Agenda item

Dr Emily Clark delivered a presentation, delivered opening remarks with Liz Andrew and Jackie Williams, and they answered the members’ questions with Megan Escott: 

Questions from Members: 

• Do we have sufficient and meaningful local data to understand suicide trends in Monmouthshire, particularly causes and drivers, and how confident can we be in comparisons between areas? 

Local data is limited in its ability to show clear cause?and?effect relationships. Much of the real?time suspected suicide surveillance data is provisional and can overestimate final figures, while confirmed Office for National Statistics data arrives with significant delay. Suicide remains a relatively rare event, meaning that small changes in numbers can create apparently large differences in rates. At present, Monmouthshire’s figures fall within normal statistical variation, and ongoing monitoring rather than firm conclusions is required. 

• If Monmouthshire appears relatively high in headline rates compared to places like Newport, why are pilot interventions not being targeted there first? 

The suicide prevention service being referred to has not yet launched and is being introduced on a Gwent?wide basis rather than targeted to one local authority. The pilot is designed to operate across the whole health board area so that access is consistent and learning can be shared, rather than concentrating resources in a single locality based on early surveillance figures.

• Are the national patterns showing higher suicide rates among men reflected locally, and what factors appear to be contributing to this?

Men presenting locally with suicidal ideation often face multiple, overlapping pressures such as family breakdown, housing insecurity, substance misuse, isolation, and prolonged stress linked to legal or statutory systems. It is often difficult to separate cause from consequence, as mental health issues and social problems frequently reinforce one another. These complex patterns align with national observations, even if precise local causation is hard to quantify. 

• How are people who are digitally excluded, particularly older residents or those with limited access to technology, able to access mental health and suicide?prevention support when so much information is provided online through platforms such as the Melo website? 

Digital exclusion is recognised as a real issue. All content on the Melo website can be printed and shared in paper form, and partners are encouraged to do this through frontline services such as GP practices and community settings. Libraries are also used through national schemes such as Reading Well. Training and support are available face?to?face as well as online, and efforts are ongoing to ensure information is accessible to people who cannot use digital services. 

• Is additional practical support available to help people who are digitally excluded to engage with services, for example through devices, data provision, or technical assistance? 

Additional support is available at higher levels of need. Device?loan schemes, data provision, and technical support sessions are used to help people access online therapy or support where digital barriers would otherwise prevent engagement, particularly for those living in rural areas, experiencing poverty, or unable to attend services in person. 

• Are there specific trends or issues emerging in Monmouthshire that councillors should be aware of when engaging with residents, particularly when conducting door?to?door work? 

Suicide remains a relatively rare event and caution is required when interpreting small local data sets, as minor numerical changes can appear significant. At present, Monmouthshire’s figures fall within expected statistical variation. The Health Board and Public Health teams continue to monitor data closely and review intelligence with partners, rather than drawing firm conclusions from short?term trends. 

• Do we have the right balance between online and face?to?face support services, and are we confident that increasing reliance on digital provision is appropriate given both resource pressures and the needs of people experiencing mental distress? 

Services are designed to be person?centred and are offered both online and face?to?face wherever possible. Patient choice is central, particularly within specialist mental health services, and people are able to choose how they engage. While online provision has expanded significantly and is often preferred because it is quicker and easier to access, face?to?face support remains available and is actively encouraged where it is more appropriate or beneficial. 

• Are face?to?face services at risk of being crowded out by online provision simply because online options are easier to deliver and fill more quickly? 

Online services are often more popular and fill faster, largely because they remove travel and time barriers. However, there is recognition that face?to?face provision offers additional value, particularly for deeper discussion and relationship?building. Efforts continue to ensure that in?person training and support remain available, especially for frontline staff and individuals with higher levels of need. 

• How effective is online training and support compared to in?person engagement, and are people receiving sufficient benefit from digital formats alone? 

Online training and support are widely used and effective for many people, particularly since the shift that followed Covid?19. However, in?person engagement is often more impactful for sensitive or complex issues. For that reason, training and services continue to be offered in both formats, with encouragement for face?to?face participation where appropriate, rather than relying exclusively on digital delivery. 

• Can additional clarity be provided on how resources such as the Padlet and the Melo platform are used to support professionals and communities? 

The Padlet acts as a shared information hub for professionals and includes data, training resources, service updates, and suicide?prevention information. Melo provides broad public?facing mental health and wellbeing resources and is widely used by both the public and professionals. Both tools are intended to complement, rather than replace, direct services and face?to?face support. 

• Have the recruitment of two additional Community Psychiatric Nurses helped address the previously reported problems with unanswered phone calls, unreturned emails, and lack of communication from the Community Mental Health Team duty desk? 

The recruitment of additional Community Psychiatric Nurses has helped improve capacity, but the main issue identified previously was operational rather than purely staffing?related. A problem with an incorrect or ineffective contact number has been resolved, and communication has improved as a result. In addition, greater emphasis is now placed on the 111 option 2 service, including its use by professionals, to ensure people have a reliable and immediate route to mental health support.

• Given that Monmouthshire appears higher than some other areas in headline suicide?rate data, are there examples of different or better practice in places such as Newport that could explain this variation? 

Direct comparisons between areas should be treated with caution. Suicide remains a relatively rare event, and small numerical changes can produce large apparent differences in rates. Different areas also face different social pressures and population characteristics, which shape how services are designed and commissioned. Newport, for example, has a different demographic profile and different partnership arrangements, which influence how resources are targeted. There is no single model identified as clearly “better”, but learning is shared across the Health Board footprint. 

• As elected members working within communities, what practical actions can councillors take to help reduce risk and support people who may be struggling with mental health or suicidal distress? 

Councillors can play an important role by helping reduce stigma, listening compassionately, and encouraging people to seek help. Being approachable, signposting residents to appropriate services, and reinforcing messages that support is available can help interrupt moments of crisis. Kind, timely intervention by trusted community figures can make a significant difference, particularly when someone feels isolated or overwhelmed. 

• Can third?sector organisations such as Mind refer directly into Community Mental Health Services, or formally contribute to referrals, given that they often hold detailed background information about individuals and have established relationships with them? 

Mental health teams are moving toward a more open and streamlined access model, including use of the single point of access through 111 option 2. In principle, referrals can be received from a wide range of sources, not solely GPs. However, how third?sector agencies contribute to referrals can vary in practice, and this is tied to how interfaces between services operate locally. It was agreed that this specific issue would be followed up by Mind and ABUHB outside the meeting to clarify referral pathways and ensure that the information held by trusted third?sector partners is used effectively.  

• Megan emphasised that third?sector workers often possess far more contextual and historical information about individuals than is captured in brief or minimal referrals, and that being able to pass this information on meaningfully could improve assessment and outcomes. 

This point was acknowledged, with recognition that good outcomes depend on effective information?sharing and clear communication between services. Improving interfaces between statutory and third?sector services, including how referrals are handled and supplemented with contextual detail, was identified as an important area for continued work. 

Chair’s Summary: 

The Chair thanked representatives from Aneurin Bevan University Health Board and the Public Health team for their detailed and informative presentation, acknowledging the complexity and sensitivity of the issues discussed. He noted that the session had highlighted both the scale of mental health and suicide?prevention challenges and the significant amount of partnership work already underway across Gwent. 

He emphasised the importance of improved visibility and understanding of data, particularly at a local level, while recognising the limitations inherent in suicide statistics and the need for caution when interpreting small numbers. The Chair stressed that scrutiny should continue to focus on outcomes, prevention, and effective targeting of resources rather than headline figures alone.

The Chair underlined the value of community?based and preventative approaches, including training, early intervention, and strong links between statutory services, third?sector organisations, and local authorities. He welcomed the development of new initiatives, including the suicide?prevention pilot and improved access routes such as 111 option 2, while making clear that ongoing scrutiny of service accessibility and responsiveness would remain important. 

He concluded by confirming that suicide prevention and mental health would remain a priority area for the Committee during the remainder of the Council term, and that further scrutiny would involve continued engagement with both the Health Board and Mental Health and Learning Disability services. He formally closed the item by thanking all contributors for their openness, professionalism, and commitment to improving outcomes for residents. Action: to place leaflets in Member’s mail trays.