Suicide prevention strategy development: early engagement - summary report

Theme Five -Tackling Stigma

Many survey respondents noted that suicide can be an outcome of poor mental health, and so tackling stigma around mental health alongside suicide should be the focus of any work. It was also suggested that mental health was a public health issue and should be treated on a par with physical health. The following areas that have been identified for consideration are premised on tackling both suicide and mental health.

In tackling stigma, a common point raised was normalising conversations around suicide, mental health, and mental illness. By doing so those who need help would be encouraged to seek support. At the same time, many responses noted concern around normalising, trivialising, or encouraging the act of suicide. Some respondents pointed to recent shows such as “13 Reasons Why” and its depiction and “glorifying” of suicide. There is therefore a balance to be found between these points.

Language

As already indicated, using the right language was believed to be crucial, and likely to be the focus of any advertising or promotional campaign. As well as using appropriate descriptions of suicide, it was suggested that the issue should be described as one of “wellbeing”, rather than “mental health”. The language used to describe other mental health conditions, and general perceptions of these, such as post-traumatic stress disorder and obsessive-compulsive disorder were raised with respondents noting that these are often discussed in a flippant manner that diminishes their seriousness and downplays the damage that they can cause.

More broadly, people have to be empowered to have the right language to talk about suicide and not use euphemisms. It was noted that the media, and social media, have an important role to play in the language they use.

Training and Knowledge Building – especially in schools

The second most discussed theme across the survey and by organisations and individuals was a need for widespread training on how to think and talk about mental health and suicide. Several commentators noted that this should be done from an early age at school to build a “suicide-safe generation”.

Many survey respondents mentioned that NHS staff can appear to be unsympathetic. This could be addressed through more training, perhaps involving individuals with ‘lived experience’.

"Definitely more compassion from NHS professionals when dealing with someone with mental health problems"

"Approach from nurses, admin, support workers is fantastic, however NHS staff can be very abrupt matter of fact and unkind."

Schools were frequently identified as a key location for activities related to tackling stigma. As mentioned above, training for teachers, and others working in school settings, was seen as crucial to this for many respondents. It was noted that good work was ongoing in Personal and Social Education classes in school, but that teachers needed more support and that conversations about mental health should begin at an earlier age. Some respondents suggested that these topics should form part of the school curriculum.

“Start from a younger age so it’s not a stigma”

“Major programme of work to tackle stigma across all sections of society, including use of influencers/celebrities etc. Inclusion of suicide awareness and mental health first aid within the curriculum.”

It was also suggested that if children were more aware of mental health issues, they would be more comfortable talking to their parents about it, in this way spreading the benefits beyond the school into the home. Other educational settings, including universities and colleges, were also highlighted as important locations where children and young people requiring support should be able to access it, with trained individuals available to provide this.

Involve Community Groups

Involving community groups and building their capacity to start conversations that challenge stigma were suggestions proposed in both the workshops and survey. Some suggestions were to include suicide prevention within locality plans, running awareness and outreach sessions with community groups, and seeking out and building on existing work by community groups. The need for consideration and sensitivity of cultural differences was also mentioned. For example, different religious, faith or ethnic groups may talk and think about mental health and suicide in a specific way or indeed not at all. Therefore, it is crucial to engage with these communities directly to find out what language to use to describe these issues and to identify what works within these cultural contexts.

“People are frightened to talk about suicide in case they get it wrong and make things worse.”

Advertising/Promotions/Campaigns

By far the most common area, perhaps unsurprisingly, under the tackling stigma theme was the success of advertising and a call to do more of this. It was suggested that this should be used to promote messages around mental health and suicide including around the language used, encouraging conversations, and how to seek help. Some of the mediums suggested for sharing these messages were TV, posters, promotions at sports and other events, celebrity endorsement, and through social media.

Some organisations tended to argue for more advertising of available local services, while individuals were generally focused on larger national campaigns. However, in both cases there was agreement of the need for a balance between advertising how to help, the support that is available, and generally a greater level of awareness of the issue and how to talk about it. Many described @FCUnited and United to Prevent Suicide, which is discussed below, and also football clubs, such as Motherwell, and other role models and respected figures and institutions promoting positive messages.

Sharing lived experience also featured prominently in discussions of how and what adverts should be shared. This included the families of those who had taken their own lives, survivors, and people who have struggled with their mental health. It was again mentioned that celebrities speaking about their experiences was particularly powerful.

Sharing statistics with the public around suicide and mental health was another suggestion.

“By promoting in the public arena on all fronts, all the simple but effective messages around listening tips and conversations with those we care about and complete strangers that every one of us could engage in.”

Lastly, a number of comments noted that any campaigns should be based on an evaluation of what works.

Media and Social Media

Survey respondents were specifically asked what could, and should, be done around the influence of the media and social media on conversations and perceptions around suicide. This area was also addressed in the workshops, although not asked in the same way.

Traditional Media

In general, traditional media was praised for raising awareness around the issue, for example, celebrity involvement in campaigns and sharing of stories. This was something that it was felt should be encouraged and expanded. Many respondents noted that traditional media had an important role to play, highlighting use of language that can encourage stigma. Several were critical of how mental health problems have been portrayed in Soap Operas, for example, or in the treatment of public figures or celebrities.

It was widely suggested that the media need to be suicide informed, with training targeted in this area. Although the crucial role of the media was recognised, however, there were very few suggestions for other practical steps that could be taken. One suggestion was to:

“Bring the media charter to Scotland; get the Press Complaints Commission to update their regulations in line with the Equality Act 2010 and stigmatising and damaging use of language.”

“One major challenge… is inappropriate and unhelpful reporting of attempted and completed suicide incidents by local press and certain social media groups. We have reported these specific incidents to national Samaritan’s colleagues for review against their media guidelines and we are keen to arrange delivery of a media workshop for our local press. However, the action we can take to address this at a local level is extremely limited. In terms of supporting local areas in relation to media and social media reporting, it would be necessary for national colleagues through the next strategy and the NSPLG to consider what further action can be considered to address this worrying increase of traditional media and social media reporting of incidents.”

Social Media

Social media was also recognised as having a complex relationship with this area, having on occasions both positive and damaging impacts. Firstly, a large number of survey responses highlighted that social media had played a very important role in normalising conversations around mental health and suicide. Campaigns such as @FCUnited and movements like United to Prevent Suicide, were praised, as was the willingness of famous figures to discuss their own experiences related to mental health or suicide. Many respondents suggested that this should be further encouraged

“We live in a celebrity culture and so young people pay attention to people who are famous. This is the best way to get young people listening, using celebrities from all walks of life.”

In addition, respondents suggested targeted campaigns could be effective, for example using “hashtags such as #AskTell.”

“We need to harness the power of social media to share the positive side of mental health awareness and as a vehicle to quickly and effectively share reliable content.”

On the other hand, however, there was strong recognition of the potentially dangerous impact of social media. Reference was made to online bullying and sites that might encourage suicide. While it was recognised that regulation in this space was challenging it was suggested that by working with social media companies, steps could be put in place to report and remove harmful messages. It was pointed out that action had been taken against Covid-19 misinformation, and so something similar could be done for suicide.

“Social media regulation is difficult with the younger and more tech savvy people being able to circumvent restrictions and accessing negative perceptions with relative ease, as they navigate faster than the tech companies can shut down sites.”

“Cyber bullying - there should be zero tolerance, you should be banned from Facebook or Instagram for a period of time and asked to complete a training course to make sure they abide by user policy agreements and standards.”

“Work with social media companies to develop algorithm that picks up when suicide is mentioned and send link to suicide prevention support.”

Target Vulnerable Groups

Some respondents noted that certain groups of individuals can be most at risk of suicide and are less likely to seek advice or support, perhaps because of perceived stigma. It was suggested that these groups of individuals should be targeted with training and messaging, with reference to some good work already ongoing, such as directing support to new mothers through health visitors. It was also noted, however, that although some groups of individuals are most at risk, everyone’s mental health is important and that anyone can have struggles in this area.

Some of the suggested groups were (please note that some of these groups have also been mentioned under other themes):

• Deprived communities
• Men
• New mothers
• Farmers and other isolated groups including rural communities
• Students

As stated above, it was also recognised that different cultures may discuss and look at suicide or mental health in different ways, and that a simple one-size fits all approach would therefore not be appropriate.

“Within Clackmannanshire and Stirling there are significant pockets of suicides and these are linked to deprivation.”

“Some cultures celebrate death in a different way rather than seeing it as something to be avoided as a topic of discussion. Less stigma surrounding death in general would help to discuss suicide.”

Encouraging Conversations

As mentioned throughout the feedback, encouraging conversations about mental health and suicide was highlighted as the best way to begin tackling stigma around the issue. Therefore, creating opportunities to have these conversations, alongside the promotional campaigns mentioned above, was considered important. One suggestion was to create safe spaces in the community where people could drop in at any time to seek support, but without any “need to be part of the mental health system or referred somewhere.” Others suggested that more counsellors, perhaps located in these safe spaces, were required. Not all respondents felt that this support had to be so formal, however, as long as organisations or communities had an identified person (or people) available to speak to about suicide and mental health, such as a mental health first aider/mental health champion.

“Offering safe spaces and promote their existence as much as possible. I'm imagining a ‘simply walk in’ type of environment.”