Impact case study database

Driving policy change

The work of the Swansea group in the design, development and use of SID-Cymru (R3) represents the first use of anonymised, routinely generated real-life data on the population of Wales. Data from SID-Cymru directed the Welsh Government’s suicide prevention strategy for Wales (2015-2020), ‘Talk to Me 2’, launched in June 2015 . The then Minister for Health and Social Services thanked Professor John in the strategy foreword “for her leadership of the National Advisory Group, and its work to develop Talk to Me 2. I commend the strategy and action plan and anticipate further improvements in the months and years to come” (C1). In December 2018, the National Assembly for Wales published a report on Suicide prevention in Wales (C2). In the report Professor John is quoted extensively, advocating training, resource accessibility, self-harm tracking to improve data collection (R5), the importance of doing more in schools to address suicide and self-harm (R6), raising awareness in journalism (R1, R2), and the need for specific funding for suicide prevention.

Influencing resource allocation for suicide prevention

In response to the aforementioned ‘Everybody’s Business’ report in 2018 (C3), and as part of its subsequent recommendations in the implementation of the ‘Talk to me 2’ strategy, the Welsh Government pledged an additional GBP500,000 a year specifically to support national and regional approaches to preventing suicide and self-harm (C4). The then Health Minister said **: “ we will target the additional investment we are making towards actions that can help prevent and reduce suicidal behaviours, as well as providing appropriate support to communities to address this complex issue. As a society, we all need to work together to prevent suicide. Friends, families, organisations, and communities all have a part to play.”

In 2016 Professors John and Lloyd conducted research to re-evaluate the quality of prescribing for depression (a key risk factor for suicide) in young people (R7). This research identified a significant gap in young people’s mental health research. The potential to bring together billions of pieces of data (including administrative health, social and education data, to psychological and clinical data) on to one platform, enabled by the SAIL Databank, has attracted a further investment of over GBP12,000,000.

Supporting the media in the responsible reporting and portrayal of suicide and suicidal behaviour

Professor John’s research on media reporting preceding and during the Bridgend suicide cluster (R1, R2), brought her to the attention of the Samaritans. As a result of this research, she attended meetings with Welsh journalists to discuss the principles of responsible reporting. She also worked with the Samaritans Wales office to translate their media guidelines into Welsh and for their formal adoption in Wales (C4). This collaboration has also led her to consult on numerous television programmes. As a result of her input, the depictions of suicide in BBC, ITV and Channel 4 soap opera storylines (Casualty, Coronation Street and Hollyoaks) were changed, including the avoidance of details relating to methods used and the construction of storylines. As attested by the executive lead of Samaritans’ Media Advice Service, “Given the millions of viewers for these programmes it is vitally important to address issues that are likely to affect vulnerable individuals (such as details of methods) and promote protective behaviours (stories of help-seeking or recovery). Irresponsible depictions can have an immense reach across the population, as seen in recent studies published in relation to the Netflix youth drama “13 Reasons Why” where a suicide death was depicted graphically and is associated with increases in imitative suicidal behaviour. Prof John worked with us with producers, writers and actors on the shows with a number of meetings held on sets across the UK. Her input and expertise were extremely useful and ensured that these programmes were aired with appropriately informed consultation. The Coronation street storyline in particular was changed in a number of ways as a result of the input from Samaritans with Prof John” (C4).

Professor John was also part of a team that created the Public Health England national guidance on the identification and prevention of suicide clusters, which referenced the work on suicide clusters (R1), media reporting (R2) and cyberbullying (R6). The guidance is used extensively across the UK by local public health teams in managing suspected suicide clusters (C5).

Providing practical guidance for schools and youth services

Professor John’s research was instrumental in the recommendation for and development of Welsh Government guidance on early intervention and the safe management of self-harm and suicidal thoughts in young people. In a research engagement seminar presenting findings from R5, R6 and R7, attended by stakeholders from across government, education, health and social services, which prompted teachers’ requests for practical advice on how to help. This seminar resulted in a recommendation for guidance on managing self-harm for those working with young people, which was reiterated in ‘Mind over Matter’, a 2018 report on the step change needed in emotional and mental health support for children and young people in Wales (C6). In September 2019, the Welsh government launched school guidance on “Responding to issues of self-harm and thoughts of suicide in young people”, issuing hard copies to all 1,569 schools in Wales ( C7). The guidance is used by school staff and governors, youth-services workers, social workers, health professionals, and voluntary organisations working with children and is now available in hard copy and online.

Reducing access to the means of suicide

Analysis of data from SID-Cymru (R3) identified several factors relevant to the deaths, from socio-demographic and educational factors to access to lethal means of suicide (antidepressants and firearms). This analysis informed the Public Health Wales “Thematic review of deaths of children and young people through probable suicide, 2006-2012” (C8). This audit combined with their Cochrane reviews of means restriction for the prevention of suicide has led to changes in the guidance for bridge design in Wales. Architects of the Pont Menai Suspension Bridge discussed suicide prevention aspects with Professor John, “ As a result considerations for suicide prevention (parapet height etc) were incorporated into the design of the bridge which will have long term impact and save lives” (C9). Additionally, Swansea research informed changes in antidepressant prescribing guidance that was circulated to all GP practices in Wales in 2015; this guidance highlighted that “ doctors are reminded that when prescribing for depressive illness in children and adolescents only fluoxetine has been shown to be effective and when initiated should be carefully monitored in line with current guidance (see current BNF for advice, which is replicated on the reverse of this letter). Use of other medication to treat depressive illness should be initiated by a specialist and only when ongoing monitoring has been put in place” (C10). Swansea research also underpinned the publication of new guidance on firearms licensing law, New guidance on firearms licensing law published in October 2014, incorporates the recommendation about safe storage of firearms including inspection by police of storage arrangements. (C11). As a result of this program of work on means restriction, Professors John and Lloyd were invited to be co-directors of the Cochrane Suicide and Self Harm Satellite.

International Reach

The success of SID-Cymru has led to similar systems being adopted internationally. For example, Swansea have collaborated with the Public Health Agency in Canada to support the development of a similar system there (C12).