. That is heartbreaking. We must bring an end to that situation by working together across the chamber and across parliaments around the UK and the world.
Bullying is another reason why a person might feel suicidal. Last week was anti-bullying week, and my first members’ business debate in the Parliament was on the stand up to bullying campaign. We have seen the statistics about the higher suicide rate in the lesbian, gay, bisexual and transgender community, and many members have signed up to the time for inclusive education campaign.
I was recently approached by a constituent who raised the heartbreaking case of her son, whom she alleges experienced extreme bullying in his workplace—a football-based modern apprenticeship scheme—to the extent that he has left the scheme, with no other employment lined up, and has experienced a severe drop in his mental health, which has led to suicidal thoughts. The situation is causing a lot of distress to him and his family. I cannot go into the details of the case, but I will take up the matter with the stakeholders involved.
That example highlights the effects of bullying in a particular context. It also highlights, in particular, how vulnerable young men are, which is something that other members, including Clare Haughey and Brian Whittle, spoke about. We really need to get the message out to young men, to encourage them to open up and talk about their feelings.
An organisation that does just that is the Centre for Help Response & Intervention Surrounding Suicide, or Chris’s House. The charity used to be based in my constituency but is now on the south side of the M8 boundary, in Clare Adamson’s constituency of Motherwell and Wishaw. It is the first organisation of its kind in Scotland and provides a safe environment in which people in crisis can get respite from their unwellness. Its 24-hour non-medical centre provides intervention and assistance around suicide. The charity’s aims include reducing the number of people dying by suicide; supporting people who are affected by suicide; and reducing the stigma and taboo around suicide. Its motto is “Let’s talk” and, on referral to Chris’s House, a guest is assigned a volunteer who works to develop a strong rapport with the guest, helping them through their crisis and supporting them to counter depression and negative thoughts and to exchange reasons for dying with reasons for living.
We need to tackle the issue each and every day, and at an early stage. That means that we should start in our schools. SAMH research shows—alarmingly—that an average of three children in any one classroom will have experienced a mental health problem by the time they are 16. Although we cannot always prevent an individual from developing a mental illness, we must ensure that support is available as early as possible and can be easily accessed when it is needed.
We need to do more in the classroom to make young people aware of their mental health needs. I particularly like the nurturing approach that is being adopted more readily in schools, and I mention Wholistic Life—Coaching for Kids, which met me to discuss doing some work in my constituency.
I see that I am running out of time, Presiding Officer. I will quickly mention the Coatbridge youth forum’s recently established sound minds project, which will encourage young people in the town to talk about their mental health. I also pay tribute to the great work of the two local members of the Scottish Youth Parliament, Ryan Kelly and Jack Campbell, who have done a lot of work in the area and recently proposed to the North Lanarkshire youth council that everyone who works with a young person should have some form of mental health training. I completely agree with that.
I support the motion and the amendments.15:43
It is a privilege to participate in this debate about a difficult and challenging issue. At the outset, I thank all the organisations who provided briefings for the debate and who continue to do so much work across our communities to support not just vulnerable people who are at risk of suicide but the families who are trying to support them.
I am sure that not many members are untouched by the terrible sadness of suicide. We probably all know of someone in our family, among our friends or in our communities, who has had to deal with the shock and tragedy of suicide.
No one in this Parliament is indifferent to the causes and consequences of suicide. We are united in a desire to do all that we can to tackle the suffering that might lead to suicide. Collectively, we want to do what we can. We want to understand what drives people to suicide and how we might better support people who are in crisis. We recognise that every person who is at risk of suicide will have made their own journey and will have their unique story, so we must understand the challenge of creating support that matches people’s unique experiences.
As we struggle to recognise the scale of the problem and understand its implications, we are driven by the profound sense of sadness that we feel when it is clear that a suicide could have been prevented—when someone reached out for help and either did not get it or got the wrong kind of help.
In my short period convening the Public Petitions Committee, we have seen a number of petitions specifically driven by the experience of those who have lost a loved one. They have a profound sense of loss, compounded by the feeling that it did not need to be that way. The importance of understanding those direct experiences in shaping policy cannot be overstated.
We have had progress on attitudes. In my generation, the silence, shame and stigma of suicide was all too evident. People are now beginning to understand how someone might be at risk and that suicide is not the shame of the family who are living with its consequences—rather, those people deserve support.
There is evidence that we are opening up about the issue, but we know that a great deal more needs to be done. The Network Rail Samaritans advert sets out the idea that we can do something as individuals, which is a very powerful message. Last night, I watched a Channel 4 documentary called “999: What’s Your Emergency?”. It highlighted the experience of our police forces in having to deal with people with mental health issues who inappropriately ended up in the justice system because there was nowhere else for them to go. That gave me two messages: first, that issues of mental health and suicide are not unique to Scotland but go far beyond here, and, secondly, that the challenge of delivering support is experienced here in Scotland and beyond.
We know the risk to young men. That is a challenge. We see an increase in young women who are self-harming and may take their own lives. We know the impact of postnatal depression and the challenge of making sure that the right support is there. My colleague Monica Lennon rightly highlighted the impact of poverty and disadvantage on the prevalence of suicide and the experience of addiction. I note for the minister the high prevalence of suicide among those whose addiction is to gambling. That experience is often not properly recognised in terms of support.
To be clear, I do not lay at the door of the Scottish Government direct responsibility for these tragic deaths, their causes or their consequences. However, the Government has a responsibility to do all that it can to put in place the strategies, systems and actions that will result in individuals being helped, not abandoned.
At the community level, there are concerns. Is it right that a young person who seeks help from a general practitioner for a physical condition can be referred to a consultant but a young person who seeks help with depression must refer themselves, when they may be distressed and not able to take that step? Can it be right that GPs have the capacity to prescribe drugs but do not have the time to talk to somebody at greater length about how they are feeling? That is a particular issue in our poorest communities, as highlighted by GPs themselves.
The truth is that any strategy must be backed up by an allocation of sufficient resources; what we say must be matched with an honest assessment of need. We know the importance of early intervention, and yet support is being stripped out of our schools. On the support that the voluntary sector might be able to deliver, we know the pressure that the sector is under and we know the pressure from local authority spending cuts. We need to think about the consequences of those choices and look again.
I say to the Government that if we are spending money in one place, we cannot spend it elsewhere. We need to test spending against how it supports the most vulnerable and most at risk in our communities. Any equality budgeting strategy worth its salt must ensure that resources truly follow need. What representations has the minister made directly to the finance secretary to ensure that sufficient resources are being put in place? We cannot separate the cold numbers in a budget line from the lived realities of people at risk who are seeking help and those who are supporting them.
There is a clear consensus in the chamber on the issues. I would like to see a commitment to tough budgeting choices to match that concern. It is important for the minister to outline her expectation of the budget, to make sure that it can match our united commitment to those who are most at risk and to make sure that we can support them when they look for that help.15:49
I am pleased to speak on an issue that is so important in contemporary Scotland. I first brought this subject to the chamber in August 1999, in a question about the steps being taken to reduce the number of suicides in Scotland. Upon receiving an answer, I was shocked to discover that more deaths of males under 35 in the preceding year were due to suicide—268—than were caused by motor vehicle accidents and drugs combined. In 2016, according to the Scottish public health observatory’s “Suicide: Scotland overview 2017”, 148 males under 35 committed suicide. Although there has been a huge reduction in the number of such deaths over 18 years, the figure is still far too high.
A great deal of progress has been made since 1999, but suicide prevention remains an on-going struggle with a long-term impact. The Scottish Government’s “Suicide Prevention Strategy 2013-16” identified key areas for action, such as responding to people in distress and talking about suicide. I never feel comfortable discussing human lives in terms of statistics, but they help in demonstrating the extent of the problem and identifying groups or individuals who might be at higher risk than others.
As we have heard, based on five-year rolling averages, the suicide rate in Scotland fell by 17 per cent over the decade to 2016, but the latest figures confirm that 728 suicides were registered in Scotland last year compared with 672 the previous year, 21 of which occurred in North Ayrshire.
Between 2012 and 2016, the suicide rate was more than two and a half times higher in the most deprived decile of the population than it was in the least deprived decile. Many colleagues have commented on that in some depth. It is true that money cannot buy happiness, but a distinct lack thereof can put immense strain on everyday life and, as such, it is important to understand which population groups, in addition to specific groups such as self-harmers, are at risk of suicidal thoughts and behaviours.
The suicide rate for males is more than two and a half times that for females, and that has been the case for years. We will all have heard the phrase “Boys don’t cry”. As Clare Haughey indicated, societal norms suggest that boys should not be seen crying or appear vulnerable in general. That an entire gender should be raised with an in-built instinct to unhealthily bottle up and suppress their emotions is regressive, and I am glad to see the beginning of a move away from that attitude.
Although society is gradually warming to the idea of bringing the discussion of so-called “toxic masculinity” into the public domain, there are still many men who are reluctant to discuss their innermost emotions and fears with even those they are closest to; I must confess that I fall into that category. Research has shown that cultural pressure for men to appear stoic and self-reliant might result in them being less likely to seek the advice of a healthcare professional. That is further proof that the stifling of emotional expression can be extremely detrimental to the mental health of some individuals.
In the same way—regardless of the aforementioned influencing factors—simply saying “I’m fine” as we push negative thoughts to the back of our minds rather than facing and processing them might feel like the easiest thing to do. When we feel that we cannot cope, it is in many cases almost ingrained in us to keep going in order to avoid what might be perceived as failure—failure to cope or be strong. However, through increased public discussion of the importance of mental wellbeing and suicide prevention, it is hoped that any negative connotations that come with asking for help can be eradicated, for most people at least.
Fortunately, negative thoughts do not spiral into depression and contemplation of suicide in the vast majority of people. Nevertheless, every suicide is one too many. It is therefore paramount that the Government and society in general continue to strive towards preventing as many people as possible from ending their own lives. Altering how vulnerable people think about suicide is complex and it necessitates the taking of a range of actions and approaches. Crucial to that is the co-ordination and delivery of efforts at national and local levels, not least to diminish people’s access to methods for killing themselves, on which much work was done in the decade before last.
I am pleased that, as many similar organisations have done nationwide, North Ayrshire health and social care partnership has promoted the national suicide prevention strategy over the past year through its choose life partnership, which works closely with charities, the NHS and Police Scotland to better promote prevention strategies and available support.
It is also important to recognise the incomparable and vital work that is carried out by many helplines and support networks across the country, such as choose life, Samaritans, breathing space, copeline and Touched by Suicide, to name just a few. Such organisations work tirelessly to provide unwavering support to those who are affected by suicide, whether directly or indirectly.
In addition, NHS Scotland’s 2016 read between the lines campaign brought suicide awareness further into the public domain by illustrating the merits of the simple art of conversation and highlighting the need to take all signs of distress seriously, because people tend to know when a friend, family member or colleague is not quite themselves. Sometimes, all that it takes to turn on a light in the dark is a question, which can provide the massive relief that comes with the ability to open up to someone.
The reality is that behind each and every suicide is a person with a story that ended too soon, whose death will have a long-term devastating impact on those who are left behind. My great-grandmother drowning herself in Ireland was the reason why my grandmother was moved to Scotland and adopted while still a baby, but that is another story.
Suicide is not inevitable; it is preventable. Nobody wakes up deciding to commit suicide out of the blue. The road is often long and painful, and their reasons are often complex. The Scottish Government will continue to recognise suicide awareness and prevention as a public health priority. Although I find it difficult myself, I encourage those who can do so to speak openly about mental health and to support one another in our communities. If we listen closely to each other and take action at an early stage, many lives will undoubtedly be saved.15:55
We are all very conscious this afternoon that we have recently seen the first increase in deaths by suicide in the past six years, which goes to show that we must never be complacent. We cannot accept any suggestion that suicide is not preventable.
Like other members, I am concerned that the previous suicide prevention strategy ended in 2016 and that the minister’s intentions to develop public engagement around the action plan indicates that we are still in the early stages.
I am also concerned that the minister’s motion does not mention self-harm at all. We have seen a worrying increase in the levels of self-harm among young people, particularly young girls. The growing up in Scotland survey shows that almost a quarter of young women have self-harmed. I raised the issue when the minister delivered a statement on the mental health strategy and was told that self-harm would be addressed in the forthcoming suicide reduction strategy. I ask the minister to expand in her closing speech on how that work will reduce the level of self-harm that we see among young people.
Providing appropriate support at an early stage is crucial. I am proud of the Scottish Young Greens, who have just launched a national campaign called healthy minds, healthy students, which calls for every pupil to receive quality mental health education in school. The Government has agreed to review personal and social education and mental health support, so the time is right to ensure that we provide robust support for good mental health for all our students and young people.
We cannot overlook or shy away from the fundamental impact that inequalities of wealth, power and opportunity have on our mental health. We have seen a real increase in the incidence of mental health problems, particularly among children and young people, and it is no coincidence that mental distress has risen alongside the programme of austerity, welfare reform, wage stagnation and insecure employment. I agree with the points raised in Monica Lennon’s amendment. There is a clear link between mental health problems, suicide and socioeconomic disadvantage. It shames us all that the suicide rate in Scotland is three times higher in the most deprived communities. Poverty, shame, stress and anxiety related to material deprivation play no small part in that.
There is a generation in Scotland who have experienced compounded hardships from deindustrialisation to a lack of investment in good quality housing to austerity and the social security cuts that are being made today. Those people should not be let down even further today by threadbare services.
The adult psychiatric morbidity survey in England found that more than 40 per cent of people who receive employment and support allowance have attempted suicide. Many people receive ESA because they have significant mental health problems and require on-going support, but the statistics indicate how vulnerable that group of people can be. They are entitled to social security support, and every cut to that support jeopardises their wellbeing.
Benjamin Barr of the University of Liverpool led research on the impact that disability assessments had on people’s mental health in England. He found that the work capability assessment was linked to almost 600 additional suicides, and he called on the Department for Work and Pensions to release that data. That emphasises the need to develop a system in Scotland that truly treats people with dignity and respect. I would be glad if the minister could tell me how work to reduce suicide and self-harm will be integrated with the new social security agency, and how it will support vulnerable groups.
Research by LGBT Youth Scotland sampled more than 600 people and found that half of lesbian, gay, bisexual or transgender young people reported suicidal thoughts or actions. That figure increases to 63 per cent among trans young people. LGBT Youth Scotland’s front-line workers deal with severe mental health issues and suicidal ideation regularly. Its previous research showed that poor mental health among LGBT young people is closely related to bullying, stigma and fear of rejection by family and friends. It is unacceptable that any young person in Scotland should feel such a level of distress, and horrifying that suicidal ideation is so high among LGBT young people in particular.
The strategy must have a thorough equalities impact assessment that accounts for the need to reach particular groups in different ways and to provide bespoke support. The equalities impact assessment for the mental health strategy did not mention race or ethnicity at all. Those aspects cannot be missing from this one.
The British Red Cross highlights that asylum seekers are at very great risk of suicidal ideation. After the trauma that they have fled and painful separation from family members, many asylum seekers and refugees are left with nothing by a system that fails to support them. It is in fact designed—in the Prime Minister’s own words—to create a “hostile environment”. It is little wonder that people experience mental distress. I would ask the minister how her strategy and other work led by the mental health directorate will support the mental health of asylum seekers, refugees and people with no recourse to public funds. Our mental health support must reach everyone, especially the most vulnerable.
As SAMH reminds us in its new pass the badge campaign,
“We all have mental health, so it’s okay to start talking about it.”16:00
Suicide is not a crime; it is a choice. For more than 700 people in any given year in Scotland, it represents the only choice—that last vestige of control that they have left to them. As a Liberal, I will always defend the right of someone to make such a decision, but I wish with all that I have that we could provide support enough that there was always a better choice for them to make.
Suicide is an option that, for some, no intervention will prevent, but we have to recognise that many of those lost to us might have chosen a different path had they only received help when they first needed it.
Therefore, I welcome the debate today. In particular, I thank the Minister for Mental Health, Maureen Watt, for making an effort last week to foster a spirit of consensus around the motion in her name. Suicide is absolutely one of the issues around which we should coalesce, stripping out any kind of partisan alignment and always—always—seeking agreement.
Although we support the Government motion and the amendments thereto, we cannot allow our efforts to be undermined by complacency. That is what I would have asked Maureen Watt to say, had she taken my intervention, because the motion fails to recognise that we are falling behind on this issue. I use the term “complacency” because although the motion speaks to suicide as a national trend that has, thankfully, dropped since the introduction of the choose life campaign, it makes no mention of the 8 per cent rise in the suicide rate last year, which James Jopling, director of Samaritans in Scotland, has described as a troubling “early warning sign”.
I associate myself with Alison Johnston’s remarks and with her dismay that there is no mention of self-harm in the motion. Suicide and self-harm are inexorably linked.
The Government’s efforts to tackle our mental health crisis, through the national mental health strategy, were delayed by over a year. When that strategy was published, it was met with tepid enthusiasm from stakeholders. I do not think that it is unfair to ask for something better from the equally delayed national suicide strategy.
As we have heard, the human cost of suicide is staggering. It tears a rent through families and communities. Although it is classless, it is far more likely in areas of deprivation. Although it is ageless, it seems to take the young more than the old. Although it is indiscriminate as to gender, it is far more common in men. Indeed, it is, as we have heard, the principal cause of death in men under the age of 50, outstripping cancer and cardiac arrest. That is heartbreaking. It is widely known that suicide can be a result of a cultural reality whereby men tend to bottle things up or are not always taught to share, but that is not the whole picture. Many seek help but what is available to them—if anything is available to them—is just not enough.
Although there is no doubt that many men and women choose to take their lives without any prior suggestion that they are in difficulty, many more come forward for help. Seventy per cent of those who have taken their own lives sought medical assistance at some point in the preceding year. A quarter had been through A and E in the three months leading up to their death, and 60 per cent had a mental health medication prescribed to them in the preceding year. Put simply, many of those people are known to us. They are coming forward but are not getting the help that they need.
What needs to change? We need to get it right earlier—and I was gratified to hear the minister’s remarks in that regard. We need to answer SAMH’s call to radically invest in support for child and adolescent mental health services. We need to train teachers to recognise mental health issues in their classrooms and to equip their schools with properly trained school counsellors, and we need to replicate that approach across colleges and universities. We need to better respond to the reality in surgeries that a quarter of general practitioner appointments are made as a result of an underlying mental health condition.
Suicides are tragedies that stalk the homes and streets of every community in our nation. I have seen at first hand the cost of our failure, and that will haunt me until the end of my days. I therefore wish to use all of the days that I have left to me in the Parliament to see us answer that failure.
The English novelist Sally Brampton wrote:
“We don’t kill ourselves. We are simply defeated by the long, hard struggle to stay alive.”
In the Parliament, we make many decisions to help people with ailments of the body to stay alive, but we do not seem to be as good at helping people to endure through hidden mental ill-health. I thank the Government for seeking to build consensus on this unbelievably tragic and desperate issue, as we need unanimity around a solution, and we will agree to support the Government’s motion tonight. However, we will continue to challenge the Government when we find it wanting in relation to finding an answer to this fundamental issue in our society.16:05
As someone who has gone through the trauma of acute poor mental health and who at one stage, a long time ago, made a cry-for-help attempt, I have some idea of what goes through the mind of a human being who feels so broken that the only way out that they can see is to become a victim of suicide. Depression, stress and anxiety can become so crippling that everyday tasks become an uphill battle. For many, even climbing out of bed every day is a struggle, and those suffering are robbed of hope and joy. It is like a black cloud that envelops people’s very existence.
Earlier this year, I wrote an article about my battles with depression and I was inundated with offers of support and stories from others who have faced horrendous battles—some, even, who have been fortunate enough to survive suicide attempts and get the support that they so desperately need. I was touched by the number of people who said that my story was their story and that I had been of some assistance to them. For that, I am eternally grateful.
Sadly, too many do not survive the horrors of poor mental health, and that is why the debate is so vital. I am sure that I am not alone in the chamber when I say that people who are extremely close to me have seen for themselves the results of what can happen when someone gets to that awful point—Alex Cole-Hamilton just talked about that. Heartening though it is to see a drop of 17 per cent in suicide rates over the past decade, we still have to examine every avenue at our disposal so that the number drops further. That is why I am pleased that the Scottish Government places such a high priority on mental ill health and suicide prevention.
I am glad that suicide rates have dropped in the past decade, but I am deeply troubled, if not surprised, to see that the suicide rate among men is still two and a half times that among women. Every death that happens at the hands of suicide is a travesty, but it is clear that we have a specific job to do with men. It took me years to open up about my illness. I had a misconception that, as a man, it was my job to be better than that or to save face in front of friends or colleagues, so I said nothing. I imagine that many men across Scotland do the same thing.
There are organisations that are trying to tackle that. The breathing space Scotland service has worked with several football clubs and organisations, and high-profile players have reached out to men across football, and indeed across Scotland, to try to remove the stigma attached to mental ill health and to show men that it is important to talk. A simple conversation with the right person can be all that is needed to save a life or at least to start someone on a recovery journey. That is why I am pleased that talking about suicide is one of the Government’s key themes.
Language around mental health is another barrier that prevents people from reaching out to those who could be suffering, especially males. Like my colleague Clare Haughey, I absolutely despise the use of the phrase “man up” when someone expresses the emotions of anxiety or depression. There is a well-used phrase that goes, “If someone had a broken leg, you wouldn’t make them walk on it.” If a man has a physical scar that the human eye can see, it seems acceptable for him to take time out, get physiotherapy and recover at his own pace. However, a mental scar can be a different ball game. Many are told to pull themselves together or can be self-critical, dismissing their emotions and thinking that they need to give themselves a shake. I am not a psychologist, but I know enough to say that if we ignore mental illness, the results will manifest themselves just as with any other physical disease—in other words, it is unlikely to self-heal. Of course, that can mean that the illness gets progressively worse, which, tragically, can result in suicide.
I know a young woman who is being seen by an expert CAMHS team. She had several physical and emotional health issues, and had cut her arms and legs with knives and attempted to kill herself. She was referred to CAMHS and I am delighted to report that, after several months in care and therapy, that young lady is almost unrecognisable.
Excuse me, Mr Dornan. I am terribly sorry to interrupt you, but the broadcasting system is not picking you up properly, so could you shift your microphone?
Do you want me to start again?
It was worth a try, Presiding Officer. I apologise.
Not only does that young lady have better mental health, but she has been given many strategies to cope with all that life throws at her. The world moves at a much faster pace than when I was young, and I am pleased and thankful that we have such brilliant teams supporting our young people as they navigate such difficult times.
I cannot discuss the prevention of suicide without considering the direct link with poverty. Alex Cole-Hamilton talked about the 8 per cent rise in suicide, as did other members. There is no doubt in my mind that the rise is partly due to austerity measures and the pressure that has been put on people. I have been there. A long time ago, I lived a life where my heart was in my mouth every time there was a knock at the door, as I was robbing Peter to pay Paul and was worried that it was Peter at the door, wanting his pound of flesh. In my constituency, there are a number of people who are, I am sad to say, struggling even more than that due to the vicious and life-crippling cuts in the benefits system.
The number of people who lose their lives to suicide is falling, and I am delighted about that. I welcome the Scottish Government’s suicide prevention strategy and action plan, key aspects of which involve responding to people in distress and talking about suicide and, indeed, mental health. As an elected member and a member of the community, I urge any of my constituents who feel completely alone to come to my door, which is always open. Although we are not experts, we are able to direct most people who are in need of care to those who are most able to provide it. Maybe—just maybe—such an open-door policy from me and others could help to save a life.16:11
The headlines on Tuesday 21 February 2017 read:
“A RISING young rugby star has been found dead just days after being named ‘man of the match’ in a game that saw his team crowned league champions … The Stewartry Rugby Club player had been celebrating winning the BT West Division 2 championship with his team only 72 hours earlier. The 22-year-old, who has come up through the ranks at the club, scored two tries in his club’s win against Cumbernauld.”
The story continued:
“Scott Carson was found dead”
by his mum and dad
“on the family farm near Gatehouse of Fleet ... It is understood he took his own life.”
Scott was not a statistic. He was not a target to be met. He was John and Helen’s son and Ross’s brother. He was my cousin’s son. He was a good friend of my son and daughter and many lads and lassies in the Stewartry. Everybody was shocked. It came as a huge surprise. Nobody could believe it because he never talked about his problems. The story might be very personal to me, my family and Scott’s friends, but it is replicated throughout the country far too often, and far too often involves young men in rural areas.
I will talk about rural suicide. Many factors put individuals at risk of suicide but four key groups of risk and pressures have been identified: risks and pressures within society, including poverty and inequality, together with access to methods of suicide; risks and pressures within communities, including neighbourhood deprivation, social exclusion, isolation and inadequate access to local services; risks and pressures for individuals, including sociodemographic characteristics and lack of care and treatment for and support towards recovery from serious mental illness; and quality of response from services, including insufficient identification of the people who are at risk. Not just one or two of those risk factors but all of them are present in rural areas.
In the days and hours after Scott’s death, his teammates met often and talked about their feelings. That is not something that tough farmers and rugby players do, but they did it. In their relatively small group, a surprising and significant number admitted to having suffered from different levels of mental health issues. Some had sought support and received medication or other professional intervention, but the majority had never spoken about the issue before or even considered that they should seek help. That is of great concern. It is important that we create a culture in which talking about mental health issues is no different from talking about a sprained ankle or a stomach bug.
Many young people who work in agriculture fall into the categories that I have mentioned. Agriculture suffers more than most industries from the stigma that is attached to mental health problems. To make matters worse, there are the additional challenges of diagnosis and treatment.
Life in the countryside creates diverse worries for young people, which are often missed by other campaigns. Farming is a 24/7 job that it is hard to switch off from. Many rural areas are isolated, lacking public transport to sports and recreational facilities, which are not accessible. Self-employed farmers are not eligible for statutory sick pay, which puts those on lower incomes under more pressure to continue working when they should seek help.
Access to treatment, and particularly to specialist health professionals, can involve long journeys, thus increasing anxiety and worry. With the GP recruitment crisis, even getting a doctor’s appointment can be difficult. That is why the Scottish Association of Young Farmers Clubs, a leading youth organisation with more than 3,500 members, has chosen to encourage the conversation and break the stigma surrounding mental ill health and wellbeing by launching the are ewe okay? campaign. The association recognises that it is about people looking out for one another and that early intervention can be as easy as asking, “Are ewe okay?” and being there to listen.
The aim of the campaign is specifically to target an audience of young people living in Scotland’s rural communities by raising awareness of the triggers and causes of poor mental health and, most important, how to recognise the signs and seek help if others are suffering. It has teamed up with SAMH, which now offers sessions for young farmers clubs that want to gain a basic understanding of mental ill health and wellbeing. Members share stories and experiences of mental health conditions online, and the association invests in training so that office bearers can recognise and understand mental health conditions and can signpost those who may have a mental health condition to help.
The rugby team is ideally placed to help young men whose only off-farm activity is often rugby. It is in a positive position to provide support and advice through buddies, or simply by signposting services. That intervention could be life saving, because stress and anxiety can lead to suicide without any visible signs.
The Stewartry rugby team coach, NFU Scotland and the local health and wellbeing project co-ordinator are working together to deliver a mental health and wellbeing project that will assist in making it more commonplace for men and women, from the club’s youngest members to its veterans, to recognise that mental wellbeing is a huge part of the overall wellbeing, performance and fitness of the individual.
Taking advice and examples from its auspicious professional colleagues at Glasgow Warriors, the club hopes to incorporate mental health as it does physical health in its day-to-day training, as a result ridding rugby of the stigma that sadly played a part in the death of a teammate. I hope that that is a model that can be rolled out to organisations across Scotland.
It is of great concern that a new action plan will not be published until spring 2018, but that should not be an excuse for failure to progress collaborative working with groups that are in a positive position to take action now to avoid more suicides.16:17
We must be grateful for that personal contribution from Finlay Carson.
I appreciate the opportunity to contribute to this important debate. Colleagues across the chamber have rightly focused on the good work that has been done in the past and that is being done, and on what could and should be done to help further reduce suicide numbers in Scotland. They have all made good and heartfelt contributions.
We have good strategies in place that are supported by dedicated staff in a number of disciplines and there is good investment to call on, which helps us to support people at risk. Is that enough, however? Do we need more money or more resources, or is something else needed that might still be missing from everything that we are doing?
I have permission from a local family to tell Jenna’s story. When members hear it they might agree that something is still missing that might allow us to intervene and help to save lives, especially young lives. Only four years ago, Jenna was 13. She was a very bright, beautiful, intelligent and compassionate young girl. She had been having problems both at school and out of it—probably bullying. I have to say “probably”, because it was never established, accepted or verified that that was the cause. She had told her mother what was happening to her to make her feel so sad but, by that time, it was too late. Less than 48 hours later, Jenna sadly took her own life.
The signs that her mother saw and the discussion that she had with Jenna did not immediately make her think that her daughter’s life was at risk. Jenna had been self-harming, but the advice that her mother got was that that rarely led to suicide and that it would be months before she would be able to see anybody professionally who could try to help. Oh, how her mother now wishes that she had acted.
With Jenna’s young life cut so short, her family has to deal with lifelong devastation and a pain that endures with every day that passes. The questions have all been asked time and again. What could have been done to help pull Jenna back from the brink? There were plans in place then—anti-bullying strategies, mental health support and counselling services—but all failed Jenna and her family.
I spoke to Jenna’s mother last night and asked her what key things have to happen to give people, especially youngsters such as Jenna, a chance to hold on. Jenna’s mother said that it is vital that there is quick action when any signs are spotted, and sustained support and counselling. She said that it needs to be recognised that bullying is a major cause of anxiety and depression in young people—more so now as a result of social media. She emphasised the importance of accountability and being seen to act to protect the victims, especially in a school setting. Youngsters who have been bullied have often moved school to get away from the bullying. Surely that cannot be right. Some of Jenna’s mother’s suggestions chime with the Mental Health Foundation’s 12-point plan, which I am sure that we are all grateful to have received in time for the debate.
My message to the ministerial team, which is working hard on the issue, is to ask it listen to Jenna’s family, back up the plan and strategies with such actions and interventions and make them available as quickly as possible.
I close with a quote from Jenna’s mother, Pauline, who said:
“This Saturday should have been the day that I celebrate my beautiful, intelligent, compassionate daughter’s 18th birthday, but I can’t because on 11th June, 2013, Jenna Moriarty, my little girl, aged 13, waved and smiled as she walked home from school, to end her own precious life.”
Jenna’s story is possibly not unique but her legacy is that her family has honoured her memory and set up a charity in her name—Beautiful Inside & Out—to work tirelessly to intervene quickly when called upon to help, and to find counselling support for other youngsters and their families who are struggling. It is working and it is saving lives. Let us all hope that our work in this area saves even more lives from the tragedy of suicide.16:22
It is a privilege to speak in a debate on such an important issue. The debate has stimulated many thoughtful contributions. Speaker after speaker has rightly highlighted that behind each of the more than 6,000 deaths from suicide in Scotland since 2009 are individuals and their families and friends who have suffered a devastating, unimaginable loss. Although the motion highlights the positive fact that there has been a 17 per cent reduction in suicides in the past decade, Annie Wells and Alex Cole-Hamilton rightly referred to the fact that, last year, there was a rise of 8 per cent in the number of people taking their own life—the first increase for six years.
Annie Wells also rightly highlighted that, because the Scottish Government’s current suicide prevention strategy expires in 2016, it is crucial that the Government consults and brings forward plans for a new strategy. As Johann Lamont highlighted so powerfully, a critical part of that new strategy needs to be the availability of and accessibility to the right mental health treatment. It is just not acceptable that a quarter of adults who require mental health treatment have to wait more than 18 weeks for that treatment. In many areas, the treatment options are limited. Staff are under increasing pressure, and many areas are struggling to recruit for key posts. There are vacancies in 9 per cent of psychiatric consultant posts, 8 per cent of clinical psychology posts and 4.4 per cent of mental health nursing posts.
Johann Lamont was right to stress that the forthcoming budget must ensure that our mental health services have the resources and staff that they require in order to meet demand and deliver the treatment that people need. Several members highlighted the broader issue that those working in health and social care services must be provided with the necessary training on suicide and mental health. I echo the Scottish Association for Mental Health’s calls for allied health professionals to receive suicide prevention training.
There is also a need for improvements in communication and co-operation between healthcare sectors and I support calls by SAMH to introduce a national Scottish crisis care agreement between statutory, emergency and non-statutory sectors to develop clear pathways.
However, we must look beyond healthcare services and expand other organisations’ ability to intervene effectively to help those people who are at risk of suicide. I welcome the work that has been done by the Scottish Government to promote applied suicide intervention skills training, known as ASIST. The Government’s review found ASIST to be
“effective on a number of levels”.
Training of that kind should be made more widely available, and it should be provided, in particular, for those people who work across our education system. Indeed, the role of education in suicide prevention is fundamental, as Fulton MacGregor highlighted in his contribution. Research has shown that half of all adults with mental health conditions say that their condition started before the age of 14. Early intervention and the promotion of lifelong mental health must, therefore, be at the heart of any truly preventative approach. People who work in all levels of education should have a strong understanding of mental health and suicide, and we must guarantee access to a qualified counsellor in every high school in Scotland.
Although suicide hits all of Scotland’s communities—Maureen Watt was correct when she said that there is rarely any single cause—we know that it impacts on certain groups disproportionately. Clare Haughey, Brian Whittle and others have highlighted that the suicide rate among men is more than two and a half times that for females. Between 2009 and 2015, 73 per cent of people who took their own lives were men, and they were found to be less likely to have had prior contact with healthcare services than women by a 21 percentage point gap. Serious barriers prevent men from accessing the mental healthcare that they urgently need. Bringing forward the cultural and structural changes that are needed to address that inequality must be part of any new strategy. James Dornan’s very personal contribution highlighted the fact that efforts to destigmatise mental ill-health must recognise the key role that is played by gender and must tackle the harmful gender stereotypes that prevent men from seeking help. Likewise, healthcare services must do more to ensure that men who are at risk of suicide receive the treatment and support that they need. I support SAMH’s calls for integration joint boards to commission evidence-based, gender-sensitive services to tackle the inequalities that are faced by men and people in areas of deprivation.
We cannot discuss suicide prevention without discussing the need to tackle poverty and inequality. As Monica Lennon said, the recent Scottish suicide information database report highlighted that suicide deaths are three times more likely among people who live in the most deprived areas compared with those people who live in the least deprived areas. Those figures reflect—in the clearest and most devastating terms—the human cost of inequality. The recent Samaritans report “Dying from Inequality” stated that there is
“overwhelming evidence of a strong link between socioeconomic disadvantage and suicidal behaviour”.
It highlighted that low incomes, job insecurity, zero-hours contracts, unmanageable debt and poor housing increase the risk of suicide. The forthcoming suicide prevention strategy must put it at its heart that, if we are to tackle this health inequality, we need to tackle wealth inequality.
Finlay Carson highlighted another inequality. He spoke about the personal case of the Stewartry rugby player Scott Carson and rightly talked about a lack of connectivity and isolation as factors in suicide. The recent Scottish suicide information database report highlighted that, although rural areas have a higher than average rate of suicide, “very remote small towns” had the highest rate of any area, and accessible small towns and rural areas both had lower rates than their remote or very remote counterparts.
On an individual level, isolation appears to play a role, with 71 per cent of people who have died from suicide reported as being single, widowed or divorced at the time of their death. I hope that we will soon see the publication of the Government’s promised strategy on loneliness, which I hope will include such options as social prescribing. Today’s debate has highlighted how complex suicide is. Self-harm has been highlighted in the very personal cases that Willie Coffey and Alison Johnstone set out, and the impact of deprivation was highlighted by Monica Lennon and others. The chamber has united behind the need for the Government’s new strategy to have clear priorities and clear objectives. I am sure that everyone will get behind that strategy.16:29
I add my voice to the united message that this whole Parliament must send out today: every suicide—which is a tragedy for the individual involved, their family, friends and society more widely—is preventable. All of us, across all parties, are committed to working towards a situation in which deaths from suicide are reduced, minimised and, ultimately, never happen. We all want Scotland to have the best possible health and support services, and for those who are suicidal, and their families, to be able to access those services as easily and early as possible.
My colleague Annie Wells highlighted recent Scottish statistics that show that the number of suicides has risen for the first time in six years. We must make sure that that is a one-off, not a trend. Alison Johnstone also told us how the suicide rate is rising.
With the previous strategy having expired in 2016, a new suicide prevention strategy for Scotland is long overdue. It is for ministers to respond to the criticisms that have been made that the current suicide prevention strategy ran out at the end of last year and the new one is not yet in place. We need it sooner, rather than later.
Throughout the debate, the importance of suicide prevention work at a local level has been mentioned by my colleagues. Suicide is the single biggest killer of men under the age of 50 in the UK, and people including Clare Haughey, Brian Whittle and Kenneth Gibson are right to say that we need to tackle the stigma, particularly among men, that makes them unable to talk about it. It is not right that we say, “man up” or, “men should never cry”; that is unacceptable in 21st century Scotland.
There are excellent examples of voluntary services working with men across Scotland, including the Men’s Shed association in Musselburgh in my region, which responds to men’s need to come together to talk about what goes on in their lives and provides an opportunity for them to work through those issues. It is not only men—women also need opportunities to talk. I know that the minister visited the Juno project in Edinburgh, which works with ladies with postnatal depression. That, again, is an issue that is too often hidden and about which society is not willing to talk.
I urge the Scottish Government to act on the calls from Samaritans to increase support for local suicide prevention work by providing resource and leadership. I agree with Fulton MacGregor and Alex Cole-Hamilton that we need to see far more done to tackle mild and moderate mental health problems that can develop into more serious conditions and suicidal tendencies if the people presenting with the initial problem fail to access the right treatment and support, or fail to get that support because of long delays. They are then more likely to go on and try to commit suicide.
Suicide is now the leading cause of death in teenage girls worldwide and the rate of suicide in 15 to 24-year-olds in Scotland has risen over the past three years. I am sure that we were all moved by the contribution from Willie Coffey and wish the best to his constituent’s family as they go on raising money and telling the story.
Education on mental and emotional wellbeing can act as prevention and early intervention. The Scottish Youth Parliament has provided helpful research in that area. The Scottish Conservatives would expand mental health education in schools so that young people know what support is available at the earliest possible time and know that there are people within their area to whom they can talk.
Finlay Carson spoke about the particular issues in rural Scotland. I will be interested to hear what the minister has to say with regard to that.
We have heard heartbreaking stories of suicide and the families and communities affected by it. We must look to see how we can give the right support to prevent that.
While we can expect some year-on-year fluctuations, we cannot ignore any rise in deaths in 2016 that would suggest a direct correlation between the lack of a robust suicide prevention strategy and the number of deaths from suicide. I urge the Government to push ahead with the new strategy, working in partnership with key partners, including those in the third sector, to develop a plan that enables people who are suicidal, and their families, to access those services as easily and early as possible. I am sure that the minister and her Government will get the full support of all parties if she brings such a strategy to the chamber, and I look forward to seeing it in due course.16:35
As I said in my opening speech, the Scottish Government is committed to continuing the strong downward trend in suicides. I am pleased that the desire to work collaboratively on the issue has been evident today among members on all sides of the chamber. I thank them all for sharing their experiences and knowledge in this area, and we will take on board their contributions in developing the new plan.
Partnership is central to suicide prevention. A new action plan on suicide prevention will create the conditions to strengthen our current relationships with partners, and reveal opportunities to develop new partnerships where appropriate in working towards our shared aim of ensuring that the long-term downward trend in the Scottish suicide rate continues.
I thank all the partners at both national and local level who provide support to vulnerable individuals and who have contributed to action on suicide prevention in Scotland over recent years. As has been said, in the past decade we have seen a 17 per cent reduction in the suicide rate, and the gap in suicide rates between the most deprived and least deprived areas of Scotland has narrowed by 42 per cent.
Many members mentioned the increase in suicide in the past year. We cannot extrapolate a trend from one year’s figures, as we need to see the five-year rolling averages, but we are determined to ensure that the long-term downward trend in suicides continues.
Our future suicide prevention action plan will be based on a range of resources, including the experience of those who have been bereaved by suicide, and the latest research evidence on what works in this very complex area. I urge all members who told the harrowing stories of constituents today to urge those constituents to feed their experiences into the new action plan. Some have already done so, and I urge the others—including the lady from Willie Coffey’s constituency—to feed in their thoughts on what should be in the next action plan. The plan will involve suicide prevention for everyone across the population and will take account of determining factors as well as characteristics and factors that can help to protect against suicide. I assure members, including Alison Johnstone, that the next action plan will be for everyone, regardless of background: rural or urban, refugee or asylum seeker or lesbian, gay, bisexual, transgender or intersex.
Johann Lamont and Jeremy Balfour mentioned postnatal depression. I had a great morning at the Juno project, which Mr Balfour knows well. We have already set up a new managed clinical network for antenatal and postnatal care, which covers postnatal depression, and there are many groups like the Juno group in Edinburgh that offer peer support for women who are experiencing postnatal depression.
The programme for government sets out our ambitions for building strong and safe communities, tackling poverty, improving housing and eradicating rough sleeping, all of which will necessarily touch on suicide prevention in one way or another. As we have said before in relation to the mental health strategy as a whole, the suicide prevention action plan will not be delivered by the health portfolio alone but will require work across portfolios.
The issue of what people can do when they need help has been brought up by a number of members. A range of factors can help to reduce the risk of suicide. As many members said, suicide is preventable. Supporting factors include social connectedness, close and supportive relationships, family resources and individual resources such as problem solving skills and personal resilience, and, of course, looking after one’s physical health as well as one’s mental health, as Brian Whittle reminded us.
It is important that we encourage and promote suicide prevention training and related work to raise awareness of suicide and its prevention, as well as taking wider action to address stigma. It is also important to encourage and support the work of local groups, which is what choose life plans and local co-ordinators do. I have witnessed the help that peer support can give to families affected by suicide and to those who have attempted suicide.
When people feel that they need additional support, they should consult their GP, but there is a range of out-of-hours supports such as NHS 24, NHS inform, breathing space and Samaritans. I recognise that men may feel stigmatised by going for support locally, so it is important that everybody knows of those sources of help when they experience low mood, depression or anxiety. Last week, I visited the Edinburgh crisis centre run by Penumbra, which provides short-term support to people experiencing emotional or mental health crises, including those who feel suicidal. I was struck by the emphasis that the centre places on listening and on treating people with compassion.
Many members, including Finlay Carson, who made a powerful speech, mentioned the incidence of suicide in rural areas. I helped launch the Scottish Association of Young Farmers Clubs are ewe okay? campaign at Thainstone mart in the north-east. I am pleased that the campaign won an award recently. The rural mental health forum has gone from strength to strength. Suicide is an issue that is very much on its agenda and the forum will take the issue forward.
The use of social media is now commonplace among children and young people. It can be a positive way of helping people to access information about supporting their health and wellbeing. I have mentioned the suicide prevention app, which has been well used in Aberdeen and Aberdeenshire. However, we need to be vigilant about the challenges that social media can present, for example around bullying, social isolation and encouraging risky behaviours. There are positive and negative aspects to social media, and we should harness the positive aspects in our next plan.
As NHS Health Scotland reminds us in its awareness-raising work,
“If you can read between the lines, you can save lives.”
Members have stressed that suicide is preventable. In addition to directing people to see their GP or to phone breathing space or Samaritans, if we are worried about someone, we should ask directly about their feelings, because that can help to save lives.
The signs of suicide can be ambiguous, but we should be alert to the warning signs and take all signs of distress seriously, even if the person seems to be living a normal life. We will know that we are making improvements when people feel comfortable about asking for help if they are in distress, and when people are also comfortable offering help if they see someone in distress.
We know that more men than women are successful in committing suicide, and we need to find out the underlying causes. Men really need to open up.
Suicide is preventable, and it is everyone’s business. I assure members, including Johann Lamont, that the health team is ensuring that we can extract every single penny from the finance secretary for the health budget, including the budget for our next action plan.
Our focus in working with partner organisations is on learning from the best examples around the country and sharing them. We should note the research evidence from the confidential inquiry into suicide and homicide by people with mental illness, for example. That shows that there is a heightened risk of death by suicide for mental health patients who have been discharged from in-patient care. We will certainly give our full attention to that in the new strategy. I fully appreciate that the issue is extremely challenging and that there need to be risk assessments of people who are experiencing mental illness.
Some members have mentioned that the strategy has expired. I assure members that the actions in it continue to be implemented across Scotland. Indeed, we have seen lots of new and innovative practices in local areas to continue to reduce the suicide rate.
I strongly associate myself with the sentiments in Monica Lennon’s amendment that inequality is compounded by the welfare cuts and that people who are left with no money feel particularly helpless.
I appreciate all the information and thoughts that members have shared in the debate. I assure members that they will be taken on board in developing the new action plan and that a group will be set up to monitor the actions in the new strategy, just as one was set up with the mental health plan.