Suicide prevention 'requires fundamental change'

Awareness of suicide in Scotland has been raised this year after the tragic death of musician Scott Hutchison, but as his brother Grant told reporters in the wake of his death, the suicide rate shows that in the time it took between Hutchison going missing and his body being found, six other people in Scotland had taken their own life.

Those people didn’t have the profile of thousands of social media messages and pledges of support to the family. More often than not, stigma and fear prevents people talking about suicide at all.

Scotland’s previous suicide prevention strategy expired in 2016, so publication of the new plans this summer was welcomed by most people in the mental health sector.

There was a recognition the new strategy had been strengthened from its previous draft – a frustratingly vague consultation document – by the new minister, former mental health nurse Clare Haughey.

As is often the case with Scottish government action plans, an ambitious target takes the headlines: this time a pledge to reduce the suicide rate by 20 per cent in the next four years.
It has taken 15 years to achieve a similar drop so far.

Holyrood’s recent policy event discussed if and how this target might be met. James Jopling, executive director of Samaritans Scotland and Toni Giugliano, Scottish policy and public affairs manager at the Mental Health Foundation, welcomed the new strategy for recognising their concerns.

Jopling said the previous draft put to consultation “didn’t do justice to the people we’ve lost” and praised Haughey’s role in providing focus to the document.

Guigliano called the plan a “high level political document” which cannot deliver the change needed on its own.

Under the plans, a new National Suicide Prevention Leadership Group will be established which will investigate every suicide, not just those of people already known to services. There will be better and more consistent support for families affected and refreshed suicide prevention training for NHS staff. 

But do any of these actions actually prevent suicide, rather than just mitigate its impact?

The drop in the overall rate of suicide over the last 15 years has masked a rise in younger men, according to stats revealed by Jopling at the event, with some groups more at risk than others. Giugliano pointed out that men in deprived areas and LGBTi people are particularly at risk.

Identifying these risks and providing adequate training will be crucial, it was agreed, but Giugliano said the “vast majority” of doctors and nurses don’t have the most basic mental health training to make early interventions, let alone suicide prevention training.

He suggested mental health must feature in all teacher training at university as part of establishing a whole school approach. “You cannot fulfill the health and wellbeing part of Curriculum for Excellence without it,” he said.

Liam Yule of SAMH said training people in crisis management can also help them to look upstream and make early interventions. He called for consistency of language and tools in a unified training programme which encompasses both basic mental health and suicide prevention.

In order to influence such fundamental change in working practices, the National Suicide Prevention Leadership Group, which is to be chaired by Rose Fitzpatrick, former deputy chief constable of Police Scotland, should be compact but include members with the authority to effect and influence change, said Jopling. He suggested representatives from education and justice settings and GPs, rather than “the usual suspects”.

The group “shouldn’t be a talking shop” or a “diary coordination exercise”, added Jopling, “it needs drive and action. Someone needs to do the work”.

Derek Chalmers, who provides peer support with SAMH in Lanarkshire, told delegates about how he struggled after a suicide attempt. Because he felt so isolated, Chalmers recalled, he’d convinced himself “I was doing this for my kids”.

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“We need to let people know there is help and hope out there,” he said. 

But that help and support needn’t be from a clinical expert, it was agreed, when a trusted ear could be “any accessible person”.

The #EmilyTest campaign to raise awareness of mental health on university campuses grew out of the tragic circumstances of Emily Drouet, who took her own life after being subject to an abusive relationship in her student halls. 

Amongst other preventative measures, the campaign has led to support cards for university staff so that they have the tools to deal with potential crisis points, including signposting to other services.

Emily’s mother, Fiona Drouet, described how a culture of not speaking about suicide had meant people were ill-equipped to respond to not only Emily’s needs at her moment of crisis, but also to those of her grieving family.

“We need to stop pushing suicide into a dark cupboard,” she said. “Suicide is a life sentence for those left behind. We needed help just to survive.”

Third sector umbrella body the Health and Social Care ALLIANCE gathered the views of those with lived experience to inform the work of its Health and Social Care Academy. They concluded that “suicidal people cannot wait for help”, “help is often offered too little and too late in the journey of a suicidal person” and that “the stigma around suicide is still overwhelming”.

These voices had a direct influence on the new action plan, said Sarah Forster, the academy’s programme manager. But will it address these concerns? Only if it is embraced, owned and driven by everyone, delegates agreed.