HEALTH, SOCIAL CARE AND SPORT COMMITTEE CONSULTATION:
INQUIRY INTO SUICIDE PREVENTION
EVIDENCE FROM CWM TAF UHB
Cwm Taf Health Board was established in October 2009 and achieved ‘University’ status in July 2013. It provides primary, community, hospital and mental health services to almost 300,000 people living in Merthyr Tydfil and Rhondda Cynon Taf. The University Health Board is also responsible for the provision of child and adolescent mental health services for South Wales. The Health Board is the second largest employer in the area, employing almost 8,000 people, a significant number of whom also live in the local area.
The extent of the problem of suicide in Wales and evidence of its causes
Suicide is quite rare but suicide, self-harm and thoughts of suicide are a cause of distress for many people - the individual, family, friends, and the wider community. There is no single reason why someone may take their own life or harm themselves. It is usually in response to a complex series of factors that are both personal and related to wider social and community factors.
Suicide rates across Wales are four times higher in men than in women. Half of all the suicides in men occur in the 30-50 age range, with the highest amount (13%) happening in men aged 40-44. Suicide rates fall in late middle age, but there is a further increase after the age of 80.
The social and economic impact of suicide
There were 332 deaths from suicide registered in Wales in 2016 (Source: ONS), and for every person who dies at least 10 people are directly affected[1]. The economic cost of each death by suicide of someone of working age is estimated to be £1.67 million. This covers the direct costs of care, indirect costs relating to loss of productivity and earnings, and the intangible costs associated with pain, grief and suffering[2].
Suicide and inequalities
Increased suicide rates are associated with unemployment, less education, low income or material standard of living, in addition to poor physical health and adverse life events.
Evidence shows that the strongest negative effect of economic downturn is on mental health and that economic recessions are linked to increases in suicide rates[3]. In addition, Cwm Taf has also been especially hard hit by recent austerity measures and welfare reforms; A recent study[4] has shown the South Wales valleys are among the areas most adversely affected by welfare reforms. For example, in Maerdy, Pen-y-Waun (Rhondda Cynon Taf) and Gurnos (Merthyr Tydfil), the estimated loss is expected to average more than £1,000 a year per adult of working age and this may lead to increased inequalities.
The Welsh Index of Multiple Deprivation (WIMD) categorises data by fifths of deprivation.Suicide rates are two to three times higher in the most deprived neighbourhoods compared with the most affluent.
The following map shows that 65% of the neighbourhoods in Cwm Taf fall into the bottom two fifths of deprivation.
The size of populations needs to be considered when looking at suicide
rates. There is more variance in rates at a Local Authority level, due in part to the relatively small numbers involved, and so there is a need to exercise caution in the interpretation of suicide data. The limitations of the data presents challenges for planning suicide prevention and responding to community needs.
The latest data from Public Health Wales Observatory shows that in Cwm Taf, the highest rate for suicides is in men aged 35-44, and this is statistically significantly higher than Wales.
The effectiveness of the Welsh Government’s approach to suicide prevention
The Talk to Me 2 Strategy and Action Plan has provided a structure and guidance for the development of local suicide prevention planning. In Cwm Taf we have a multi-agency Suicide and Self Harm Prevention Group and we are currently in the process of developing our 2018-2020 action plan.
Suicide has an effect on the frontline staff from a range of agencies (Police, Fire & Rescue, Ambulance, A& E staff and others) who have to respond to an incident. It is important that these staff are trained and supported to deal with this. It would be helpful if resources could be made available for this.
The contribution of the range of public services to suicide prevention, and mental health services in particular
The mental well-being of children and young people is supported by a range of educational programmes and the school-based counselling service. The Child and Adolescent Mental Health Service (CAMHS) supports those with more severe mental health problems. CAMHS Services are provided through a regional NHS network, hosted by Cwm Taf UHB to children and adolescents for the University Health Board areas of: Cwm Taf, Abertawe Bro Morgannwg and Cardiff and the Vale.
Valleys Steps offers free, open access, self-help courses in Stress Control and Mindfulness to help people better understand and manage their feelings in order to improve their wellbeing. Courses are available throughout Rhondda Cynon Taf and Merthyr Tydfil.
http://www.valleyssteps.org/ [Accessed 26.05.18]
The Health Board’s Primary Care Mental Health Support Services are aimed at individuals of all ages who are experiencing mild to moderate, or stable, severe and enduring mental health problems. These services are based in four locations – Rhondda, Taff Ely, Cynon and Merthyr.
Crisis services are available 24/7 for people with an urgent mental health issue and many who use this service are experiencing suicidal feelings so urgent support plans are put in place.
There is a high risk of suicide in people admitted to adult mental health wards.
Managing environmental risks are only effective when done in conjunction with individual clinical risk assessment so ongoing staff training is essential to ensure a whole system approach. This is an essential part of mandatory and developmental training for all staff and will remain high on the agenda within the drive towards achieving the best quality of care for patients.
Cwm Taf’s Safeguarding Board has developed a Protocol for the Immediate Response to Critical Incidents to manage the consequences of critical incidents (including suicide) in Cwm Taf in order to ensure that those who are affected, including friends, family, professionals and the wider community, are effectively supported.
http://www.cwmtafsafeguarding.org/media/1461/immediate-response-protocol-endorsed-december-2016-version-5.pdf [Accessed 26.05.18]
The contribution of local communities and civil society to suicide prevention
South Wales Valleys Samaritans support the suicide prevention agenda through a number of local initiatives:
· Awareness raising and promotion of help-seeking behaviour.
· Teacher training on the use of DEAL resources – Developing Emotional Awareness and Listening
· Emotional support is delivered in a variety of outreach venues e.g. Feet on the Streets, in town centres, Police custody suites, hospitals, pharmacies, job centres.
These activities will increase as the volunteer base expands.
Cwm Taf Mental Health Forum is a syndicate of health board, statutory and voluntary sector mental health organisations working in Rhondda Cynon Taf and Merthyr Tydfil to enhance partnership working across the mental health sector.
The Director of Merthyr and the Valleys Mind is the current Chair of the Cwm Taf Suicide & Self-harm Prevention group.
A number of voluntary and community organisations support population well-being in Cwm Taf.
Other relevant Welsh Government strategies and initiatives
The Together for Mental Health Strategy is overseen by Cwm Taf’s Mental Health Partnership Board.
The Well-being of Future Generations (Wales) Act 2015 provides a unique opportunity for all public services to work differently together, involving communities in shaping their long term future and improving well-being for all. Tackling loneliness and isolation is the cross-cutting objective of Cwm Taf’s Well-being plan; loneliness and isolation are risk factors for suicidal behaviour. Conversely, social connectedness through family and community support is a protective factor. One of the other objectives in the plan is to promote safe, confident, strong, and thriving communities improving the well-being of residents and visitors and building on our community assets. The actions being developed under these objectives will aim to improve community resilience and complement Talk to Me 2.
Innovative approaches to suicide prevention
Merthyr and the Valleys Mind are in collaboration with Welsh Rugby to take forward the #ItTakesBallsToTalk Campaign. This will reach out to 2500 men aged 18 – 50 via local rugby clubs and ‘pop-up’ awareness sessions across the Cwm Taf community, sharing events via Twitter to spread the word and offering free Talking Treatments as follow up support. The campaign has secured funding from Big Lottery and will run from September 2018 – August 2019.