Creating Hope Together: suicide prevention action plan 2022 to 2025

Outcome 3

Outcome 3: Everyone affected by suicide is able to access high quality, compassionate, appropriate and timely support – which promotes wellbeing and recovery. This applies to all children, young people and adults who experience suicidal thoughts and behaviour, anyone who cares for them, and anyone affected by suicide in other ways.

Priority

• Promote and provide effective, timely, compassionate support – that promotes wellbeing and recovery.

Context / Messages

• To prevent suicide, we need to create the conditions for good mental health and wellbeing and tackle the social determinants of suicide. We must also ensure there is timely and effective support for anyone who feels suicidal – from the earliest moment. As such, our support must span from early intervention, preventing crisis, support during crisis, and post crisis support and recovery. When providing support to anyone feeling suicidal, we must value their resilience and strength, and seek to create a sense of hope.
• To achieve this, we must continually seek to understand what interventions work for different individuals (and groups), and how we can help people to reach out for help when they need it; and indeed, for support services to reach in. Our support must always be culturally safe, trauma informed, and embody the principles of Time, Space and Compassion.
• We know that a priority must be ensuring support services are available and relevant to all communities of place and communities of interest; and we will focus on areas and groups where suicide rates are highest, including deprived areas. This focus will include building protective factors, such as social connectedness, as well as a focus on risk. Given this, we will build the understanding and capacity of our communities, including through peer-support and our programme of awareness raising and learning.
• We know many people affected by suicide are in contact with statutory services, including primary care, mental health services, and unscheduled care settings. They may also be in contact with services beyond health and social care, such as homelessness services and education. As such, we will focus our efforts on improving patient safety and experience in health and social care settings, whilst supporting greater partnership working across key statutory services.

What we will keep doing

• Through other Government mental health priorities and programmes we will continue to support population mental health and wellbeing. Over the last two years this has included: increasing mental health staff in primary care, investing in school counsellors, our communities funds for adults and children and young people, our public information and digital resources about where to access support, including the Mind to Mind website, investing in assessment and support services (such as NHS 24 mental health hub and Breathing Space), and work to support particular aspects of mental health (such as perinatal, self-harm and eating disorders)
• Ensure suicide prevention is considered in our workforce planning and in system improvements for mental health unscheduled care. Introducing quality standards for Mental Health will directly support the pathways, assessment and care for people who are suicidal and reach out for help
• Take a human rights-based approach to our work and engage with protected characteristics groups and the trusted organisations who connect to them
• Continue to invest in promoting support for people who are suicidal, including through digital, such as the ‘surviving suicidal thoughts’ videos
• Continue to improve suicidal crisis responses by embedding the principles of Time, Space and Compassion in commissioning and service design, as well as growing workforce and community capacity and capability to offer Time, Space and Compassion based support
• Continue to learn from our suicide bereavement support services – both for family and in workplaces
• Continue to roll out of the Distress Brief Intervention (DBI) across local areas, informed by evaluation. We know from the evaluation of the initial DBI pilots that one in ten people reported that they may have attempted suicide or continued with suicidal thoughts if DBI had not been offered to them
• For children and young people, we will continue to invest in Child and Adolescent Mental Health Services (CAMHS) and wider community supports. We will also support children and young people who have neurodevelopmental support needs through implementation of our National Neurodevelopmental Specification. We will continue to pilot DBI for under 16s (and consider wider rollout following evaluation).

New actions

Action area 5: Supporting a compassionate response

Action 5.1: Consider ways to adapt Distress Brief Intervention (DBI) programme to ensure it supports people at the earliest opportunity, and to ensure it is considered for everyone who has thoughts of suicide or has made an attempt, where appropriate. We will consider the potential for new referral pathways, and ways to re-engage with support after discharge.

Action area 5: Supporting a compassionate response

Action 5.2: Respond to the diverse needs of communities.

To support this we propose at least two tests of change to reach groups / communities where there is a heightened risk of suicide. We plan to work with trusted organisations to (1) review the design and delivery of learning approaches to ensure they reflect the communities’ experience of suicide, and (2) test new approaches to reaching and supporting people in those communities who are at risk of suicide. As part of this we will seek to understand help seeking behaviours and tailor support for cultural and diverse groups. We will use the learning to inform our overall approach to supporting communities and groups where suicide risk is high. (This is the same action as set out under action area 4, along with considerations in developing this approach).

We will also consider the findings from the joint International Association for Suicide Prevention (IASP) and Scottish Government funded research ‘Interlinked systematic umbrella reviews of the effectiveness of interventions to prevent suicide’, due to publish in 2023.

** We consider children and young people will benefit from this action.

Note:

Trusted organisations / groups could include those with a focus on: men, women, LGBTI, minority ethnic communities, migrants, asylum seekers, socially isolated communities, occupational groups, additional support needs, criminal justice, self-harm, mental illness / support, gypsy travellers, unpaid carers, students, gender based violence, victims, and disability.

Action area 5: Supporting a compassionate response

Action 5.3: Build new peer support capability to enable further use of peer support and recovery models for suicide prevention, working with key partners, such as Scottish Recovery Network.

Action area 5: Supporting a compassionate response

Action 5.4: Develop resources to support families, friends, carers / unpaid carers (including children and young people), and anyone else affected by suicidal behaviour – building on existing resources. Such resources should provide information and advice for people who are supporting someone who is suicidal (including after a suicide attempt), which would include their rights under the Carers Act as well as self-care advice.

** We consider children and young people will benefit from this action.

New actions

Action area 5: Supporting a compassionate response

Action 5.5: Ensure relevant staff such as pastoral / guidance staff, school nurses and counsellors in education settings are skilled and responsive to signs of suicidal concerns, whilst ensuring proactive approaches to supporting children and young people at key transitional stages, as part of a continuum of care.

** We consider children and young people will benefit from this action.

Action area 5: Supporting a compassionate response

Action 5.6: Develop approaches to prevent suicidal behaviour in children and young people, with a focus on delivering action in key settings, including education, health and social care, youth work. This will include:

• Engaging with Youth Advisory Group to understand the concerns and priorities for action for children and young people
• Reviewing and synthesising evidence around the needs, risk and protective factors, and effective responses (including the findings from the Children and Young People’s Joint Delivery Board Task and Finish Group on crisis and support)
• Learning from reviews of suicide deaths in children and young people undertaken through the National Hub for Child Death Reviews.

** We consider children and young people will benefit from this action.

Action area 5: Supporting a compassionate response

Action 5.7: Develop new approaches to prevent suicidal behaviour in older adults, with a focus on delivering action in key settings. This will include:

• Engaging with people with lived experience
• Reviewing and synthesising the evidence around the needs, risk and protective factors and effective responses
• Implementing learning from the reviews of suicide deaths in older adults.

Action area 5: Supporting a compassionate response

Action 5.8: Consider how those working in primary care settings – including GPs, nurses, mental health teams and the broader primary care workforce – can identify and support people who are at risk of suicide, who may present in distress or with low mood, anxiety or self-harm. This could include: safety planning, referrals to DBI, community support (social prescribing), and proactive case management, especially for people with a high risk of suicide.

We will consider effective ways to share good practice and learning with clinicians and managers in primary care settings across Scotland, which will include support for the workforce.

** We consider children and young people will benefit from this action.

New actions

Action area 5: Supporting a compassionate response

Action 5.9: Work with clinicians in unscheduled care settings to ensure (a) they are alert to suicide risk - particularly for people who have self-harmed or attempted suicide – and respond effectively through the provision of psychosocial assessment; and (b) they work with partners to ensure care pathways and support are put in place, including in the community (which may include via primary care). Care pathways for people who have self-harmed or attempted suicide should focus on their mental wellbeing and recovery needs.

Distress Brief Intervention should be offered, where appropriate as part of an increased range of potential interventions. The pathways to these interventions will be monitored through implementation of unscheduled care pathways.

Considerations in developing this approach:

• Review current models of ongoing support at the point of at the point of onward referral or discharge from unscheduled care settings (including international examples), to inform our future approach to ensure a high quality of continued support and recovery for those who are, or have been, suicidal.
• Consider how to share good practice across clinicians and managers in clinical settings, including support for the workforce.
• Involve families as appropriate in developing care / aftercare strategies.
• Ensure principles of Time, Space and Compassion are embedded at each stage – right through arrival, assessment, care and discharge.

** We consider children and young people will benefit from this action.

New actions

Action area 5: Supporting a compassionate response

Action 5.10: Work to support statutory services to continuously improve the quality of clinical care and support for people who are suicidal, and share good practice and learning, both individually and by working together across services.

To achieve this a first step is for mental health services to adopt the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) recommendations into their patient safety planning and operating practices, and the relevant Medication Assisted Treatment (MAT) standards.

Considerations in developing this approach:

• Undertake work to help embed assertive case management approaches which engage all relevant agencies to support someone with suicidal risk or following an attempt. This could include services such as: mental health, primary care, secondary care, social work, alcohol and drug services, housing services (and frontline homeless organisations, where appropriate), education, police, prisons, and youth workers. Community based organisations should also be engaged where that will support the individual. This approach would ensure a person who is suicidal has all relevant local services working together to provide an effective and seamless support – the No Wrong Door approach
• Where suicide risk is identified, a multi-agency, assertive approach should be used to span early intervention, prevention, crisis and recovery – with a particular focus on transition between parts of the system / service
• When services are supporting someone who has been suicidal, they should carefully plan handover between services, and discharge from services. They should also ensure people can quickly and easily re-engage with their service should their needs change
• Transition points should be fully planned for, particularly as children and young people move from children to adult services.
• Support should take a human rights based approach, recognise risk and protective factors and include safety planning as reflected in the evidence on suicide risk management (included in NICE guidance on self-harm),^[1]
• Services must also consider how they reach and meet the needs of particular groups, such as minority ethnic communities, people affected by trauma, and gypsy travellers
• Develop opportunities to share good practice across clinicians and managers in service settings, including support for the workforce.

** We consider children and young people will benefit from this action.

New actions

Action area 5: Supporting a compassionate response

Action 5.11: Provide suicide bereavement support across Scotland to ensure fair and equitable service, based on the evaluation of the pilot services and engagement with local service partners.

** We consider children and young people will benefit from this action.

Action area 5: Supporting a compassionate response

Action 5.12: Consider the value and impact of a single Scottish specific telephone number which will provide access to existing telephone support and resources.

What will we do next

• Ensure the mental health unscheduled care programme is leading to improvements for people at risk of suicide.
• Understand and address gaps in early intervention for suicide risk, for the whole population, as well as for individuals or groups who may have heightened risk of suicide.
• Continue to consider new models of support for people who are suicidal, based on evidence and insight.