8th September 2023
To mark #WorldSuicidePreventionDay on 10 September, and to highlight the vital role that health visitors play in suicide prevention in the perinatal period, we are delighted to share this Voices blog by Emily Rounds, Professional Development Officer, Perinatal and Infant Mental Health at the iHV.
Suicide is a significant public health issue which affects all age groups and communities. For a person contemplating suicide, the challenges they face are unimaginable, while losing a loved one to suicide can be an extremely painful, emotionally complex experience.
In the UK, suicide is the leading cause of direct maternal deaths within a year after the end of pregnancy1, and remains the greatest cause of death in men under 50 years of age2. Disparities in the identification, diagnosis and treatment of maternal mental health conditions for black, asian and other racialised minority communities are reflected in the maternal mortality rates, which are almost four times higher amongst women from black ethnic backgrounds, and almost two times higher amongst women from asian ethnic backgrounds, compared to white women. The rising rates of teenage suicide in the perinatal period is a significant concern, alongside the increasing impact of deprivation and severe and multiple disadvantage1. Suicide and attempted suicide are also higher amongst other marginalised groups, including people who are disabled, and people who are LGBTQI+3,4.
Scotland has the highest rates of suicide in the UK. People living in Scotland’s most deprived areas remain more than three times more likely to die by suicide than those living in the least deprived areas5. Earlier this year, Scotland published priorities for year one of their Suicide Prevention Strategy6 Creating Hope Together: 2022-2025. The strategy is an action plan to reduce the number of suicide deaths in Scotland, whilst tackling the inequalities which contribute to suicide. This fresh approach draws on levers across national and local government to address the underlying social issues that can cause people to feel suicidal, while making sure the right support is there for them and their families. The strategy calls for all sectors to come together in partnership, and support communities to become safe, compassionate, inclusive, and free of stigma. It aims to help people at the earliest possible opportunity and promote wellbeing and recovery through an integrated provision of effective, timely, compassionate support.
The strategy includes a number of new approaches to suicide prevention, including:
- Widening support to anyone affected by suicide
- Investing in peer support to help guide wellbeing and recovery
- Focusing on safety planning for those experiencing suicidal thoughts
- Improving the way services identify, assess, and care for someone who is suicidal
- Prioritising work on reaching people with heightened risk of suicide
- Bringing insights on poverty and marginalised groups into work
- Focusing on the particular needs of children and young people, and working alongside them to meet their needs
- Working with the media to support responsible media reporting
Health visitors have a significant role in preventing suicide in the perinatal period. They are skilled in holistic assessment and establishing trusting, therapeutic relationships with families that enable disclosure of need and ensure effective identification of the most appropriate support, intervention or treatment. This includes the identification of ‘red flags’ and risk of suicide.
Complementing Scotland’s Suicide Prevention Strategy, MBRRACE1 has recently released new Parental Red Flags for Suicide, so that parents have an increased awareness of what to look out for, and are encouraged to seek advice from healthcare professionals when they notice any of the following:
- Do you have new feelings or thoughts that you have never had before, which make you disturbed or anxious?
- Are you experiencing thoughts of suicide or harming yourself in violent ways?
- Are you having severe struggles to sleep?
- Are you feeling incompetent, as though you can’t cope, or estranged from your baby? Are these feelings persistent?
- Do you feel you are getting worse?
Health visitors can feel confident that, by asking parents sensitively and directly if they are experiencing thoughts of self-harm or suicide, they will not trigger someone to harm themselves. Remember:
- New expressions or acts of violent self-harm; new or persistent expressions of incompetency as a mother or estrangement from the infant; and recent significant change in mental state or emergence of new symptoms are ‘red flag’ symptoms. Take them seriously.
- Be aware of the significant negative impact that sleep disturbance and stigma can have on perinatal mental health.
- Recognise the complexity and multiple challenges facing each parent that you care for, including any history of trauma.
- Pre-birth and post-birth care is vital.
- Ensure that mechanisms are in place to prevent parents falling through the gaps between services. For example: continuity of care; personalised practice; robust information sharing between services, particularly at service transition points.
- Keep your knowledge, skills and confidence in promoting perinatal mental health up to date and ensure you practice safely by engaging in regular supervision and continuous professional development.
- Be the person to notice, hear and act.
(Adapted from MBRRACE guidance, 20221).
If you are thinking about suicide, help is available. Call 116 123 or text SHOUT to 85258.
If you or someone you know is in immediate danger, the quickest way to get help is to call an ambulance on 999.
Since this blog was published, the Government published its Suicide prevention strategy for England : 2023 to 2028.
This strategy outlines the actions required to provide tailored and targeted support to priority groups, and includes a much needed focus on pregnant women and new mothers. The strategy announces the planned launch of bereavement services by 2024 to support families who have experienced baby loss, and affirms the significant role which health visitors play in suicide prevention for all mothers and families.
Emily Rounds, Professional Development Officer, Perinatal and Infant Mental Health at the iHV
- MBRRACE 2022 Knight M, Bunch K, Kelly T et al, eds, on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care: Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2018-20. 2022; Oxford: National Perinatal Epidemiology Unit, University of Oxford Available from: https://bit.ly/3oQ1odu [Accessed 04.09.23]
- Office for National Statistics (ONS) Suicides in the UK: 2018 registrations. Registered deaths in the UK from suicide analysed by sex, age, area of usual residence of the deceased and suicide method. 2019 [accessed 04.09.23]. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/suicidesintheunitedkingdom/2018registrations#suicides-in-the-uk
- Office for National Statistics (ONS 2021). Sociodemographic inequalities in suicides in England and Wales: 2011 to 2021. 2021. [Accessed 04.09.23] Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthinequalities/bulletins/sociodemographicinequalitiesinsuicidesinenglandandwales/2011to2021
- Stonewall. LGBT in Britain – Health. 2018. [Accessed 04.09.23]. Available from: https://www.stonewall.org.uk/lgbt-britain-health
- Office for National Statistics (ONS), released 06 September 2022, ONS website, statistical bulletin, Suicides in England and Wales: 2021 registrations.
- Scottish Government. Creating Hope Together: Scotland’s Suicide Prevention Strategy 2022-2032. 2022. [Accessed 04.09.23]. Available from: https://www.gov.scot/publications/creating-hope-together-scotlands-suicide-prevention-strategy-2022-2032/