Jenny Paisley is a consultant in our Edinburgh office. Here, she writes about translating emerging evidence on the impact of COVID-19 on mental health in Scotland into a public health response which listens to the voices of those with lived experience, to ensure increasing mental ill health does not translate into a preventable rise in suicide.
What we know so far
Marginalised groups, such as those living in poverty and with long term physical and mental health conditions have experienced the greatest deterioration in their mental health and wellbeing since COVID-19 first emerged in the UK according to the Scottish Mental Health Tracker Study (SCOVID) . This finding is also supported by a growing body of evidence on the mental health impacts of the pandemic, with more than 2,500 papers published on the subject of COVID-19 and mental health since March 2020.
While there was an improvement in some mental health measures as we emerged from the first lockdown in Summer 2020, overall anxiety, depression and thoughts about suicide have all increased when compared with pre-COVID rates and there are alarming trends in suicidal ideation for particular demographic groups. The wave 2 SCOVID report , surveying people between July and August 2020 showed:
- An increase in suicidal ideation in the Scottish population from 9.6% between May and June to 13.3% of respondents between July and August reporting thinking about taking their lives
- 34.4% of men aged 18-29 reporting suicidal thoughts in wave 2, up from 21.5% in wave 1
- People with pre-existing mental health conditions also reported higher suicidal ideation, with 36.7% reporting suicidal thoughts in wave 2 and 25.2% in wave 1
- ONS statistics show that young people have borne the brunt of the impact of COVID-19 on the labour market, accounting for nearly two thirds of unemployment since the pandemic began . Loss of employment, financial stressors and social isolation are all widely recognised risk factors for suicide.
There has been a demonstrable rise in suicidal ideation, but we do not yet have reliable data on the impact of the pandemic on suicide rates. Although there has been an increase in risk factors associated with suicide, suicide is preventable and a rise in suicide is not an unavoidable consequence of the pandemic. Suicide prevention must be prioritised.
What do we need to do about it?
To ensure those experiencing poor mental health and at risk of suicide are not left behind in the recovery from COVID-19, we need higher investment for groups that have been marginalised during the pandemic to achieve equity through a combination of targeted and universal interventions. Emerging evidence on demographic groups experiencing worsening mental health and suicidal ideation must be rapidly translated into policy and investment. While there are a range of risk factors for suicide, policy makers need to act fast to acknowledge the known relationship between unemployment and suicide, as part of a holistic approach to suicide prevention strategy in the wake of Covid-19.
Public health responses to prevent suicide need to focus not only on formal mental health services, but on investment in community responses. We need a cross-sectoral response, with action on social determinants of mental ill health such as economic inequality, to address factors contributing to suicide risk.
Crucially, responses need to be shaped on the voices of those with lived experience. The National Suicide Prevention Leadership Group, formed in 2018, has a lived experience panel working closely with academic and professional experts to inform suicide prevention plans. Acknowledging that local people are experts in their own communities, the panel has been involved in the development of local suicide prevention plans.
The Suicide Prevention Action Plan in Scotland includes pilots of compassionate support for those in distress  and a suicide bereavement service, recognising that those bereaved by suicide are 65% more likely to die by suicide than those bereaved by natural causes . Robust evidence on the effectiveness of these pilot services must be rapidly collected and shared, so that services that work can expand to reach the people who need them most.
Finally, voluntary sector services supporting those at risk of suicide are facing additional pressures due to the pandemic, with more people seeking help and support, and financial challenges meaning organisations are struggling to stay afloat. Elevated and sustained investment in Scotland’s third sector will be crucial to ensure it can play its role in a national effort to prevent suicide.
 The study authors note that this finding should be interpreted with caution due to small sample sizes