We now move to item 6 on our agenda, which is a debate on the Health, Social Care and Sport Committee report, 'Everybody's Business: A Report on Suicide Prevention in Wales'. I call on the Chair of the committee to move the motion—Dai Lloyd. 

Motion NDM6974 Dai Lloyd

To propose that the National Assembly for Wales:

Notes the report of the Health, Social Care and Sport Committee, Everybody’s Business: A Report on Suicide Prevention in Wales, which was laid in the Table Office on 5 December 2018.

Motion moved.

Thank you very much, Deputy Presiding Officer. I consider it to be a privilege to open this very important debate today on the Health, Social Care and Sport Committee’s report on suicide prevention in Wales, 'Everybody's Business'. The number of deaths by suicide in Wales is staggering. There were 360 registered deaths from suicide in Wales in 2017, 278 of those in men. This is an increase from the 2016 figure, when there were 322 registered suicides, and there has been no apparent downward trend over time. It is also likely that official suicide statistics may under-represent the true scale of suicide due to the need to establish beyond reasonable doubt that suicide was the cause of death in a coroner’s inquest.

We undertook this inquiry to understand what is currently being done and where action is needed to drive the change and improvements that are required to reverse this worrying trend. As part of this inquiry, we took a wide range of evidence. In addition to the usual formal evidence gathering carried out in committee meetings, Members met with representatives of Tir Dewi, formed to help the farmers of west Wales in difficult times, and the Jacob Abraham Foundation in Cardiff, which provides support around mental health issues and supports people bereaved by suicide. I would like to thank everyone who contributed to this work.

We have made 31 recommendations in this report, which, if implemented, would be a big step forward in making Wales a zero-suicide country. I will address some of these in the time that I have today.

Suicide is everybody's business; that’s the key message we’ve heard throughout this inquiry. That's the message we all need to remember and share. Suicide can affect anybody, there isn’t a community in Wales where people haven’t been touched by suicide, and talking about suicide does not make it more likely to happen.

The committee heard clearly that raising awareness amongst the public, as well as those working in front-line services, is absolutely paramount. We need to encourage help-seeking behaviour and promote a more compassionate response to people in distress. Evidence from a range of stakeholders suggested that there would be merit in front-line staff across various professions receiving training in suicide awareness. In particular, we heard from the Samaritans that achieving much more consistent training for people on the front line, who are likely to encounter people who are at risk of suicide, is something that we can make some real progress on.

I am therefore pleased to refer to the Welsh Government’s response to recommendations 1 and 2 of this report. We welcome the Government’s commitment to make training resources available, and are keen to see how effective this will be in increasing the uptake of training in suicide prevention, both by the public and front-line professionals. It's not just a matter for doctors. 

The committee also welcomes the fact that the Assembly Commission has accepted recommendation 3, and we encourage the Commission to continue to promote the availability of training and support to all its staff, given the role everybody has to play in suicide prevention, and we need more talking therapies available everywhere, but more of that later. 

We are pleased that the Government has accepted recommendation 5 and has committed to take positive steps to ensure that all GPs in Wales understand the General Medical Council guidelines on sharing information in order to protect life. The committee received powerful evidence from Papyrus during this inquiry about their campaign to encourage NHS bodies to support staff appropriately to make a best-interest decision to break patient confidentiality in this setting. We understand that Papyrus also welcomes this response. As a committee, we recognise this is real progress.

In recommendation 13, we make it clear that action on a Wales-wide postvention strategy for suicide is an immediate priority. We welcome the Government’s positive response to look at what is happening in England with a view to adapting it for Wales. As a committee, we intend on returning to this issue in six months and expect development in this area.

In relation to part b of this recommendation, we have some concerns around the guidance to schools on talking about suicide and the support offered more generally to this vulnerable group. Now, Lynne Neagle, as both a member of this committee and Chair of the Children and Young People and Education Committee, will talk more about this in her contribution, as many of this committee’s recommendations strongly echo those in that committee’s report into the emotional and mental health of children and young people, 'Mind over Matter'.

Briefly, in relation to recommendation 25, there is strong evidence that reducing access to means is an effective element of suicide prevention. In line with our key message that suicide is everybody’s business, I want to highlight the important role that planning authorities, architects and others can play in suicide prevention, with the inclusion of measures to prevent suicide in all new building design. We strongly urge the Welsh Government to do all it can to ensure structures are safe.

Turning to a separate angle, many people feel unable to talk about their mental health, mainly due to the stigma that still surrounds admitting they have a problem. We need to overcome this issue so that everybody feels comfortable to seek the help they need without fear of being judged or losing face. Access to appropriate and timely specialised services is key in ensuring people get the support they need. There must be parity in the support available for mental and physical health conditions, so that people can access appropriate support when they need it to prevent reaching a point of crisis. Therefore, we are pleased that the Government has accepted recommendation 6 of this report, where the committee calls for all necessary steps to be taken to ensure this parity. We look forward to seeing how a new delivery plan will address this need and expect this work to move at pace, including development of the mental health core data set.

Recommendations 7 and 12 refer to urgent referral routes for GPs and the waiting times for psychological therapies like cognitive behavioural therapy. Although the Minister has accepted these, the Government’s response does not marry with the evidence heard by the committee during this inquiry. We heard from GPs that it is often very difficult for them to refer and get someone seen as quickly as they believe is necessary. With serious physical illness, GPs can ring doctors in secondary care hospitals for immediate hospital admission. No such right exists for GPs' access to secondary care psychiatric doctors. It is unacceptable that mental health services are not prioritised in the same way as physical health, and this needs to be addressed as a matter of urgency.

Turning to male suicide, inability to talk about mental health is particularly true of men. Throughout our evidence gathering, we heard that men, particularly middle-aged men, are at higher risk of suicide. It is a staggering statistic that suicide is the single biggest cause of death among men aged 20 to 49 years. We need to overcome this issue so that everyone feels comfortable to seek the help they need without fear of being judged. New approaches are now needed to encourage help-seeking behaviour and to improve mental health, well-being and resilience among men. These can make a huge difference, but often rely on the commitment of individuals or are unsustainable due to short-term funding of charitable institutions. Reducing and, ultimately, preventing male suicide needs to be recognised as a national priority, and we are pleased that the Minister has accepted recommendation 18.

There are certain factors that create risk and stress to people living in rural areas over and above the suicide risk factors affecting general populations. The committee heard that, whilst there are no specific statistics available on the number of farmers who had completed suicide, all farmers knew a farmer who had taken their own life. We were particularly struck by the evidence provided by Tir Dewi when they told us, and I quote:

'When a death occurs on a farm, the cows still need to be milked this morning, and this evening and tomorrow'.

This clearly demonstrates the importance of understanding the impact various pressures can have on farmers’ mental health and the need for mental health awareness training to be undertaken by staff of all those organisations who interact with farmers and their families.

We welcome the Minister’s response to recommendation 22 and we note that the Welsh Government’s farm liaison service have recently attended training. However, I would highlight that all staff who work to support farmers would benefit from this training, such as those involved in arranging farm inspections. The committee was particularly pleased to learn that the Farmers' Union of Wales has recently made a public commitment to further raise awareness of mental health problems in rural communities.

Turning briefly to prisoners’ risk of suicide and self-harm in Wales, the committee is pleased that the Government has accepted this recommendation. The committee is embarking on an inquiry into prison healthcare and will take the opportunity to look at this issue in more depth over the coming months.

Finally, we welcome the additional £500,000 annually recently announced by the Minister towards the delivery of suicide prevention in Wales. We know that the Samaritans report that the average cost of a suicide in the general population is estimated at £1.67 million per completed suicide, which clearly highlights the economic cost of suicide. While, in his response to recommendation 31 of this report, the Minister accepts in principle the need for specific funding to be made available for suicide prevention, the committee would wish to see some protected resource. We would therefore welcome further information on how this additional funding will be spent.

To close, there is a lot of work being done to raise awareness of the risks of suicide and I would like to praise the excellent work being done by third sector organisations in putting support in place for those affected. There is a momentum building, but greater direction is needed to really drive forward the change still needed, and the committee is committed to ensuring that suicide prevention remains on the agenda. I look forward to hearing others’ contributions this afternoon and to seeing real progress being made in this area. Thank you very much.

Thank you. In accordance with Standing Order 12.23, the Llywydd has not selected the amendments tabled to the motion. Darren Millar.

Thank you, Deputy Presiding Officer. I'm very grateful for the opportunity to take part in this debate, and I think that the health committee has done some sterling work in terms of taking forward this particular inquiry. Every time somebody commits suicide, they take a little bit of the life of everyone else around them as well, and, you know, we in this Chamber have known individuals who have taken their own lives, and we know of the tragedy that can unfold for those who love them as a result of that.

Three hundred and sixty deaths in 2017 is 360 too many, and we all must do everything that we can to ensure that those numbers start coming down. As the Chair of the committee quite rightly pointed out, the statistics are absolutely going in the wrong direction, and that should be a cause of alarm for each and every one of us. And I don't think that it's any coincidence that, at the same time as those statistics going in the wrong direction, we've also seen a lengthening of waiting times for people getting access to talking therapies, and problems with mental health services in different parts of Wales as well.

I was very struck by the comments about the farming industry. I can remember inviting Tir Dewi to come in to give evidence to the cross-party group on faith about their work, because I know that they are an organisation that is inspired, effectively, by the Christian faith of those volunteers who engage with it. I was alarmed at some of the individual stories that they shared at that cross-party group just about the challenges—the unique challenges, really—that many in the farming community face. And I think it is absolutely right that the committee has highlighted this in this important inquiry report and the need to have some focus on the farming industry going forward.

I'm also pleased to see the references to building design in the report. I can remember visiting a mental health unit at Glan Clwyd Hospital around two and a half years ago with the current mental health director, not long after he started in his post, and I was absolutely appalled to see that there were many ligature points, even in that mental health ward where people are sectioned because, sometimes, they're at such a point of crisis that they're thinking about taking their own lives. And I was astonished that these were things that had not been addressed in that building design, despite the fact that that was a health board that was in special measures for mental health purposes. So, clearly, there's an awful lot of work to do within our own public health service estate in addition to, of course, retrofitting buildings and dealing with any new building applications that come through, and making sure that the planning system adequately considers these sorts of things as we go forward.

I think it's quite right that the report also highlighted the need to address the ongoing stigma that there is in relation to those with mental health not feeling as though they are able to talk about the things that they are encountering. I think that the statistics that Mind Cymru and Hafal have highlighted, which say that 40 per cent of employees are reluctant to discuss their mental health with their employer, are pretty stark. But, what's really awful is that fewer than four in 10 employees would consider hiring someone if they knew that they had a mental health problem. That is shameful. We've got to address this sort of prejudice in our society and amongst the workforce. I think that, yes, quite rightly, the Welsh Government, the National Assembly for Wales and other public services have got to show some leadership on this. But, somehow, we've also got to reach out to employers across Wales and make sure that they are also engaging positively with the workforce. I think that we can look at public sector contracts with private suppliers, whether they be supplying parts of the workforce or goods and services, to see what they are doing, frankly, to ensure the positive mental health and well-being of the workforces that they employ.

So, I want to commend this report to the Senedd. I was very pleased to see the recommendations—pleased to see many of the positive things that the Government had said in response to those recommendations. But, I think that we do need to continue to have a focus on this issue on a cross-party basis, so that we can reduce this problem, reduce this prevalence of suicide, with so many needless lives actually lost.   

I really do believe that suicide prevention is everybody's business and everybody's opportunity. I'd love to speak about every recommendation but, given the time constraints, I will focus on two areas. The first is particularly close to my heart—young suicide and the overlap between this report and the Children, Young People and Education Committee's 'Mind over matter' report, because the two are inextricably linked. Suicide is the leading cause of death for young people aged 15 to 19. More than 200 children die by suicide every year in the UK. In 2017, 226 children died by suicide. That is a national scandal. As Papyrus told our inquiry, if Ebola or HIV or any other disease was killing 200 schoolchildren a year, we would be throwing millions of pounds at it. I agree. The findings of 'Mind over matter’ were clear. The urgent challenge now lies at the preventative end of the pathway, with emotional well-being, resilience and early intervention.

The parable of the river feels more relevant now than ever. I’m sure some of you know it, but to summarise: one night, villagers were sitting by their riverbank, about to eat, when one villager noticed a young child floating upside down and drifting down the river. Several villagers jumped up, dived in and tried to rescue the child. It was too late. A short while later, another young child was noticed, coughing and screaming as it struggled to stay afloat. This time, the villagers were luckier and the child, although bruised and battered, lived. This turn of events continued, and the frequency with which the villagers had to rescue children from the river increased—sometimes successful, but not always guaranteed. Soon all the resources and people power of the village were directed at saving as many children as they could. This occupied the villagers constantly, and other endeavours that they'd previously pursued had to be forgotten. This was accepted because it was a worthy cause. One day, two villagers began to walk away from the village, heading upstream. They were questioned, 'Where are you going? We need you here to help save the children.' The villagers replied, 'We’re going upstream to find out why those children have ended up in the river in the first place.'

That is absolutely where I believe we need to be—upstream, before young people fall in that river in the first place. That’s why I am delighted that 'Everybody’s Business' wholeheartedly endorses the recommendations in 'Mind over matter', which aim to do just that. It is the first time that one committee report has fully endorsed and supported another in this way, and I'd like to thank Dai Lloyd for the collegiate way that he leads the health committee and for the constructive partnership that has developed between our two committees on the fundamental issue of our nation’s mental health. Because it is not just young people who will benefit from the recommendations of 'Mind over matter'—they set out a road map for developing resilience for all.

We've heard today about the scale of the challenge with male suicide. It is the leading cause of death for men under the age of 45. It is without any shadow of a doubt a public health emergency. Yet, most men who die by suicide have no previous contact with mental health services before their death. So, how do we reach them? With half of all mental health problems beginning in childhood, Samaritans Cymru have told us that developing resilience and early intervention in schools has a major role to play in preventing male suicide. I agree.

Myself and other committee members will continue to hold Welsh Government’s feet to the fire on progress with 'Mind over matter'. But in the meantime, we still need to pull young people from the river. So, I was really disappointed that the recommendations made in 'Mind over matter' and repeated, in full, nearly a year later in this report on the need to issue urgent guidance to schools on talking about suicide, are only accepted in principle again. 

Now, I really welcome the work that has been done to prepare guidance for schools by the brilliant Professor Ann John, but I am deeply concerned that Welsh Government has not made any commitment to making this guidance statutory. Talking about suicide does not cause suicide. Talking about suicide saves lives. Every day lost on this is a day when we could potentially see another child die by suicide as, indeed, we have done since 'Mind over matter' was published. It simply cannot wait until we have implemented the other reforms.

To lose someone you love to suicide is a uniquely devastating loss. People bereaved by suicide are themselves at much higher risk of themselves dying by suicide. So, I was disappointed that recommendation 15 on support for those bereaved by suicide was only accepted in principle. During the inquiry, we met a group of relatives at the Jacob Abraham Foundation, all of whom had lost sons, husbands, fathers to suicide. One lady had lost her two sons to suicide—a heartbreaking reminder of the risk that suicide bereavement poses. Shockingly, not one of those families had received any specialist support, apart from the support offered by the foundation, which receives no statutory funds and is operating on a hand-to-mouth basis. Minister, I don’t need another review to tell me that suicide bereavement support in Wales is woefully inadequate and that we need to address it urgently.

In conclusion, I know that both the health committee and my committee are asking a lot of Government on mental health, and I make no apologies for that. I also acknowledge both this Minister and the Minister for Education's commitment to the new task and finish group to deliver the 'Mind over matter' recommendations. Welsh Government regularly reminds us that mental health is a priority in 'Prosperity for All', but we are still not seeing sufficient evidence of that on the ground. It is time for Welsh Government to make parity between mental and physical health a reality in Wales.

I wasn't, of course, a member of the committee when the evidence was received, and I want to begin my contribution to this debate by expressing my gratitude to all involved in this very important piece of work—to my fellow committee members, to staff and most of all, of course, to those who gave evidence. This is a wide-ranging and comprehensive report, and as Lynne Neagle has said, I think any one of us contributing to this debate could talk about it for hours. I want to concentrate on just three of the recommendations. 

I want to begin with recommendation 2 around public awareness. It is crucial that we create a climate where suicide is truly understood to be everybody's business. Suicide can affect any family in any community at any time, and it remains incredibly difficult to talk about. There is still shame, there is still stigma, and there absolutely should not be. We all need to be aware when those around us may feel isolated, lonely and desperate, we need to be ready to ask when someone is okay, and to listen, to really listen to their reply, and perhaps most of all to what they do not say. 

And we need more openness, and it is in this spirit that I share with this Chamber today the fact that my own family is one of those that has been affected. When I was a very little girl, my cousin David, who was in his late teens, took his own life. I chiefly remember him just suddenly not being there any more, and when I asked where he was, being told to shush. What had happened was never spoken of, and it was years until I really knew. What I did know was that my much loved aunt was never the same again.

Now, that, of course, was many years ago, and much has changed, but not enough. And this brings me to recommendation 15 and the others that refer to the need to provide services for the bereaved. I want to associate myself with every word that Lynne Neagle has just said. Of course, in the 1960s, when we lost my cousin, there was nothing. My aunt was never supported to address the terrible grief and the complex emotions that those bereaved by suicide experience, and this is not surprising. What is surprising and, indeed, is shocking, is that today, many families affected by suicide are still unable to access any bereavement support, let alone the specialist suicide bereavement support that they need and to which they should be entitled. The committee heard of excellent examples of good practice, but Members describe themselves in the report as 'staggered' at the lack of support still available to those bereaved by suicide, and I am staggered too. This cannot stand. Such support does not need to be expensive, but the cost to those who do not receive the help is incalculable. Welsh Government, with appropriate agencies, must ensure that appropriate bereavement support is available to all those who need it, when they need it, in a form that works for them, all over Wales. Specifically, they need to support the third sector organisations who excel in this regard. And I have to say, as Lynne Neagle has said to the Minister, that in this regard, acceptance in principle is not enough. Too often, acceptance in principle means kicking this into the long grass. I very much hope that is not the Minister's intention, and I would ask him today to review that acceptance in principle and turn it today into an acceptance in full.

I finally want to turn briefly to recommendation 18, which calls on the Welsh Government to recognise male suicide as a national priority. It is beyond doubt that the sexist stereotypes around acceptable masculine behaviour contribute directly to the very high suicide rate in men. Society still does not encourage men and boys to be open about their vulnerabilities—weakness is still frowned on. Most of us are conscious of the negative effects that sexism and patriarchal norms have on the lives of women and girls. We need to remember that this sexism, these patriarchal norms, are sometimes literally fatal to men and boys too. Recommendation 18 calls on the Welsh Government to allocate appropriate funding and to implement new approaches, encouraging men to talk about their mental health and seek help. The Welsh Government needs to act. But there is one thing that we could all do. Let's all commit today never again to say to a little boy, 'Big boys don't cry.'

The Welsh Government's overall positive response to this committee's recommendations are welcome on the whole, but there is a need for urgency, as Dai Lloyd and Lynne Neagle and others have said. We must none of us rest until Wales is suicide free. The committee will closely scrutinise the Government's delivery on this vital agenda, and I will be privileged to take part in that work.

I want to begin today by welcoming this report and the hard work the committee has done on this issue, and I also echo the comments made by Members from across the Chamber this afternoon. It's about time that we are debating this extremely important issue within this Senedd Chamber, and in preparation for my contribution today, I thought I'd go back to something that myself and mum stumbled across when we were going through dad's clothes after his sad death. Whenever we used to look in his suit jackets, we often found a pen that wasn't working, broken glasses or a white ribbon. But on this occasion, we found a piece of paper, a menu from a town council ball in Connah's Quay, and on the back it had written these words that he was going to make his speech based on: 'Edrych ar ôl ein gilydd'—look after each other.

Deputy Llywydd, in that spirit, I want to focus my contribution to this debate today. Nothing can prepare you for the lasting impact of suicide. It's devastating and the effects on family members and loved ones can be severe and far reaching. The ripple effect in particular hits you—it hits me. It's impacted close friends as well as friends of friends, and many of my friends looked up to my dad as their second dad. Some days, these ripples will be small, and sometimes we make progress. And other days, I struggle to get out of bed.

Unfortunately, friends and family of those who've committed suicide experience impacts on their own mental health. Learning that you've lost someone you love through suicide is traumatic enough. Personally, I can say that you do begin to have other feelings, and those feelings impact your own health and well-being—the feeling of guilt, anger, confusion, distress over unresolved issues and many, many more—all of which I know have had a long-term effect on me and will continue to do so. And I know they have a long-term effect on others in many different ways as well.

It's extremely shocking that statistics in 2017 show that 360 people took their own lives in Wales alone, and it's a horrible feeling that my dad is one of those 360. It's terrifying that thousands of others have had suicidal thoughts. As Members know, I try to speak openly about this issue, because I know there are others suffering in silence. No matter how hard it is, I will continue to speak out. It's what dad would've wanted; it's what he would've done.

Deputy Llywydd, I must pay tribute to Abbie Penell from Pontypridd who was recently in the news for speaking about the impacts of suicide following her father's suicide. And she was completely right about the need for support of those bereaved by suicide, and I must say I respect her bravery.

Deputy Llywydd, I'm going to finish by saying the words Dai Lloyd said earlier: suicide is everybody's business. We must all do more to support each other. We must all do more to prevent suicide. I do not want another family to go through what we're continuing to go through. So, let me take you back to the start of my speech, let's remember those words that dad had on that piece of paper in his suit jacket: Edrych ar ôl ein gilydd. Look after each other. Diolch, Deputy Llywydd.

Well, Deputy Presiding Officer, I think in all the years that I've been in public life, I've never felt more inadequate in rising to my feet to take part in a debate, following that powerful speech from Jack Sargeant, because none of us can, of course, compare in experience or knowledge with him—tragic as it is that I have to say that. I've been touched by suicide tangentially, but never directly, and it is a terrible, terrible thing, made all the more powerful, I think, by the way in which Jack described the impact of this upon his family.

A very close friend of mine's wife, from university days, just before Christmas, committed suicide out of the blue, and I know what a devastating impact this has upon everybody around. Jack was absolutely right in saying that it affects not just the immediate family, but also the wider circle of friends as well. And it's difficult to imagine, actually, the black place that somebody is in, feeling so desperate that this is the only way out, and it touches everybody's hearts, I think, just even to think about it. And I've been in some black places in my life too. I've been falsely accused of sexual misdemeanours and found myself on the front pages of newspapers and the lead item in news bulletins,  and I know the pressure and impact that can have upon you. I was never tempted down the suicide route, but I have personally experienced a sense of loneliness and desperation, and I think it's that loneliness that lies at the heart of this whole problem. As Jack very well said, we need to look after each other in this respect. It's only when people feel that there is nobody to whom they can turn, for whatever reason—. I think Helen Mary Jones again hit a nail on the head in what she said particularly in respect of men, that we are—at least, certainly men of my generation—much too buttoned up. I find no difficulty in expressing myself in public, but I have to say, on emotionally related issues, I find the greatest difficulty in opening up in private, in circumstances where it would be to my benefit to do so. And I'm far from alone in that. So, it is vital that we do as much as we possibly can to take away what remaining stigma there is relating to suicide or suicidal thoughts. We've come a very long way since the Mental Health Act of 1959, before which anybody with some kind of mental illness was described officially as a moral and mental imbecile. There is, of course, a much greater understanding in society today than there was in the world into which I was born, but we still have a very, very long way to go, and Government has a very important role, I think, in this respect, and particularly, as Helen Mary pointed out, in respect of men. Indeed, Dai Lloyd, in his opening speech, also pointed out that middle-aged men in particular, we discovered—. I wasn't, sadly, a member of the committee when the evidence was taken, but I've read with great interest the report and a lot of the documents around it. There is a particular problem with men, and I think the more people of my generation are able to talk about it in public, then it may help somebody.

The roles of charities and the third sector in all of this is absolutely vital as well. In a world of family break-up, very often the man is forgotten about because women are overwhelmingly the victims of domestic violence, but men can sometimes also be the victims of domestic violence. Where families break up and children are taken away, then that also is often a cause of suicide amongst men, which perhaps needs more attention. I have had, as many Members have had, contact with a charity called Both Parents Matter, which has drawn this to my attention, which is why I mention it in the course of this debate today. It is important, without depreciating in any way the importance of looking after women in these circumstances, for us also to remember that men can sometimes be victims too. 

It is a tragedy and perhaps an indictment of society today that suicide is on the increase. It's a paradox, isn't it, that in a world of global communication and instant communication, and in an increasingly urbanised world, people can actually feel lonelier than ever? We have to do all that we can, every one of us in public life, to ensure that we reduce the stigma and maximise the help that can be given to people who are so desperate that they are tempted to take their own lives.

Someone came to see me in a surgery last week, as it happens—a mother who was grieving for her daughter following suicide. She was in grief, and she was asking 'Why?' Why couldn’t more have been done to help her? Why were those things that were obvious to her now as signs that her daughter’s life was in danger not obvious to her at the time? She had been in contact with mental health services. The mother said that she’d tried to take her own life once. Three weeks later, she was offered a mental health consultation over the phone.

This isn't the first time that I've sat in a room with a family who were grieving in similar circumstances since my election, and far too many mothers and fathers, brothers and sisters, children, friends are also asking 'Why?' And that’s what we as a committee did, and I was shocked in taking part in this inquiry. Each of us was. We heard the reports of those who have suffered the impacts of suicide. We received evidence on the steps that could be taken here in Wales to respond to this national crisis. I do recognise that there is work being done by Government, but this is what we are facing—a crisis, no less. Suicide is the main cause of death in young men in Wales, as we've already heard; the main cause of death in those under 35. It emerges from something that is preventable. If it were a physical illness, as we've already heard, then everything would be thrown at it to ensure that people are given the support that they need, but at the moment that simply isn't the case.

We need to raise awareness, therefore, about the issues related to suicide. We need greater training, we need better quality training, we need clearer pathways through the health system to assist those who are at risk of suicide. But from my point of view, what is central to the recommendations is that the Welsh Government needs to take all possible steps to ensure that there is equality between the provision of healthcare and mental health care. I hear far too often from constituents about the difficulties they face in accessing mental health services. Often, it includes difficulties in accessing children and young people’s mental health services, and this has to change. We must do more to encourage people to seek the support that they need and to look for that support at an early stage. We need to raise awareness of the kind of support that is available before they get to that crisis point.

I hear too often of vulnerable people who are being turned away from services when they do seek out those services—hearing, perhaps, that their mental health condition is not considered to be sufficiently serious. There was a recent case in Anglesey over Christmas: a young boy had completed a suicide, although he went to hospital seeking help. Unfortunately, there was no bed available for him. He was considered not to need that support and he himself decided what he needed to do in order to deal with his pain. And it was a very severe blow to that community—a community that has responded by coming together and identifying that suicide, as we’re discussing today, is everyone’s business. I’m very pleased to see the response of organisations such as the young farmers, individuals such as Laura Burton from the Time to Change Wales movement, which have responded by deciding to spread that message within our communities on the impacts of suicide and the factors that can contribute to it, and there is a role for us all to play in safeguarding and helping each other.

Those who have lost someone to suicide are urging us to ensure that no other parent, partner or child should suffer as they have suffered. We’ve heard that appeal from Jack again this afternoon. Yes, we talk more about mental health these days than we have done in the past, and that is a positive step. There’s no doubt about that in terms of dealing with that stigma surrounding mental health, but there is a long, long way to go. A quarter of the population, as we often hear bandied about as a statistic, will suffer some sort of mental health problem during their lifetime. We all know somebody who has been affected, and we ourselves can be affected at any time too. So, we must continue to talk about mental health and we must talk about suicide, but we must also remember that that talk has to go hand in hand with action.

Can I place on record my thanks to everyone who gave evidence in this inquiry, recognising how difficult it must have been for so many of them? During our wide-ranging work on the health committee, we do consider some difficult issues. We've dealt with families living with dementia, the use of antipsychotic drugs, the challenges of isolation and loneliness, to name just a few, but I found the inquiry on suicide prevention to be the most challenging and at times the most harrowing of these experiences. Indeed, at the time that we decided to undertake the inquiry, as we know, and as Jack has so powerfully spoken about today, we in this very place have been directly touched by the tragedy of suicide, so I'm aware of how close the subject is to all of us.

For me, one of the key messages from the inquiry was the need for increased awareness. That became clear after listening to accounts of bereaved parents, children, husbands, wives, sisters, brothers—people seeking answers to why their loved ones had taken their own lives. It was simply heartrending. And as a parent myself, I was left with a feeling of such overwhelming sorrow after talking to the parents at the Jacob Abraham Foundation that I couldn't wait to get home that evening to speak to my own two sons to reassure myself that everything in their lives was okay and to make sure that they knew that it was okay to talk to me about anything that was worrying them. And yet, on reflection, it was probably a personal shock for me to also realise how relatively limited my own awareness of suicide was and about how to spot the signs, or to be aware of the techniques for making interventions. I realised that a lack of awareness should be a wake-up call to all of us. Because we heard those families say that when people spoke to them afterwards about the signs, they could see that they were there, but they just didn't know or recognise them or know what to have done. Being aware of those signs is the first step to having the conversation that could prevent a tragedy. I'm mindful of the evidence to the inquiry by the Zero Suicide Alliance who told us there is no easy way to ask someone if they intend to kill themselves, but it won't make it more likely. 

Then, to hear that bereaved families had little or no support in the immediate aftermath of their tragedy, not even access to relevant information on a leaflet giving them practical advice on what to do next—that was also shocking to say the least. So, having invested in support such as 'Help is at hand Cymru', we do need to make sure that that support is available across our primary care services, other public services and third sector organisations, and that people have the knowledge needed to offer practical advice when it's required, because to date this hasn't happened.

For some insights into front-line experience, it was also useful to hear evidence about how the police deal with cases of suicide. I noted the evidence about their existing training programmes. We must build on that kind of experience too. But it did strike me that, while the police have the unenviable job of going to tell a relative of a death by suicide, because no crime has been committed, they spend relatively little or no time talking to or comforting the families, however personally sympathetic they may be. In contrast, however, the police do provide support to families in other circumstances through their family liaison officers if a deceased loved one has been the victim of a crime. So, it was evidence like this that highlighted for me how across the public services we can increasingly help to make sure that suicide is everyone's business and why the report calls on Welsh Government and all partners to focus on addressing causes, providing support and working on prevention. 

Llywydd, while our inquiry was wide ranging and looked at a whole range of suicide statistics, for me, like Lynne Neagle, in the week that we heard the inquest findings of 14-year-old Derek Brundrett from Pembrokeshire who took his life in 2013, suicide by young people came through for me as a particular concern. Young people are impressionable, they're dealing with many changes in their lives, through puberty, schooling, university, moving away from home. They're often not prepared for the pressures that these changes bring with them and they can suffer terribly with low self-esteem and feelings of helplessness and not knowing where to go or who to turn to for help. Despite the evidence suggesting that awareness and discussion is often the best form of prevention, as has previously been mentioned, we also heard that schools are often reluctant to address this and to talk about suicide. 

But most worryingly, when young people do reach out, the level of support that is out there in theory is rarely available in practice at the time that it's needed. We heard about young people who have taken their lives while waiting for counselling support, about GPs being unable to directly access professional advice, about appointments being cancelled because a psychologist or counsellor was off sick. I was struck by the analogy that was given to us about this. It was unlikely, for example, that an appointment would be cancelled if you were a cancer patient who went for your radiotherapy treatment. Someone else would cover it. The parity of esteem argument between physical and mental health was writ large in that example. 

I am, however, satisfied that, between the efforts of Lynne Neagle and the Children, Young People and Education Committee report, 'Mind over matter', and now this report, we are providing the evidence for the continuing case for a step change in our intervention services. It's only by delivering—

Are you winding up, please?

—improved intervention in schools, in colleges, with employers and in the voluntary sector that we can help to make sure that suicide is everyone's business. 

I had the privilege of being a member of the committee whilst the inquiry into suicide prevention was undertaken. I would like to thank the Chair, fellow members of the committee, the clerks and all those who gave evidence over the course of the inquiry. As Dai quite rightly points out in the foreword to the report, the number of deaths by suicide in Wales is truly staggering.

In 2017, 360 people chose to take their own lives, up by almost 12 percent on the previous year while the numbers of deaths by suicide have fallen in other UK nations. The vast majority of those who die by suicide are male. Men are three times more likely to take their own life. We have to ask ourselves why. What are we doing wrong as a nation? During the inquiry one message stood out to me: we have to improve access to psychological therapies. Waiting times for talking therapies can be well over a year, and this is unacceptable. Talking can literally save lives.

We must also overcome the stigma—the stigma surrounding suicide and the stigma relating to mental health. Tomorrow, Time to Change Wales is launching a campaign to tackle the stigma surrounding mental health amongst the male population in Wales. Hundreds of men are dying each year because, as a society, we have perpetuated the myth that admitting you have a mental health problem is a sign of weakness. It is not. This couldn’t be further from the truth. In fact, it demonstrates strength to admit you are suffering. We need to recognise this collectively as a society that treats mental health no differently from physical health. You wouldn’t criticise someone suffering from a broken arm, so why would suffering from depression be treated any differently?

We have to eliminate the highly toxic phrase of ‘man up’ from our collective vocabulary. It forces men to suffer in silence and undoubtedly contributes to increased suicide rates. The Talking is a Lifeline campaign will encourage men to open up about their mental health issues without concerns of feeling judged or embarrassed. Time to Change Wales research found that many men were unable to talk to family and friends because of fear and anxiety about negative consequences.

There should be no negative consequences. Men should be free to talk about their mental health to someone they love, a friend they trust, or their GP. We have to eradicate the stigmas associated with mental health and, to that end, I fully endorse the Time to Change Wales Talking is a Lifeline campaign. Reducing the stigma is the first step, and while government has role to play, Time to Change Wales is best placed to drive the conversation. What Welsh Government can do is ensure that, when someone overcomes the stigma, help and support is immediately available.

I am delighted that the Minister has accepted the committee’s twelfth recommendation. We have to speed up access to psychological therapies. The voluntary sector and organisations, for example the Samaritans, play an irreplaceable part in society, and I know many people who have benefitted and survived dark times in their lives due to them. So, I pay tribute to these volunteers and thank them from the bottom of my heart for being there.

I'd like to say that we have an over-reliance on antidepressant medication. Wales has one of the highest antidepressant prescription rates in western Europe. GPs prescribe enough of these drugs to provide everyone in Wales with a 19-day supply. These drugs are effective for some people, but not for everyone, and can have horrific side effects for many patients. Cognitive behavioural therapy has been shown to be effective and trials have indicated that patients are less likely to relapse once treatment stops.

It’s time to end the stigma and it’s time to improve access to talking therapies. Talking saves lives; let’s be open about our mental health and take an important step towards making Wales a zero-suicide nation. And while we are having the conversation about our mental health, I hope that the Welsh Government makes swift progress in implementing the committee’s 31 recommendations. Diolch yn fawr. 

I'm glad the report was done, and I'm glad to hear that you will be returning to the issue, but there are gaps in the report. I'd like to pay tribute to all the work done in this area. I met with the Jacob Abraham Foundation, and they do brilliant work in Cardiff. 

A constituent wrote to me, to five other AMs and to the Health, Social Care and Sport Committee with quite serious concerns about the Talk to Me national conference. I’ve had messages this morning from constituents, messages this afternoon, a phone call at around 8:00 this morning to discuss the report. Constituents do feel let down by the report. They do not feel that a vulnerable group of men were fully engaged with as they should have been. I’m here speaking on behalf of those people today, and many hidden victims.

Every time I’ve been to a support group meeting—such as Both Parents Matter, for example—I have met people who either have been suicidal or are in fact suicidal, and I recommend that the committee maybe go to such support group meetings and meet with people there.

Hidden domestic abuse of men is a factor in the epidemic of male suicide. As we heard, in 2017, 278 men took their own lives—five a week, almost one a day. As mentioned, it is a staggering statistic, and something must be done when we hear that suicide is the biggest cause of death in men between 20 and 49 years of age.

There is a hidden form of domestic abuse that is permitted in society, and it is that of parental alienation. Many men who come into my office are suffering from emotional abuse and coercive control. Children are used as weapons, and everybody loses. In south Wales, the police refuse to accept such abuse as abuse, and that’s a scandal. What saddens me also—and I say this as a man—is that I see an increasing percentage of mothers facing the same abuse. Justice Wall, in 2003, said that

'parental alienation is a well-recognised phenomenon.'

Well, it should be in the report. I’m going to read a quote from a man in a lot of pain, a father. And he said: ‘Quite simply, severing a relationship between a parent and child is, short of taking somebody’s life, the worst thing one human being can do to another’.

The culture of false allegations, sometimes to get legal aid in the family court arena, is also a killer. I'll read another quote, off another real person: ‘I had my children taken away from me, then 42 allegations were made against me. Suicide seemed the best option. Twice I tried to hang myself, and once I stood on a railway track and the Samaritans talked me off the track’.

Men are criticised for not engaging and not talking about how they feel, but when you are in the family court system, you cannot talk about any suicidal feelings, any emotional turmoil, because that will be used against you to prevent you from seeing your children. And I look forward to the day when criminal justice is dealt with by Wales in a completely different way, especially in the family arena.

In this city, in our capital city of Wales, there is no non-judgmental support for men. Men are always treated as perpetrators, and they are screened. I want to quote a friend of Alex Skeel, a very brave man who took part in a BBC documentary. He was abused by Jordan Worth, the first female to be jailed for coercive control, and he said:

'It doesn't matter what gender they are. A victim is still a victim. An abuser is still an abuser. A victim still hurts whether they are male or female. An abuser is just as nasty whether they are male or female.'

I get messages from people saying that there is nowhere for them to go—and I will wind up now—

Are you winding up? Thank you.

In context, in the last few months, two people have contacted my office to say that our intervention with them stopped them killing themselves. One was a dad. One was a mother. Something must be done. Diolch yn fawr.

Thank you. Can I call the Minister for Health and Social Services, Vaughan Gething?

Thank you, Deputy Presiding Officer. I'd like to start by thanking the committee members for their work in producing the report 'Everybody's Business' on suicide prevention in Wales. And I do welcome today's debate. It's been difficult but important and a step forward in discussing the issue in what, in the main, has been a very mature and sensitive manner, because improving mental health and well-being and preventing suicide continue to be a priority for this Welsh Government.

The recommendations align broadly with those in the midpoint review of the 'Talk to me 2' strategy. Work is already under way with the national advisory group to deliver on these. The report provides further evidence, which will help to shape our programme of work, to maximise its impact on reducing suicide here in Wales.

I was pleased to agree or agree in principle with all of the recommendations, and I will summarise some of the main actions arising out of the inquiry. Members should be aware of the steps we've taken in recent years to improve suicide prevention through 'Talk to me 2'. I remain determined to strengthen our approach to prevent suicide, because, whilst we have come a long way, I recognise that there's still much more that can be done.

I was pleased to announce at the recent national suicide prevention conference the extra £500,000 additional money each year to support the national and regional approaches to help prevent suicide and self-harm. This additional funding will be used in part to recruit a national lead and three regional leads across Wales to co-ordinate and drive that work forward and to support the monitoring and implementation of local plans. However, that funding should not be seen in isolation. Our broader approach to improve mental health and well-being and improve access to services helps to support the aspiration that we all share. We continue to spend more on mental health services than any other part of NHS Wales. Mental health spending is ring-fenced in Wales, and over the last couple of years we've increased funding by a further £20 million to £655 million in this financial year. And that's included funding targeted at improving access for a number of specific areas, including older persons' mental health, child and adolescent mental health services, psychological therapies for adults, community perinatal mental health services and the local primary and mental health support services.

Improving access to out-of-hours and crisis care is a priority for our mental health transformation fund. We've recently committed £1 million for a range of approaches to improve support, including liaison services, crisis support and street triage. And crisis and out-of-hours care have been identified as a priority area for investment in the year ahead. So, we are working with a range of agencies, including the police and local authorities, to determine the most effective approach to target this investment.

The additional £7.1 million a year that I recently announced will build on our previous investment and aims to achieve sustainable improvements to child and adolescent mental health services, but it will also be used to support the whole-school approach to emotional mental health and well-being, because we are confident that a whole-school approach will help to ensure that mental health and well-being become central to the way that schools work and that the school ethos will support the broader mental health and well-being of learners.

And, in response to one of Lynne Neagle's points, I can say that the education Minister and I expect guidance for schools on talking about suicide to be published in April this year. On a separate point, relating to young people rather than children, the education Minister will shortly make an announcement on support for mental health provision within higher education.

Central to our approach with children and young people is having the opportunity to directly feed in their views. So, we're working with Children in Wales and the NHS to convene a youth stakeholder group, which will meet for the first time this month, to work alongside and advise us as activity progresses. As part of our continued effort to improve the knowledge and skills of front-line staff, including GPs, through the implementation of a training framework, we'll include providing information to services to make informed decisions about appropriate training for their needs.

We do recognise the need to ensure appropriate support is available for those bereaved by suicide. There's some challenge about language, and I'm not sure that everyone will understand what 'postvention' means, but we are talking about the support that we do provide. That's why we've committed to a review of existing support and to targeted investment where it is needed, and I expect that there will be further investment needed. That is certainly not being kicked into the long grass. I am committed to improving how we improve support, not whether we should do so, and I recognise the committee's expectations for action to be taken within a reasonable period of time, and not several years of waiting.

This work will include the implementation of the support after suicide pathway and improved awareness-raising of resources, including 'Help is at Hand', and, to be fair, this inquiry has a made a difference in making sure that that is much more easily available online, and in hard copy, to support people who have been bereaved by suicide. We'll undertake an awareness campaign targeted at front-line staff in the public sector, including ambulance staff, GPs and A&E clinicians. The aim is to ensure that front-line services can respond appropriately and sensitively to people in distress.

One of the recommendations in the report was to provide a single point of access to help and support. I was pleased to support the national advisory group with the launch of its new website on 30 January this year. The website aims to improve access to support and enable people to access advice and information. It will include sections for workplaces, children, young people, schools, parents, those who work in health and social care settings, as well as those bereaved through suicide.

Supporting people to talk about mental health problems is the first step to providing appropriate and adequate support. Raising awareness, and tackling stigma and discrimination, are central to 'Together for Mental Health' and 'Talk to me 2', and a theme that many have mentioned in their contributions today. The Welsh Government continues to be a strong supporter of voluntary sector-led campaigns to do just that.

I do understand that people are also concerned about the effect that social media can have on mental health. Our chief medical officer, together with counterparts across the UK, recently published advice that recognised that social media and screen time can be beneficial. However, it also highlights the impact of screen time on healthy child development, such as exercise and sleep, and challenges the industry for a voluntary code of conduct to safeguard children and young people online.

Now, I do recognise the specific links of suicide in the farming community, as we mentioned today in this debate, but also in my appearance before the health committee this morning. It is a feature of our current and future work to improve the practical support available. The committee report also highlighted male suicide as a national priority—again, mentioned by a number of Members. We do recognise the importance of identifying support, and we have a range of programmes already in place to help support men. Phase 3 of the Time to Change Wales anti-stigma campaign, which we jointly fund, has a focus on middle-aged men for the next period. We also provide funding to third sector organisations through section 64 mental health grants to supplement and enhance services already being provided by NHS Wales and local authorities.

Two specific schemes we're currently funding are Men's Sheds, to help address loneliness and isolation, and the Samaritans, who focus on suicide prevention, whilst Government officials will continue to meet regularly with the national advisory group. And now that all regions of Wales have developed their local plans, officials will develop clearer reporting guidelines to monitor implementation of local action alongside national work. We have a serious programme of work that can make a real difference. I look forward to providing further updates on the progress made against the recommendations in this report.

Thank you. Can I now call on Dai Lloyd to reply to the debate?

Diolch, Dirprwy Lywydd. In the few minutes that I have, I'll just concentrate on replying to some of the contributions in what has been a difficult, at times, but very powerful debate. I think this Senedd is at its best, sometimes, when we have to confront issues that are very difficult and challenging for us all, and we manage to debate in a very mature and considerate way with one another, because lots of people have been touched here by suicide. We've had Helen Mary's personal experience, notably Jack Sargeant's obvious personal experience, even with Neil Hamilton, and people coming to see Rhun ap Iorwerth as well, and Lynne Neagle's obvious personal experience and powerful testimony that she provides both in the health committee and in the children and young people's committee. So, we know about suicide.

Professionally, I don't know if I mentioned previously I've been a GP for so many hundreds of years now, and occasionally you get touched by suicide. You have that conversation where somebody vaguely threatens suicide and you try to do something about it, and that's the point. I can't get people into emergency psychiatric hospitals now, whereas 20 years ago I could, you know. I could just ring up, as if you had chest pain. I could get people into hospital. I can no longer do that, and people are saying, 'Where was the GP in all this?' Yes, we understand suicide, and we understand the devastation of it all. That's come through in this very powerful debate. 

And there's some excellent work happening on the ground. We need more of it. That's all we need—more talking therapies. 'Help is at Hand' is wonderful, as is the 'Talk to me 2' series. We need a step change in resourcing. The bereavement support organisations in the voluntary sector are excellent. We need more of them. They need more help, because, as we said, suicide is devastating.

A GP that I knew some years ago in the practice that I am now a GP in killed himself, died by his own hand, and that's never left the practice. That was 18 years ago now, and there's still devastation in the practice that I'm still the GP in—absolute devastation. And people couldn't talk about it for years. Now they're talking about it, because it is suddenly becoming acceptable to talk about these issues, and we're slowly starting to understand that talking about suicide does not make it more likely to happen. There is still that prevailing idea that, if we talk about it, it's likely to happen. That is so utterly wrong.

It is everybody's business, absolutely everybody's business, and I take Carl Sargeant's words to heart: look after each other. Diolch yn fawr. 

Thank you. The proposal is to note the committee's report. Does any Member object? Therefore, the motion is agreed in accordance with Standing Order 12.36. 

Motion agreed in accordance with Standing Order 12.36.