Creating Hope Together: suicide prevention action plan 2022 to 2025

Annex A – Whole of Government and society approach

Action area 1: Whole of Government and society approach, supported by local policies and action. This will be updated on a rolling basis as key policy developments occur.

Mental Wellbeing and Social Care

Self-Harm

• We will publish Scotland’s first dedicated self-harm strategy and action plan in 2023. The strategy is aimed at supporting anyone who self-harms, including people who are suicidal. The strategy development is being driven by people with their own lived, or living, experience of self-harm, and informed by insights from those who support them – whether family and friends, or frontline services. The strategy and action plan will reflect the diverse range of self harm experiences and seek to ensure people receive support which is inclusive, appropriate, sensitive and person-centred – in a range of appropriate settings. We are already supporting people who self-harm through our investment in new pilot support services (delivered by Penumbra in three local areas), and that will increase through the new national online portal which will provide vital information and advice to people who self-harm, and those who support them.

Trauma and Adverse Childhood Experiences (ACEs)

• We will increase the capacity of the workforce to deliver individual support and interventions to improve recovery from the impact of trauma. As part of the National Trauma Training Programme, NHS Education for Scotland (NES) will increase capacity for delivery of ‘Safety and Stabilisation, training (a programme that helps the relevant workforce to deliver individual support and interventions to improve recovery from the impact of trauma), and ‘Survive and Thrive, training (a trauma-enhanced group-based psychoeducation intervention that can significantly reduce trauma symptoms and facilitate recovery for people affected by complex trauma).

Dementia

• We will explore how suicide prevention activity can inform and be embedded in the diagnosis process and subsequent Post Diagnostic Support offer, which is available to anyone in Scotland newly diagnosed with dementia, for up to a year. This includes support for staff delivering the services and for those accessing them
• We will highlight that people living with dementia are at a higher risk of suicide and consider this in the development of the new dementia strategy and tailor campaigns accordingly.

Mental Health Law

• We will continue to take forward recommendations from the Scottish Government’s ‘Review of investigating deaths of patients being treated for mental disorder’ (2018), and work with partners to ensure suicide prevention learning coming out of that work is shared and acted upon to help reduce the number of deaths by suicide after someone has been discharged from hospital
• We will consider the final recommendations from the independent Scottish Mental Health Law Review (SMHLR) to identify where there may be an impact on suicide prevention in any proposed changes to legislation or practice.

Care Quality Standards

• We will work with the Quality and Safety Board and NHS Assure to improve our understanding and the assessment of the quality and safety of mental health estates
• We will work with Healthcare Improvement Scotland (HIS) and healthcare partners to reduce ligature risks and ensure the assessment, care and discharge of patients who are suicidal is carried out proactively, including through safety planning, and is mindful of risk factors (including trauma and complicated grief)
• We will create opportunities for clinical staff across Scotland to share learning on supporting patients who are suicidal – we will explore options for how this can best be achieve
• We will work with HIS to ensure the approach to serious adverse event reviews for suicide aligns with the ongoing roll-out of multi-agency reviews of suicide, including the most effective way to share the learning across reviews
• We will work to ensure a trauma-informed approach and the principles of ‘Time, Space and Compassion’ are embedded within the National Standards for Mental Health.

Workforce, Digital and Primary Care

• We will support local planning groups which have been established with funding from the Mental Health Recovery and Renewal Fund, to embed suicide prevention in their work – ensuring better and more timely access to support for those in distress
• We will work to ensure the primary care workforce is aware of the risk factors for suicide, and are equipped to respond to anyone presenting who is suicidal – this could include safety planning and referral to statutory and third sector partners. (Further detail under Outcome 3)
• We will consider how Mental Health multi-disciplinary teams can support people most at risk of suicide and provide primary care teams with information and resources about where support can be accessed for people who are experiencing suicidal thoughts.

Wellbeing and Prevention

• We will continue to make connections across suicide prevention and wider population mental wellbeing initiatives, and will identify opportunities to collaborate and share learning. These include: tackling mental health stigma through See Me, understanding the social determinants of mental health, supporting employers to promote mentally healthy workplaces, and providing online resources to support population mental wellbeing (including Mind to Mind website)
• We will include suicide prevention as a priority area under the Communities Mental Health and Wellbeing Fund. In Year 2 of the fund, suicide prevention implementation leads will proactively engage Third Sector Interfaces (TSIs) to raise awareness of this priority issue and help ensure access to funding for suicide prevention focused projects.

Supporting Mental Health of the Workforce

• We will review the evidence, and commission new research where needed, to identify workforce sectors, industries and particular groups of employees where staff are at higher risk of suicide or have high exposure to suicide (for example, health and social care, transport and construction). We will use this to inform future suicide prevention activity and targeted support, which could include workforce policies and supports. This links to the mental health and wellbeing platform for employers
• We will continue to support the wellbeing and mental health (including around suicide prevention) of the Health, Social Work and Social Care Workforce via a range of national resources – namely the Workforce Specialist Service, the Workforce Development Programme, the National Wellbeing Hub and the National Wellbeing Helpline
• We will continue to engage with stakeholders in Health, Social Work and Social Care, in order to ascertain potential new initiatives as appropriate to support the wellbeing and mental health of the aforementioned workforces.

Student Mental Health

• We will ensure the Student Mental Health Action Plan (to publish in 2023) prioritises suicide prevention through actions to address suicide prevention in our colleges and universities.

Autism and Learning Disabilities

• We will review the suicide prevention learning resources to ensure they address the needs of people with learning disabilities and neurodivergent people (including autistic people), and recognise their higher risk of suicide. We will seek to target those resources at professionals, including GPs and wider primary care teams
• We will ensure suicide prevention is embedded within the single neurodevelopmental pathways (for children and young people, and for adults) and the national post diagnostic support web hub, recognising the increased risk of suicide in neurodivergent people, including autistic people.

Wider Government Policy

Homelessness

• We will pursue Homelessness Prevention Duties. We will introduce legislation in this Parliamentary session to both strengthen Local Authority homelessness prevention activity and to create new homelessness prevention duties on wider public bodies. We aim to ensure that people get early support to prevent homelessness, and that the risk of homelessness is identified and acted on regardless of the service first approached. To support this, we will prioritise suicide prevention training for public services covered by the legislation, including Local Authority housing staff
• We will prioritise third sector front line homeless organisation staff for suicide prevention training
• We will request Local Authority housing teams are included in multi-agency case management approach for anyone suicidal, as well as third sector frontline organisations (where they are engaged).

Drugs Mission

• We will identify joint drugs / suicide prevention opportunities as part of the National Drugs Mission – particularly around access to services, compassionate / trauma-informed support, and peer support models
• We will engage with mental health and substance use services to support the implementation of Medication Assisted Treatment (MAT) standards, specifically MAT Standards 6, 9 and 10 which focus on mental health support and trauma-informed care. MAT standards are designed to enable the consistent delivery of safe, accessible, high-quality drug treatment across Scotland
• We will prioritise staff in Alcohol and Drugs services for training in suicide prevention
• We will request Alcohol and Drugs services staff are included in multi-agency case management approach for anyone suicidal
• We will consider follow up opportunities for suicide prevention coming from the Healthcare Improvement Scotland (HIS) mental health and substance pathfinders.

Alcohol

• We will ensure effective links across alcohol brief interventions and distress brief interventions to ensure people receive integrated support to meet their needs
• We will ensure learning from stigma and help seeking behaviours on alcohol and substance use are shared to inform suicide prevention / distress approaches, and vice versa.

Child Poverty

• We will explore the potential to embed suicide prevention and distress support in the delivery of Best Start, Bright Futures our second tackling child poverty delivery plan
• We will support partnership working between local child poverty and suicide prevention leads, to collaborate and share learning.

Money and Debt Advice

• We will further develop a response for people whose mental health has been affected by issues relating to debt and finances. We will work closely with a range of advice organisations including Citizen’s Advice Scotland to better understand and tackle these issues, including the prevention of suicide
• We will continue to work with the advice sector to understand and respond to the continuing impacts of the pandemic and rising cost of living on their services and how they are delivered; and we will ensure our funding continues to support the sector to help the people who are struggling the most financially, which we recognise is a risk factor for suicide
• We will prioritise staff working in money advice and welfare services for suicide prevention training.

Social Security

• We will work with Social Security Scotland to support embedding Time, Space and Compassion as part of their approach to working with – and supporting – members of the public who may be at higher risk of suicide in line with the Social Security Scotland Charter^[2]. This will include providing learning for staff to be able to recognise those who may be at higher risk of suicide and ensure they have knowledge, skills and confidence to support the person at the time of interaction, and know how to signpost to further support or escalate concerns to ensure someone’s safety.

Social Care / National Care Service

• We will ensure our approach to delivering suicide prevention activity is to be flexible and responsive to the changing landscape we are operating in. This includes the transformative redesign of community health and social care through the creation of the National Care Service which will support more multi-disciplinary and person-centred care
• We will explore how to effectively support the mental health and wellbeing of the health and social care workforce, including around suicide prevention

Whole Family Wellbeing Support

• We will invest at least £500 million in Whole Family Wellbeing Funding over the course of this Parliament to help transform services that support families, ensuring families can access the support they need, where and when they need it, enabling families to thrive – which will support suicide prevention
• Over 2022-23 we will invest the initial £50 million of funding to: help local areas shape and scale up services that are already effectively wrapping around the needs of families using a multi-agency, multi-disciplinary approach; to support local areas to shift from crisis intervention to preventive support; and to provide support for national activity needed to drive these changes. We will continue to explore links to suicide prevention through this investment.

Social Isolation and Loneliness

• We will consider how suicide prevention can be included in the implementation of ‘A Connected Scotland’ strategy – to tackle social isolation and loneliness, and to build stronger connections.

The Promise / People with Care Experience

• We will work with stakeholders, including The Promise Scotland, to engage with care experienced people to better understand what action is needed to embed suicide prevention activity in our support to children and young people in care, and care leavers.

Children and Young People

• We will consider the findings of the Children and Young People’s Mental Health and Wellbeing Joint Delivery Board in relation to suicide prevention, when it makes its final recommendations in December 2022
• We will work with Perinatal and Early Years Mental Health – including the Perinatal and Infant Mental Health Programme Board – to develop approaches and mental health support to ensure suicide prevention is considered during the perinatal period.

Bereavement Support for Children and Young People

• We will consider any recommendations relating to suicide and suicide prevention, which come out of the final report of the National Childhood Bereavement Project.

Family Law

• We will embed suicide prevention support and awareness raising as part of future guides for adults and children on attending the family courts and alternatives to court
• We will develop greater understanding of suicide risk for people interacting with the family law system, and explore how to better support people and prevent suicide.

Criminal Justice and Prisons

• We will continue to work with partners across justice and wider public services to explore how to better support those at risk of offending, accused of offending, those currently in prison or custody and upon liberation – who may be at higher risk of suicide. This will include exploring how to embed suicide prevention as part of release planning and co-ordination, and as part of wider through-care activities.

Victims and Witnesses

• We will consider opportunities to increase suicide awareness training for organisations working with and supporting people who have been victims of crime.

Violence Against Women and Girls

• We will work with our partners across the Violence Against Women sector to ensure that suicide prevention is embedded within the refreshed Equally Safe Strategy, and within the approach of individual partner organisations.
• We will prioritise third sector front line staff in organisations working in violence against women and girls services for suicide prevention training

Hate Crime

• We will consider the support available for victims and witnesses of hate crime, including the ability to access mental health and suicide prevention support, in the development our new Hate Crime Strategy for Scotland.

Asylum and Migration

• We will explore how to effectively support people with ‘No Recourse to Public Funds’ (including people seeking asylum and people at risk of, or experiencing, destitution) to access the services they need to support their mental health, including where there is a risk of suicide.

Veterans

• We will work to reduce the risk of suicide by developing services through the Veteran Mental Health and Wellbeing Action Plan that improve access to evidence based psychological services.

Physical Health and Activity

• We will actively play our part in challenging stigma and preventing suicide through physical activity and sport
• We will explore how suicide prevention can be supported by Scotland’s Mental Health Charter for Physical Activity and Sport
• We will consider opportunities to address the mental health impacts of chronic pain, including suicide risk, as part of the implementation plan for the Framework for Pain Management Service Delivery
• We will work with sportscotland and the wider sports sector to consider and support the mental health impacts of performance sport and the performance environment on athletes and staff.

Planning and Building Standards

• Spatial Planning: We will seek to make links between suicide prevention and the National Planning Framework 4 (NPF4)
• Building Standards: We will review existing evidence, and commission any new research needed, to consider whether targeted regulatory interventions on the development or management of buildings, would assist in reducing suicide risks.

Road Safety

• We will consider through our Safe System’s approach to road safety how our policies focusing on reducing people killed or seriously injured on Scotland’s roads can help reduce the risk of suicide.

Menopause

• We will explore the links between peri-menopause, menopause and suicide to gain a better understanding of the impact menopause can have on mental health and the links to suicide risk
• We will explore how best to embed suicide prevention as part of support available to women in peri-menopause and menopause, in recognition of the impact that menopause can have on mental health, and the links to suicide risk.

Gambling

• We will work with Public Health Scotland to develop a better understanding of the scale of problem gambling in our communities by reviewing and developing official Scotland-level data
• We will work towards ensuring people experiencing gambling-related harms are able to access the right support, and treatment, across health and social care services.

Redundancy

• We will ensure suicide prevention continues to be considered in the planned work to improve the health and wellbeing offer through the Partnership Action for Continuing Employment (PACE) Continuous Improvement Programme.

Carers

• We will improve training and support for health and social care professionals to help identify and support unpaid carers at risk of suicide
• We will support unpaid carers who care for people at risk of suicide by promoting learning resources and awareness-raising on suicide prevention.

Volunteering

• We will explore where there are opportunities to further encourage volunteering across the actions contained in this plan, in recognition of the benefits volunteering has on reducing social isolation and loneliness, improving mental health, and empowering communities - volunteering can powerfully contribute to suicide prevention.