Suicide prevention strategy and action plan: consultation analysis

Section 2: Action Plan

The new actions which make up this Action Plan, are built around 7 themes which sit under the overarching 'Outcomes'.

Theme One: Whole of Government and Society Policy

We recognise that we must strengthen our approach to suicide prevention by addressing the social determinants specific to suicide prevention. To support that we will adopt a whole of Government and society approach to suicide prevention.

This will involve aligning policy action to ensure all relevant Government polices take action to prevent suicide – from the policy design stage, right through to delivery.

Our approach will encompass the spectrum of need – prevention, early intervention, intervention, postvention, and recovery. We will focus on social, economic and spatial policies – and strive to reach communities most affected by inequalities and poverty.

We Asked

We sought views on the proposed actions contained in the accompanying action plan document.

In answering this question we advised respondents to consider:

• If you agree with the proposed actions outlined.
• If there are any proposed actions you disagree with and why.
• If there are any actions you think we should consider that haven't been included.

You Said

There were 113 responses to this part of the question.

The majority of respondents were very positive about the whole of Government and society approach, welcoming the focus on people most at risk of suicide, and tackling the social determinants of suicide. The following themes were identified from the corresponding comments:

• On the whole, participants were supportive of the whole of Government and society approach, particularly the focus on partnership working and the inclusion of the social determinants of health. This quote highlights the point: "We recognise and welcome the Government's ambition to ensure suicide prevention is mainstreamed across wider policy areas and agree this is the right approach".
• The impacts of living in rural communities needs to be more explicit under this theme.
• Understanding the value of community based resources as an early suicide prevention tool could be further explored under this theme. This quote highlights the point: "Strengthening communities and developing community resources, including co-production of designing these by including communities, agencies and individuals experiencing suicide and their families as partners in this process is vital to ensure success and sustainability. This has not been represented within this theme".
• The approach should also include a focus on groups where there is an higher risk of suicide. This quote highlights the point: "Many unpaid carers experience serious physical and mental health problems, are socially isolated, and tend to have more financial hardship. An emerging body of evidence suggests they might also be a high-risk group for suicide and homicide, yet this is an area which is under-researched and not addressed at policy or service development level."

We Did

The actions set out under this action area are wide ranging covering mental health and wellbeing and wider Government policy.

Based on the feedback received, a number of additions were made, such as considering how volunteering can support delivery of the action plan, actions to address the needs of carers, and support people facing social isolation and loneliness.

The actions set out under this action area form the first stage of the whole of Government and society approach. There will be an ongoing process of identifying further cross Government policy opportunities to embed suicide prevention over the lifetime of the strategy and action plan - to ensure that every opportunity is taken to include a focus on suicide prevention.

The points raised on rural areas and role of communities, have led to changes in other areas of the strategy (for example as Guiding Principles) and feature across the action plan.

Theme Two: Access to Means

We recognise the need to ensure our communities are suicide safe places, and we will seek to proactively design-in suicide-aware places and buildings, and be responsive to practice and evidence on access to means of suicide, including locations of concern.

We Asked

We asked people to tell us what they thought about two particular actions focussed on this area, one exploring the use of a cross-sector action plan, and the other identifying priority actions relating to the recently launched Delphi Study.

You Said

There were 185 responses to the responding question A and 184 to question B, with over 70% of respondents who agreed or strongly agreed with the actions detailed under Access to Means.

Theme Two: Access to Means

Proposed Actions:	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
A. Develop a comprehensive, cross sector action plan to address locations of concern with an initial focus on falling/jumping from height (and which complements the national guidance).	2%	5%	12%	26%	44%
B. Consider priority actions on access to means following the Delphi study – including wider work on locations of concern which includes waterways, railways and retail outlets.	2%	5%	11%	30%	41%

The percentage figures given do not add up to 100% as not all participants answered this part of the consultation.

From the corresponding comments, the following themes were highlighted:

• There is an opportunity to build and develop safer environments under this theme including physical builds and the online space. This quote highlights the point: "We would also specifically endorse importance of building safer environments (including civic design aspects – implying need to engage with a wider array of stakeholders – town planners, architects, emergency services, infrastructure specialists, leisure providers etc.) as well as including the online environment as an area of focus."
• Value in building on international and local best practice, including to update PHS guidance on how to reduce suicides at locations of concern.
• There is value in delivering suicide awareness training for people who work in, and close to, specific locations of concern.
• Consideration should be given to the links between alcohol and suicide deaths at locations of concern.
• Importance of sharing research findings so to improve awareness and drive change, such as increasing awareness of the Delphi study. This quote highlights the point: "Further work in spreading awareness of findings of Delphi study and allied work would be beneficial in gaining buy in to additional actions on reducing means. There would also be merit in strengthening communication on proportionate risks from different kinds of means and how these can be experienced for different groups, plus continuing to track and report changes over time".

We Did

Based on the feedback received, we added reference to the national Locations of Concern guidance published by Public Health Scotland. The Delphi study has also been published and is now publicly available.

The action to review the current learning offer will also ensure our approach to learning is fit for purpose, including to address the different needs across the workforce and communities, including those living and working at locations of concern.

The action plan also sets out a range of actions to create a safer safe environment.

Theme Three: Media Reporting

We recognise that responsible media reporting (including social media) of suicide is needed, and we will work with the sector to improve this.

We Asked

We asked people to tell us what they thought about a specific action relating to responsible media reporting.

You Said

There were 190 responses to this question, with the majority supportive of the proposed action and less than 3% disagreeing with what it set out.

Theme Three: Media Reporting

Proposed Actions:	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Hold a series of awareness raising events about responsible media reporting (including social media) which begins to support change in media reporting of suicide. Scope to draw on lived experience insight.	1%	1%	7%	23%	60%

The percentage figures given do not add up to 100% as not all participants answered this part of the consultation

From the corresponding comments, the following insights were obtained:

• Social media should be seen as important as other methods of reporting if not more so. This quote highlights the point: "It is our view that social media is at least as important in terms of communicating policy messages, providing information support but also a contributing factor to suicidal behaviour, therefore there should be a specific focus on how government approach social media and support local authorities to address more localised issues in relation to social media inimical to suicide prevention".
• References were made to the Online Safety Bill, seeking consideration to be given to balance regulation and using the online space for freedom of expression and peer support.

We Did

To reflect the range of media this action relates to, we have explicitly added reference to social media.

The Scottish Government continues to engage with the UK Government to ensure its Online Safety Bill offers maximum protection against suicide content, without restricting online spaces which offer compassionate peer support.

Theme Four: Learning and Building Capacity

We recognise the need for individuals, families, communities, workplaces and services to have a better understanding of suicide, so that they can be more confident and responsive to suicidal behaviour and risk.

Promoting awareness of suicide and reducing stigma is a core element of preventing suicide. We will therefore continue to work to increase awareness of suicide to create a foundation of understanding and compassion in our communities and services, thereby equipping people to respond more effectively to someone who is suicidal. This focus also helps to create the conditions for people who are feeling suicidal to understand their feelings and feel safe in expressing those to others, knowing they will receive a compassionate, timely response, and the support they need.

We Asked

Those who participated in the consultation were asked for their thoughts about a series of actions relating to Learning and Building Capacity, and which included activity in relation to the following:

• The suicide prevention social movement.
• A review of the learning approach to suicide prevention.
• Including suicide prevention in the Whole School Approach to Mental Health and Wellbeing.
• Materials for the school curriculum.
• A portal to host suicide prevention resources.
• Availability of workforce policies and supports for those affected by suicide.

You Said

There ranged between 188 and 191 responses to each sub question under Theme 4, as outlined as follows:

Theme Four: Learning and Building Capacity

Proposed Actions:	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Continue to evaluate our social movement and campaigns to ensure they reflect emerging good practice and are having the desired reach and impact, and draw on wider learning, for example from See Me.	1%	0%	6%	28%	57%
Implement actions from review of learning approach to suicide prevention to ensure it is fit for purpose and meets the different needs of the workforce and communities alike. This will likely lead to a tailored and targeted learning approach and resources – including to focus on areas where our learning approach can achieve the greatest system-wide impact	1%	0%	5%	30%	56%
Support the embedding of the Whole School Approach to Mental Health and the Children and Young People's Mental Health and Wellbeing professional learning resource, which includes suicide prevention, and share good practice	1%	0%	3%	20%	66%
Develop material for inclusion in the school curriculum which builds understanding on mental health, self-harm and suicide prevention	2%	1%	3%	15%	71%
Create a portal to host our suicide prevention resources and information in one, accessible digital space - and which links to other platforms.	1%	3%	3%	23%	62%

The percentage figures given do not add up to 100% as not all participants answered this part of the consultation

There was strong support across all of the actions proposed under this theme with more than 80% of respondents agreeing or strongly agreeing with the approach undertaken.

The following key themes were identified from the corresponding comments:

• A call to create a national database of relevant and local contact details for places to access support, with an opportunity to share learning, resources and best practice. This quote highlights the point: "We believe a central database is needed as we have experienced multiple instances where support phone numbers/ emails have changed as staffing changes, and it can be challenging to reach the support needed for individuals in a timely manner".
• Explore different ways to develop and deliver learning approaches. This quote highlights the point: "Ensure that any education resources, and learning, is mirrored with time and capacity to use the knowledge, and skills acquired. A range of learning approaches and platforms should be considered to enhance engagement".
• More emphasis on community awareness and capacity building.
• The approach to learning should be specific to suicide, as well as a broad approach to wellbeing and mental health. This includes treating suicide and self-harm as separate subjects in their own right.
• A need to review the public communications on suicide prevention, and specifically the social movement work and United to Prevent Suicide campaigns, so we are confident they are driving change and involving local communities more. This quote highlights the point: "There was a widely shared view among our consultees that the public communication function to-date is not meeting its potential, despite there being some very positive resource development through United to Prevent Suicide and allied initiatives. There needs to be significantly more depth and breadth of resource and campaign type support available, to meet diverse communities and needs, plus support for local campaign / engagement activity. There is still limited understanding of what the "social movement" aspect is trying to achieve and a feeling there isn't sufficient momentum around this aspect – meaning many opportunities for engagement aren't capitalised on. With little to no ring-fenced funding for suicide prevention in most areas of the country, many areas have no capacity to develop local campaign approaches and materials without central support."
• More detail was sought on suicide prevention as part of the whole school approach suggested. This quote highlights the point: "How will this be embedded? What support will be made available to schools? Will this be an opt-in for teachers or will it be mandatory? Will resources be made available? Will it be proactively promoted? Who will deliver and drive it?"

We Did

Overall, there was strong agreement with the actions set out under this action area. Where there were suggestions for enhancing the action, this was included in the final action plan. This included:

• Adding detail on the action around the social movement, campaigns and anti-stigma work, to include the breadth of evidence and experience which will be included in shaping this going forward.
• Expanding the key settings where promotion of suicide prevention learning resources will make a difference, and including suicide prevention action in the new Scottish Government Carers Strategy.
• Adding detail on who is the intended audience for actions, for example, confirming the action to develop an online portal is intended for both the workforce and individuals, families, and carers.
• Adding detail on which actions relate to children and young people.

Theme Five: Support

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.

We Asked

Those who participated in the consultation were asked for their thoughts about a series of actions relating to support, and which included activity in the following areas:

• Help seeking and help giving.
• A single Scottish telephone number for support.
• Adapting Distress Brief Interventions.
• Responding to the diverse needs of communities.
• Embedding of counsellors in education settings.
• Development of resources to support family and friends affected by suicidal behaviour.
• Peer support models for suicide prevention.
• Embedding suicide prevention in perinatal care.
• Ensuring suicide prevention features in the student mental health action plan.
• How primary care settings can identify and support those at risk of suicide.
• Ensure clinicians in unscheduled care settings are alert to suicide risk.
• Statutory services continuing to improve the quality of clinical care and support for people who are suicidal – (through NCISH^[2] guidelines).

You Said

There ranged between 179 and 194 responses to each sub question under Theme 5, as outlined below:

Theme 5: Support

Proposed Actions:	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Increase our understanding and practice around help seeking and help giving (potentially through test of change and sharing of good practice.	0%	1%	4%	26%	62%
Consider value and impact of a Single Scottish specific telephone number which will provide access to existing telephone support and resources	3%	2%	10%	22%	54%
Consider ways to adapt Distress Brief Interventions 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. Potential for new referral pathways, and ways to re-engage with support after discharge.	1%	0%	4%	24%	63%
Respond to the diverse needs of communities – we propose at least two tests of change, e.g. to reach particular groups and community setting by working with representative organisations (1) review the design and delivery of learning approaches to ensure they reflect the communities' experience of suicide, and (2) test new approaches to supporting people in those communities who are at risk of suicide. As part of this we will seek to understand help seeking behaviours and tailored support for cultural and diversity groups, by working with trusted organisations to develop approaches / interventions that work for groups who are at heighted risk of suicide. We will use the learning to inform our overall approach to supporting communities and groups where suicide risk is high.	1%	1%	6%	21%	64%
Continue to support embedding of counsellors in education settings, and ensure they are skilled and responsive to signs of suicidal concerns, whilst ensuring proactive approach to supporting CYP at key transitional stages, as part of a continuum of care.	1%	0%	4%	19%	64%
Develop resources to support families, friends and carers, or anyone else, affected by suicidal behaviour – building on existing resources.	0%	0%	0%	17%	75%
Build new peer support capability to enable further use of peer support models for suicide prevention	1%	0%	4%	22%	64%
Embed suicide prevention in perinatal care.	0%	0%	5%	16%	66%
Ensure suicide prevention is prioritised in the student mental health action plan	0%	0%	2%	15%	69%
Consider how primary care settings - including GPs, nurses, and mental health teams - can identify and support people who are at risk of suicide, who may present with low mood or anxiety or self-harm. This could include: safety planning, referrals to DBI, community support (social prescribing), and proactive case management, especially for high risk individuals.	0%	0%	1%	16%	76%
Undertake work to ensure clinicians in unscheduled care settings are alert to suicide risk - particularly those who have self harmed - and respond effectively through the provision of psychosocial / psychiatric assessment and ensure care pathways and support are put in place, including in the community. DBI should also be offered, where appropriate.	0%	0%	4%	15%	71%
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 NCISH guidelines into their operating practices [in full], and the relevant MAT standards [in full]	0%	1%	3%	21%	66%

The percentage figures given do not add up to 100% as not all participants answered this part of the consultation

People were broadly supportive of the actions set out, with on average over 75% either agreed or strongly agreed across the board, compared with an average of less than 6% who either disagreed or strongly disagreed.

The following insights were identified from the follow-up comments made:

• This section of the plan was deemed by some to be over-medicalised and needs to consider the value of non-clinical support avenues.
• There were questions on the value of a national telephone line. Some thought it may cause confusion, whilst others thought the opposite. This quote highlights the point: "unsure of the value in undertaking this when we have existing helpline numbers in place which are recognised and widely utilised". Also this quote, "This has potential to reduce confusion from the perspective of someone seeking support. Careful consideration of any potential unintended consequences will be required, alongside clear care pathways to existing resources such as Breathing Space and the NHS 24 Mental Health Hub. Clarity on messaging will be key to ensure people requiring immediate or emergency care are escalated to appropriate care (such as emergency services) seamlessly."
• Primary care settings, particularly GPs, are an important point of contact and need to be better trained to identify suicide risk.
• Need to invest in person-centered support and understanding the needs of specific groups, including older people. Engaging with BAME communities was highlighted as important to this.
• Need to recognise the impact of the pandemic on groups, especially children and young people, and to recognise that services are more difficult to access post-pandemic.
• Scope for greater involvement of Community Pharmacies. This quote highlights the point: "There is an under-realisation of the potential that pharmacies hold given their frequent contact with not only those in treatment but PWUD (people who use drugs) within communities, and insufficient funding to fully support the needs of the people that we see each day".
• Emphasis on providing continuous support. This quote highlights the point: "One issue highlighted by our volunteer focus group is that people feel once their crisis stage has passed, there is no continuous support. The wording around 're-engaging' here suggests there will be a gap in support before re-engaging, but the support should be continuous".
• Parity of support is needed between out-of-hours services and Monday-Friday services, as well as different services joining up to ensure people receive the range of support they need. This quote highlights the point: "There is also a critical need to invest in services and to ensure that they are equipped to provide person-centred support where needs are identified. i.e. that people are supported more holistically, rather than isolating different issues such as alcohol, mental health, and suicide risk from one another and placing processes above peoples' needs".

We Did

We heard what was said about an over-medicalised approach to providing support. There are a number of actions in this section which focus on clinical care. It was felt these were important in order to address the issues which had been raised during the early engagement. In areas such as unscheduled care, primary care and mental health services the evidence suggests there are opportunities for earlier intervention and improvements to assessment and care, therefore these actions were retained. These clinical approaches are however balanced (both in this section of the action plan and across the strategy) with a strong focus on the role for communities and the workforce, for example, staff working in schools and youth work have a significant role to play in suicide prevention activities.

The role of pharmacies has been made explicit in the action plan.

We have also sought to build in the need for ongoing support and care right across the strategy and action plan.

We also recognise that there were no actions which focused specifically on the needs of older adults, we therefore added an action which would build our understanding of the needs of this group and help address these.

Theme Six: Planning

This theme intended to address areas where effective planning for risk was required. This included action plans for settings where evidence indicates people are at higher risk of suicide and situations which may emerge within communities such as suicide clusters or contagion.

We Asked

• Those who participated in the consultation were asked for their thoughts about a series of actions relating to Planning, and which included activity in relation to the following areas:
• Ensuring all key settings with a higher risk of suicide have a suicide prevention action plan.
• Guidelines for communities to respond to contagion or clusters.

You Said

There were 190 and 188 responses recorded against each sub question under Theme 6, as outlined as follows:

Theme Six: Planning

Proposed Actions:	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Ensure all key settings with a higher risk of suicide have a suicide prevention action plan, which connects to local suicide prevention plans (to ensure smooth transition at discharge). Plans should include actions for the people they support as well as their workforce. Key settings include: schools, further & higher education, criminal justice, secure accommodation, and residential care.	1%	1%	5%	22%	63%
Guidance: guidelines for communities to respond effectively to suicide clusters and contagion within their local context.	1%	1%	6%	22%	61%

The percentage figures given do not add up to 100% as not all participants answered this part of the consultation

Again, respondents to the consultation were supportive of the actions set out under Theme 6, with over 80%, strongly agreeing or agreeing with the planned need identified.

From the comments which followed, the corresponding observations were identified:

• A recommendation that local areas are provided with guidance about how to deliver on some of the policies and protocols highlighted in order to standardise practice. Whilst, also recognising the need to take a flexible approach to reflect the local context.
• A recognition that communities, can be wider than a geographical context. This quote highlights the point: "Support for communities should not only be geographical, but also those of interest. It is noted that the impact of drug related deaths has an impact on others using drugs, but may not all reside in the same locality".
• The synergies of learning which can be gained from drawing evidence from different sources. For example, adverse death reviews which are co-ordinated by Alcohol and Drug Partnerships can also provide insight into wider issues, such as homelessness.
• When identifying key settings for targeted work, these should also include community and voluntary support providers.
• Greater recognition should be given to rural settings under this specific theme. This quote highlights the point: "Serious consideration needs to include remote and rural communities where isolation, deprivation, housing, costs of living, and education, are all potential contributing factors - not to mention access to, and equal service provision of, health and social care". And this quote: "Suicide rates are high in rural areas (Highland region has the highest rate), therefore the rural dimension must be considered. This includes digital online methods of support, use of existing networks (National Rural Mental Health Forum), building of resilience and knowledge of suicide prevention and intervention".

We Did

In recognising the strong connection between Planning and Data and Evidence (as confirmed by responses), theme six in the consultation was combined with theme seven in the final action plan.

We clearly set out that this action area relates not only to settings but also to services and should draw on existing plans, resources and best practice approaches.

In relation to a specific point raise about clusters and contagion, the action was changed to include reference to 'timely' along with effective responses.

The rural theme has been picked up across the action plan, and sits as one of our Guiding Principles. Across the strategy and action plan we recognise social isolation as a standalone issue, i.e. that it doesn't only relate to people living in remote or rural areas.

Finally, the point about communities of interest has been highlighted right across the strategy and action plan, with examples, such as focussing awareness raising and tailoring responses for the LGBTI community, disabled people and racialised communities. We also have a number of areas within the action plan which refer to the need for integration of services, and data, to reflect the range of circumstances and type of support individuals need. This approach is needed to ensure people receive holistic support, and also to ensure we use all available data to inform our overall suicide prevention approach - nationally and locally. Specifically, we also included a focus on the action to improve data recording and reporting, the need to connect data which is available through other sources such as the drug related deaths and evidence around gender based violence, trauma, criminal justice etc. This will enhance the data currently available to support action on suicide prevention.

Theme Seven: Data and Evidence

By designing-in our data needs and taking a broad view of different types of evidence (including management / evaluation data, qualitative data and service insights) we will build an effective evidence informed approach to suicide prevention.

Our data, evidence, practice and lived experience insights are all essential for good design, delivery and evaluation of our actions, and will inform the continued evolution of our approach to suicide prevention.

Our outcomes framework will identify indicators and measures which will enable us to assess progress and evaluate delivery of the outcomes.

We Asked

Those who participated in the consultation were asked for their thoughts about a series of actions relating to Data and Evidence, and which included activity in relation to the following areas:

• Embedding and enhancing the Lived Experience model.
• Introducing a horizon scanning function to produce a 6 monthly digest of new evidence.
• The roll-out of multi-agency reviews.
• Hosting learning events as a way to disseminate information and share learning.

You Said

Between 187 and 191, respondents responded to the questions asked in this section, with a breakdown of results as follows:

Theme Seven: Data and Evidence

Proposed Actions:	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Continue to embed and enhance our lived experience model, and ensure it is representative of groups experiencing suicidal behaviour. Enhancing the model could include developing resources/toolkit to support people with lived experience sharing their personal stories in safe, meaningful and impactful ways [links to peer support].	1%	1%	5%	28%	58%
Introduce a horizon scanning function to produce a 6 monthly digest of new evidence, which connections to the mental health Research Advisory Group. Priority areas may include: COVID and cost of living impacts. This insights and evidence will form a core part of our suicide prevention planning, delivery and evaluation, both at a national and local level.	1%	1%	6%	27%	55%
Roll out multi-agency suicide reviews and learning system (aligning with the serious adverse event reviews process within mental health services).	1%	0%	8%	25%	57%
Host learning events to disseminate information and share learning and good practice between and across sectors on suicide prevention. This will build on the Suicide Information Research Evidence Network (SIREN) model.	1%	0%	5%	29%	57%

The percentage figures given do not add up to 100% as not all participants answered this part of the consultation

Across all suggested actions under this theme, respondents either strongly agreed or agreed with what was proposed, with the hosted learning events receiving the most support. Less than 2.5% of those who answered strongly disagreed or disagreed with the actions proposed.

From the corresponding comments, the following themes emerged:

• The importance of safeguarding when engaging with people with lived experience of suicide.
• A request to undertake research and evaluation of the interventions and therapies which can be used to support an individual.
• A proposal to include data currently gathered from Water Safety Scotland, who are also implementing the Drowning and Incident Review (DIR) process and as such, would have relevant crossover with suicide data.
• Agreement with the suicide review proposal but concerns raised regarding funding, capacity issues and impact on clinician time. There was also a proposal to include family members and also people bereaved by suicide. This quote highlight the point: "The lack of connection between services can cause serious issues for individuals, and any attempt to bring services closer together is welcomed. Families should always be involved as equal partners in multi-agency reviews".
• Welcome of the horizon scanning function to identify emerging trends, which will help guide local partners. This quote highlight the point: "Horizon scanning will also allow for advance notice / consideration for local partnerships to amend the direction of their intervention services on the ground".

We Did

We heard the need to ensure that people with lived experience who support and inform Scotland's work on suicide prevention are well supported. To address this we have included specific reference and actions on this with the action plan. This mirrors the continuous improvement approach we are already taking to ensure people with lived experience are engaged in our work in safe and meaningful ways.

We have included a timescale for the International Association for Suicide Prevention research we are funding 'Interlinked systematic umbrella reviews of the effectiveness of interventions to prevent suicide', which will publish in 2023. We will ensure the findings are disseminated widely and the learning informs our ongoing work.

General Comments on the Action Plan

Respondents were asked if they had any further comments on the proposed action plan. There were 60 responses to this section of the consultation with a summary of some of the key points highlighted below:

• Third sector / voluntary services need to be more prominently represented in the action plan.
• Funding and its allocation needs to be more explicit across the plan.
• Queries regarding the method of reporting to be used.
• Despite the comprehensiveness of the plan, greater focus on prevention is required.
• How will this translate from national into local action?
• Query raised about how this plan will complement the work of the Mental Health Strategy and also to avoid duplication of effort.
• Clarity on the criminal justice locations referenced in the plan.
• The impact of alcohol and drugs should be referenced more prominently throughout the plan.
• Although the whole society and tackling societal factors approach is welcomed, the needs of those at immediate risk of suicide should still be recognised.
• The plan needs to go further to address the needs of at risk groups who are unemployed or in low paid employment.
• A concern was raised that education has not been recognised as a core sector for developing and delivering the suicide prevention strategy.
• Greater clarity on how the action plan will be delivered including roles and responsibilities.

We Did

In response to these key points (many of which were also flagged through specific questions), the following areas were either added or strengthened in the final strategy and action plan:

• The need for collaboration and partnership working across the strategy was strengthened – with specific references to the value and importance of working with and supporting the third and private sectors to take action, alongside the public sector and communities.
• More detail on funding, and a commitment to a transparent funding approach.
• Confirming the development of an outcomes framework to underpin the strategy and action plan which will enable robust monitoring and evaluation of delivery, and the changes that result. Alongside that there will be a transparent reporting cycle.
• A commitment to continue the implementation support for local areas which ensures learning between areas, and also as a vehicle to ensure connections are made between local and nationally led work. The scope for local and national collaboration will be further strengthened through the Delivery Collective model.
• Clearly setting out how the Delivery Collective model will bring together partners at national, local and sectoral levels.
• Setting out how accountabilities and governance are being improved, including through the new National Delivery Lead role, the revised NSPLG role, and then the links to wider Government policy, such as the mental health strategy, self-harm strategy and the wider programme of work to support mental health and wellbeing of adults and children and young people.
• Explicitly setting out the settings where targeted action is necessary to reach people with higher risk of suicide, including specific criminal justice settings.
• Strengthened the actions where there are opportunities to connect linked policies and programmes of work, for example on alcohol and drugs, homelessness, poverty, and suicide prevention.
• Strengthened the focus on inequalities including its addition to the strategy's vision.
• Strengthened actions around education and explicitly set out the actions which relate to children and young people.