Suicide Bereavement Support Service: evaluation report - year 2

1. Introduction

Background to the Suicide Bereavement Support Service (SBSS)

In 2021, the number of people who died from suicide in Scotland fell to its lowest level since 2017, with 753 probable suicides registered. This follows a year-on-year decrease from 2019 (833 registered) and 2020 (805 registered).^[4]

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.^[5] The findings of a 2018 research study suggest that up to 135 people are affected to some degree by a death by suicide.^[6] Bereavement by suicide can have a severely detrimental effect on emotional and mental wellbeing and increases the risk of serious mental health issues. Many practical and emotional barriers prevent people who have been bereaved by suicide from accessing or seeking support until they reach a crisis point, if they seek it at all. These barriers include not knowing what support is available, where to look, or 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’.^[7] This Action Plan contains ten actions for suicide prevention, including Action Four: ‘with the NSPLG, the Scottish Government will ensure that timely and effective support for those affected by suicide is available across Scotland by working to develop a Scottish Crisis Care Agreement’. 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 model builds on relevant research and other evidence/good practice models. Following a competitive tendering exercise, Penumbra and Change Mental Health (formerly named Support in Mind Scotland), working in partnership, were commissioned to manage and deliver the pilot, with Change Mental Health delivering the service in NHS Highland and Penumbra in NHS Ayrshire and Arran.

The pilot SBSS launched in August 2021 and was scheduled to end in April 2023. An extension to March 2024 has recently been granted to enable further learning to be generated and captured, informing any future service rollout.

‘Creating Hope Together’, Scotland’s Suicide Prevention Strategy (2022-2032) was launched in late 2022. It continues the commitment in the previous suicide prevention strategy to ensure that people bereaved by suicide can access timely, effective and compassionate support. The strategy document explains:

Our aim is for any child, young person or adult who has thoughts of taking their own life, or are affected by suicide, to get the help they need and feel a sense of hope.

Purpose of the SBSS evaluation

The Scottish Government commissioned The Lines Between to deliver an independent evaluation to run alongside the SBSS pilot. The evaluation aims, objectives and research questions are described below.

The evaluation aims were to:

• Understand whether the pilot has been implemented as intended and the elements of service provision that are working well or less well.
• Assess whether the service provides flexible support and makes the required connections with specialist services.
• Review whether participants considered the service to be supportive and beneficial.
• Analyse available data and review and advise on using baseline and outcome measures for service monitoring and evaluation.
• Make recommendations for any service improvements that can be implemented during the pilot period.
• Provide recommendations for further national roll-out, considering questions of scale and sustainability.

The specific evaluation objectives were to:

• Review the operational delivery model, including referrals into and onwards from the support service and the use of centralised coordination and support in combination with local staff and services.
• Review and analyse routine monitoring data, and track service design, implementation and delivery.
• Explore peoples’ experiences and perceptions of the support they have received from the SBSS, including an assessment of the whole family-based approach.
• Assess any change in outcomes for people supported by the service (with reference to the draft logic model provided separately), considering the limited duration of the pilots.
• Understand the views of the staff in central and local functions on service delivery and sustainability and barriers and enablers to service delivery.

The Research Questions for the evaluation were:

• To what extent have the pilots delivered on their intended aim to provide a rapid response and liaison service for bereaved families?
• What contextual factors have influenced the implementation and delivery of the pilots?
• What has been the experience and short-term outcomes for those using the service?
• To what extent can the impact and benefits for families be evaluated, and are there improvements that can be made to routine monitoring data?
• What are the key lessons for further roll-out, scale-up, and service sustainability?

Report structure

This report is the second annual report, drawing and building on the findings collected over the 2 years of the evaluation to date while also providing additional learning and evidence on experiences and outcomes. A summary of the first annual evaluation report was published in Autumn 2022^[8]. A further report will be published in early 2024 following the end of the 3^rd and final year of the evaluation. The Year 2 evaluation report is structured as follows:

• Chapter 2 covers the evaluation activity delivered throughout the evaluation.
• Chapter 3 provides an overview of service delivery activity and the profile of people that accessed the service.
• Chapter 4 explores the experience of service staff in managing and delivering the service and the learning generated from it.
• Chapter 5 presents findings on the experiences of people supported by the service and the impact of the support they have received.
• Chapter 6 presents our reflections on the draft service logic model.
• Chapter 7 provides conclusions and our recommendations for the future.
• Appendix 1 presents detailed Alt-text descriptions for infographics and charts.