Suicide Bereavement Support Service: final evaluation report

1. Introduction

1.1 Background to the Suicide Bereavement Support Service (SBSS)

People who are bereaved by the suicide of a close friend or family member are estimated to be 65% more likely to attempt suicide than if the deceased had died by natural causes.^[1] The findings of a 2018 research study suggest that up to 135 people are affected to some degree by a death by suicide.^[2] In 2022, the number of people who died from suicide in Scotland was 762; a slight increase from the previous year (753), which was the lowest level since 2017.^[3]

Bereavement by suicide can have a severely detrimental effect on emotional and mental wellbeing, and many practical and emotional barriers prevent people who have been bereaved by suicide from accessing or seeking support. These barriers include not knowing what support is available, where to look, or an inability to access support due to trauma and distress.

The National Suicide Prevention Leadership Group (NSPLG) was established in 2018 to support the implementation of the Scottish Government’s Suicide Prevention Action Plan ‘Every Life Matters’.^[4] In 2019, the NSPLG’s Annual Report included a recommendation that the Scottish Government fund a pilot to test a new model of suicide bereavement support.

In response to this recommendation, a pilot support service for families bereaved by suicide - the Suicide Bereavement Support Service (SBSS) - was funded by the Scottish Government. The service requirements and the core components of the service model were informed through a research project^[5] undertaken by the Mental Health Foundation (MHF), jointly funded by the Scottish Government and MHF.

Following a competitive tendering exercise, Penumbra and Change Mental Health, working in partnership, were commissioned to manage and deliver the pilot. Change Mental Health delivered the service in NHS Highland and Penumbra in NHS Ayrshire and Arran.

The SBSS launched in August 2021 and was originally scheduled to end in April 2023. The Lines Between was commissioned to carry out an independent evaluation of the pilot, beginning in February 2021 and ending in March 2023. During this period, two mid-year interim reports and two annual reports were produced detailing the findings and evidence captured. A summary of the first annual evaluation report was published in Autumn 2022^[6] and a full report of Year 2 of the evaluation was published in September 2023^[7].

In 2022, ‘Creating Hope Together’, Scotland’s Suicide Prevention Action Plan (2022-2032), was launched. Outcome Three in this action plan sets out the ambition that: “Everyone affected by suicide is able to access high quality, compassionate, appropriate and timely support – which promotes wellbeing and recovery.”

To enable further learning that could inform decisions about the longer-term future of the service, the pilot was extended to March 2024, and the evaluation extended to October 2023. The specific aims of the evaluation extension are detailed in the following section.

1.2 Purpose of the extension to the SBSS evaluation

Stakeholders highlighted specific areas of insight and learning to capture during the evaluation extension period. This included:

• What are the longer-term experiences of people engaging with the service, and what outcomes are achieved?
• To what extent has the following changed over time:
  • number of people being referred,
  • sources of referral,
  • reasons for referral,
  • frequency and length of sessions, and,
  • Different types of support and the impact they have
• What can the profile of those using the service tell us about who benefits most from the service and who may be missed within current approaches?
  • How has the profile of people accessing the service changed over time?
  • How recently have people experienced suicide bereavement before accessing the service and has this changed over time?
• What are the views, experiences and key learning amongst frontline practitioners, particularly on issues around training and supervision, and how can this inform the service rollout and support new practitioners?
• What are the barriers and opportunities associated with different referral pathways into the service? What is the key learning for the development of new pathways for referrals?
• What are the opportunities and limitations of the current ‘hub and spoke’ model for service delivery with respect to wider service rollout?
• How does the service fit within the wider ecosystem for support and provision for suicide bereavement and suicide prevention?
  • What do referrers say about the service and the referral processes?

1.3 Report structure

This final report presents findings generated from the extension period of the service evaluation, covering the period March 2023 to October 2023. It also recaps key findings and learning from previous reports to provide a summation of reflections that cover the 3 years of evaluation activity.

This report is structured as follows:

• Chapter 2 provides a summary of evaluation and data collection activity carried out over the full duration of the evaluation.
• Chapter 3 provides an overview of service delivery activity and the profile of people who accessed the service.
• Chapter 4 explores service delivery from the perspective of service staff, as well as discussing how the service fits into the wider support landscape and its alignment and contribution to local suicide prevention priorities and activities.
• Chapter 5 presents the experiences and outcomes of people who have received longer-term support from the service.
• Chapter 6 discusses the considerations and options for the future of the service.
• Chapter 7 presents conclusions aligned with the evaluation questions.
• Chapter 8 provides recommendations for the future of the service.