We welcome the opportunity to respond to the Equality, Local Government and Communities Committee inquiry into the impact of the Covid-19 outbreak 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 (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. The ways in which callers talk about these concerns have evolved during the pandemic – from being physical health-related (about the virus/COVID-19 itself) at the beginning to being focused on the economic, social and mental health-related impacts of lockdown as restrictions continue. In the first month of lockdown, callers’ worries were particularly focused on accessing essentials (e.g. food, medicine) and benefits. Since the pandemic began, many callers have been worried about losing their job and/or business as well as being furloughed. In the second month of lockdown, some volunteers also reported an increase in calls from people for whom those worries have materialised. Common themes include not being able pay rent/mortgage, financial help from the government not being enough, and fear of homelessness. As lockdown continues, some callers are concerned about the pressure to go back to work when they don’t feel safe to do so. (Source: Samaritans volunteer survey)

There isn’t currently sufficient evidence to demonstrate the link between the pandemic and increased suicide rates in Wales. It’s likely, however, that the pandemic will have a profound impact on the mental health of the nation, and there are a number of predictable risks associated with Covid-19. The pandemic isn’t likely to have an equal impact, and some groups are likely to be disproportionately affected as existing inequalities are exacerbated. Currently, thoughts of death or self-harm are relatively stable but are higher amongst younger people and those living alone, with low household income, with a mental health condition, and living in urban areas. (source, UCL study).  

Financial hardship and socio-economic disadvantage are well-recognised risk factors for suicide. Coronavirus is having a huge impact on people's lives, with many people facing furloughing and job loss.  We know that job loss is often connected to a downturn in wellbeing. The sudden change often leaves people more disconnected and unsure of what to do with their time. Job loss is often a 'critical point' where emotional support should and needs to be offered.     

We know that people who are unemployed are two to three times more likely to die by suicide than those in employment. Long-term unemployment is particularly associated with suicide risk. One fifth (19.70%) of people surveyed who identified as unemployed have had suicidal thoughts and feelings – this is compared to 8.64% of people in employment.1

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 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 Welsh Government should support low income middle-aged men   

Short term: The next Government should fund community-based support services to innovate and expand their offer where possible according to the needs of service users, using digital and physical outreach (when possible within the regulations) to ensure that men at increased risk of suicide are not isolated  

Medium term: Government should mitigate key risk factors for this group through targeted practical support and specific schemes to provide financial security and help people back into work where necessary   

Forced isolation and disconnection from support networks is likely to exacerbate problems for these men, who recent Samaritans research found to be socially disconnected and struggling with feelings of suicidality for many years without any form of support   

Job loss and problem debt, connected to a widely predicted forthcoming recession, are key risk factors specifically for this group. Middle aged male mental health patients, especially those unemployed or suffering with addiction issues, were found to be at increased risk of suicide during the last recession.   

Recommendation: The Welsh Government should mitigate poverty and its impact on individuals and communities

Short term: The Welsh Government should urgently set out a centralised Wales Poverty Strategy which promotes consistent cross-governmental and cross-sectoral involvement to tackle poverty 

Suicide is a major inequality issue. There is overwhelming evidence of a strong connection between socioeconomic disadvantage and suicidal behaviour. However, while economic downturn is considered to be an inevitable result of the pandemic, suicide is not. The Welsh Government must act with urgency to prevent future suicides linked to job loss, financial hardship and deprivation. 

Medium term: The Welsh Government should establish non-stigmatising labour market programmes  

Social and employment protection for the most vulnerable in society, and labour market programmes to help unemployed people find work, can reduce suicidal behaviour by reducing both the real and perceived risks of job insecurity and by increasing protective factors, such as social contact. In order to be effective, however, programmes must be meaningful to participants and felt to be non-stigmatising. 

It's vital that all suicide prevention plans recognise the importance of supporting a compassionate response to distress, building resilience and recognising and building on the capabilities of individuals and communities. We must recognise the importance of not medicalising the distress people may feel as a result of job loss. It’s natural that people will feel anxious or unsure during these challenging times. Most people feel a desire to contribute. When individuals feel they’re unable to play an active role in society they can feel extremely isolated and lose their sense of belongingness. It is well evidenced that a lack of belonginess and social connectedness increases risk of suicidal feeling.2

Recommendation: The Welsh Government should support people who are lonely  

Short term: We need to understand more about who is feeling lonely, who is isolated and who is feeling unable to cope during social distancing measures. While the Welsh Government has identified the most vulnerable from a physical point of view, a similar exercise is needed for people struggling emotionally   

According to a recent Public Health Wales survey of Welsh adults, over a third said they had feelings of loneliness in the “past week’’.3 Unfortunately, we know that there exists an association between suicide and loneliness. While physical isolation is a necessary outcome of the lockdown restrictions, loneliness doesn’t have to be.   

Recommendation: The next Welsh Government should collect 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

More must be understood around the trends and prevalence of suicide, and will help identify at-risk groups and help inform suicide prevention measures. 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.