3. Will the First Minister provide an update on Welsh Government efforts to tackle self-harm in Wales? OAQ55171

I thank the Member for that. The causes of self-harm are complex and require a multi-agency response. We continue to work with a range of partners to reduce self-harm in Wales as we take forward the actions set out in the 'Talk to me 2' strategy and the recently published 'Together for Mental Health Delivery Plan'.

I thank the First Minister for that reply. The First Minister will know that the incidence of self-harm is massively enhanced by those who suffer adverse experiences in childhood. That can be neglect or it can be abuse—whether it's physical abuse, emotional abuse or sexual abuse—or household dysfunction, which can include all sorts of things, like things that happen in a broken home or the imprisonment of close family members and even things like divorce. Public Health Wales has produced figures that show that those who suffer four or more of these adverse childhood experiences are 10 times more likely to have felt suicidal or to have suffered from self-harm, and where there are six or more of these adverse childhood experiences, then the risk of suicide is enhanced by a massive 35 times.

He'll be aware that the WAVE Trust is a charity that deals with these kinds of problems, and that they have proposed the introduction of a target for the Welsh Government to reduce the incidence of ACEs by 70 per cent by 2030. Every single Member of this Assembly, apart from Government Ministers, has signed up to this—with the exception of the Minister for Education, who has signed up to it—does he think that we're all wrong? Would it not be an advantage to able to have a target? Because although one accepts the Government don't always meet their targets, it's often not their fault that they fail to meet them. But nevertheless, a target is important to aim at and gives a greater urgency to the solution of the problems that we all want to deal with. 

I thank the Member for that. Those are all important points and, certainly, the Welsh Government's approach to trying to reduce incidence of self-harm has three main components to it: tackling adverse childhood experience is one of them; the whole-school approach that we have to dealing with young people in the school setting who report self-harm; and tackling mental health stigma, which also has such a big impact on young people who feel themselves to be in a difficult mental health position, and where self-harm can be the result.

Is a target the best way to focus attention on it? I'm only in favour of targets where they are genuinely specific, measurable, achievable, realistic and timely, and where other ways of making a difference have been attempted and have been found not to be effective. So many different things are counted within the adverse childhood experience ambit; a fraction of them are devolved and in the hands of the Welsh Government. A target over which you have so little control as to whether or not it can be achieved, I think, is of doubtful value.

I want to see adverse childhood experiences reduced, of course. That's why we have invested in this area, that's why we have set up a source of expertise in this area; to make sure that those professionals who come into contact with children understand what those young people might have gone through and respond to it in the right way. Setting a target—I'm yet to be convinced that it would make the difference that we all want to see made.

First Minister, in the first eight weeks of this year, I've already dealt with four different sets of parents who have come to me bereft, in tears, not knowing what to do, because their child has started to self-harm or has been self-harming for some time. And of course, it is sometimes a precursor leading into eating disorders, and so on. What seems to be very difficult for them to find is real support, understanding and comprehension, so they go to the internet to try to read up about it. I've pointed them and signposted them to charities that I know of. I appreciate that there's a lot done in schools and in the school setting to educate the children. We wait for child and adolescent mental health services to come and step in, or we wait for other mental health interventions.

But I wondered if your Government might turn its mind to reviewing and seeing if we can improve the support that parents and carers can receive. Because it is a very unknown minefield for so many of them, and they are terrified; they don't want to say the wrong thing, to encourage it by mistake, to say, 'Come on, let's have something', and for it to lead to worse and worse and worse sadness in the young child or the young person, and to greater mental health issues. So, more support for parents, or more easily-accessible support, because even with the resources I have in the Assembly, I'm still not clear of all of the opportunities there are to support parents and carers.

Llywydd, I entirely agree with what Angela Burns has said about the distress that parents feel when trying to deal with a young person who exhibits these sorts of difficulties, and the sense of powerlessness and not knowing how best to help, and so on. It is part of the reason why we're putting an extra £0.5 million this year into addressing issues of suicide and self-harm; because suicide and self-harm, to remind us all of the title of the committee report in this area, is 'Everybody's Business'. That means finding ways in which parents and carers can be helped, so that they can feel more confident in either assisting young people directly or signposting them to other sources of help.

We are also sponsoring Swansea University, Llywydd, since December of last year, in a new study to look at services that have had significant contact with young people before those young people have a tendency to self-harm, to see whether there was anything we could do in that preventative way, as we talk about here—trying to plug things in earlier in the system so that young people don't find themselves in that position. That involves improving the skills of staff, but it can also be a way of making sure that parents have access to information that they themselves need, but also the practical ways in which they themselves could be of more help. Because that's generally what parents are looking for: what more can they do. They may need help to do it, but they want not to feel, as they often do, helpless in the face of something awful that is going on inside their own family.

The recent review of deaths of children and young people by suicide and probable suicide identified better management of self-harm in children and young people as a key opportunity for suicide prevention. Now, there is clear National Institute for Health and Care Excellence guidance in place for the management of self-harm, but the review highlights the fact that that needs to be fully implemented across Wales and also audited, particularly in relation to emergency department attendance, psychosocial assessment there, and referral and signposting from such attendances. What more can we do, First Minister, to ensure that all young people get an appropriate service when they're admitted to an accident and emergency department through self-harming in Wales?

I very much agree that the experience that a young person, or anybody who has had an experience of self-harm or attempted suicide, has in an accident and emergency department is really crucial to their ability to make a recovery from that. It is why, over the last five years, we have invested more in specialist mental health presence at the front door of emergency departments, so that people who otherwise spend their time dealing with the physical ailments that come through the door have access to specialist help on the spot when they know they are dealing with an episode that is rooted in unhappiness and mental health causes. And making sure that those staff have access to that specialist help themselves, are trained to identify instances of self-harm, and to be able to respond to that in a supportive way, in a way that doesn't imply blame, that doesn't imply that people are somehow getting in the way of other people who need help more—we've all read the accounts in that report and other places—making sure that we tackle that by training and by additional specialist help at the front door of hospitals are the ways in which we have attempted to strengthen services.