We welcome the opportunity to respond the Health, Social Care and Sport Committee’s inquiry intothe impact of the Covid-19 outbreak, and its management, on health and social care in Wales.

Samaritans Cymru exists to reduce the number of people who die by suicide. Each year, between 300 and 350 people die by suicide in Wales, which is around three times the number killed in road accidents. Every one of these deaths is a tragedy that devastates families, friends and communities.

Samaritans Cymru calls on the Welsh Government to adopt a comprehensive and ambitious workstream for preventing suicides connected to the COVID-19 pandemic. This approach should recognise the far reaching and unprecedented nature of the impact of the Covid-19 crisis and that suicide prevention is a whole population public mental health issue.  The plan should be responsive to emerging evidence and draw on existing strategy and structures. It should recognise the importance of not medicalising distress, of supporting a compassionate response and building resilience, recognising and building on the capabilities of individuals and communities.  It should be informed by what we already know about those who are at greatest risk and those actions which are the most effective mitigations.

In the six weeks since lockdown began, we have provided emotional support nearly 400,000 times. Callers have mentioned COVID-19 specifically in 1 in 3 emotional support contacts. We are seeing significant caller concerns being expressed around mental health and illness, family and relationships, isolation and loneliness. Volunteers said some of the most common concerns include being unable to access mental health services, reduced coping mechanisms – for instance through the loss of seeing friends, taking part in hobbies or having a consistent routine and strained relationships both from being separated from loved ones or tensions rising in households.  Lack of access to mental health services (e.g. crisis teams, appointments) has been a major theme since the beginning of the lockdown and is causing callers increasing levels of distress. As lockdown is eased, we are hearing additional reports of insufficient and inadequate support. Samaritans helpline has been used as an alternative by some callers (Source, Samaritans volunteer survey).

Volunteers have also told us that callers are concerned about the impact on basic needs such as food, housing and employment. Coronavirus and lockdown is exacerbating callers’ existing conditions – mainly anxiety, but also depression, OCD and others too.  Levels of expressed suicidality in our callers appear to have remained steady but anxiety has risen, with more callers talking to us about anxiety and the level of anxiety being higher (Source, Samaritans volunteer survey).

At Samaritans Cymru, we believe that preventative action and reaching high-risk groups is vital to minimising the number of people who reach crisis point. Suicide is not inevitable, and preventing suicide needs to be approached with urgency.

Policy recommendations

The Welsh Government must prioritise support for groups already at increased risk of suicide, likely to be especially impacted by social distancing measures and a possible economic recession.  The Welsh Government should also recognise that suicide prevention is a whole population public mental health issue, and early intervention can reduce human, social and economic costs

Samaritans Cymru welcomes the recent Lancet article Suicide risk and prevention during the COVID-19 pandemic. This document identifies a number of priorities which can inform the next Welsh Government, which should also draw on the discussions with the Wales Alliance for Mental Health (WAMH), to form the basis of its response to ensure that as few people as possible die by suicide during and following the pandemic.   

Recommendation: The next Welsh Government should prioritise self-harm 

Short term:  The next Welsh Government and NHS Wales should work together to bolster quality support provided online, by scaling up and fast tracking the development of existing support apps 

Medium term: NHS Wales should provide comprehensive online therapies to deal directly with self-harming behaviour as well as underlying distress  

We are concerned that many people who self-harm may have been left without their usual coping mechanisms and are struggling to access external support. Measures are needed to ensure that particularly vulnerable people are supported throughout the pandemic and beyond.   

Recommendation: The next Welsh Government should ensure remote and digital support is available to those who are struggling

Short term: NHS Wales should increase remote and digital support to:

· Ensure clear remote assessment and care pathways for people who are struggling with their mental health

· Support people who have been bereaved

Medium term: NHS Wales should ensure that evidence-based online interventions and therapies are made available to support people who are suicidal.

It’s possible that existing mental health conditions will be exacerbated by the pandemic and those with poor mental health or a mental health problem may experience a worsening of symptoms as a result of fear, self-isolation and uncertainty. It’s also possible that people may develop new mental health problems, especially depression, anxiety, and post-traumatic stress (all associated with increased suicide risk).³

There is a serious risk that those struggling with their mental health or at crisis point won’t be able to access their usual mental health services and support networks. Poor management of severe and enduring mental health problems during isolation or due to limited access to the usual mental health services or support networks could increase risk of worsening mental health or suicidality. As a result, it’s absolutely vital that remote and digital support is available and accessible for those who are struggling.  

Recommendation: Collecting timely, quality data on suicide

Short term: Real-time surveillance must be rolled out across Wales to understand and effectively respond to emerging trends in suicide linked to COVID-19 in a timely way 

More must be understood around the trends and prevalence of suicide, for example in different ethnic groups, and how these trends are being impacted in relation to COVID-19. Implementing a system of real-time surveillance of suicide data also presents an opportunity for coroners’ records on suspected suicides to be stored digitally, rather than in paper form.