National Suicide Prevention Advisory Group Annual Report 2023/2024

4. Progress on Delivering Scotland’s Suicide Prevention Strategy 2022-2032

4.1 Strategic Context of Suicide Prevention

Related Developments in Scotland

We note that there have been a number of significant strategic developments over 2023/24 which directly impact on suicide prevention in Scotland and on the Suicide Prevention Strategy 2022-2032: Creating Hope Together.

In June 2023 the Scottish Government and COSLA published their joint Mental Health and Wellbeing Strategy, followed by an initial delivery plan and workforce action plan. The vision of the Mental Health and Wellbeing Strategy is of a Scotland free from stigma and inequality, where everyone fulfils their right to achieve the best mental health and wellbeing possible.

Clearly, in offering a framework for promoting good mental health across the country the overall Mental Health and Wellbeing Strategy should also progress suicide prevention. As the NSPAG we advise that it will be important to ensure the Suicide Prevention Strategy and the Mental Health and Wellbeing Strategy continue to complement one another, that there is absolute clarity over resource allocation and that there are no gaps through which the focus on suicide prevention can fall.

In November 2023 the Scottish Government and COSLA published what is believed to be the world’s first standalone Self-Harm Strategy. We understand the development of a separate strategy reflects evidence that most people who self-harm have no intention of attempting suicide, and that people with lived and living experience of suicide support this approach.

However, evidence shows a person’s history of self-harm to be one of the highest predictors of suicide and we note that Scotland’s new Self-Harm Strategy therefore offers new opportunities not only to support people affected by self-harm in a compassionate and effective way, but also to reduce the risk of suicide. It will be important to ensure that Scotland’s Suicide Prevention Strategy and its Self-Harm Strategy, together with their delivery plans, are connected effectively. Opportunities for joint working and sharing of resources should be taken wherever possible, reflecting the fact that for example in clinical settings suicide prevention and self-harm responses may involve the same services and workforces.

During spring and early summer 2024 the Scottish Parliament Equalities, Human Rights and Civil Justice (EHRCJ) Committee has been conducting an inquiry into suicide prevention in Scotland. The Committee stated it would focus on scrutinising the progress of the Suicide Prevention Strategy 2022-2032: Creating Hope Together, budget allocations, the unequal distribution of deaths from suicide across different population groups and engagement with those with lived experience.

The EHRCJ Committee issued a Call for Views on six specific questions and the NSPAG provided a written submission on 2 April 2024.

On 28 June 2024, as this annual report was being written, the EHRCJ Committee wrote to the Scottish Government Minister for Social Care, Mental Wellbeing and Sport setting out the Committee’s findings and inviting a response. The NSPAG will carefully consider the Committee’s findings and the Scottish Government response together, in due course.

4.2 Suicide Prevention in England, Wales and Northern Ireland

During 2023/24 the NSPAG has made initial contact with and been welcomed warmly by colleagues leading and advising on suicide prevention in England, Wales and Northern Ireland.

In the coming year we have confidence that our relationships with colleagues across the UK will develop and lead to the sharing of insights, evidence and good practice which reflect our shared aim of supporting all those working so hard and so passionately across the UK, whatever their role, to prevent the tragedy of suicide in our communities.

4.3 Scotland’s Suicide Prevention Strategy 2022-2032: Creating Hope Together

The NSPAG commends the ambition and breadth of the vision set out in the Scottish Government and COSLA’s Suicide Prevention Strategy 2022-2032: Creating Hope Together to reduce the number of suicide deaths in Scotland, whilst tackling the inequalities which contribute to suicide.

We welcome the readiness with which the Scottish Government and COSLA together embraced the recommendation made to them by Scotland’s then NSPLG in its June 2020 Covid-19 Statement: that they should develop a joint, long term (ten year) evidence-based strategy supported by an agreed cross-government (national and local) programme of work and an outcomes-based evaluation framework, with continuing investment and including those specific wider policy areas beyond mental health policy which also have a role to play in suicide prevention.

A strategic planning framework for the suicide prevention strategy has been introduced which consists of the following elements:

• Long Term Suicide Prevention Strategy
  • Creating Hope Together Strategy 2022-2032 published
• Medium Term Action Plans
  • Current Action Plan 2022-2025 published
• Annual Delivery Plans
  • 2023/24 Delivery Plan completed
  • 2024/25 Delivery Plan published, including forward look to 2025/26

As Scotland’s NSPAG we understand that what drives someone to suicidal thoughts, suicidal crisis or to taking their own life involves in each tragic case a complex set of factors and complex relationships between those factors. These may include but are not limited to such social determinants and environmental issues as societal inequalities, health inequalities, poverty, deprivation, unemployment, financial stress, discrimination, marginalisation, isolation, stigma, social and family factors, access to means of suicide, timely access to services and the effectiveness and compassion with which services are provided, access to effective support, media reporting of suicide and access to harmful material online.

In addition, we understand that individual factors which also contribute to the risk of suicide may include, but are not limited to, such issues as bereavement by suicide, the experience of psychological trauma, care experience, experience of the criminal justice system, economic pressures, mental and/or physical ill health, alcohol misuse, substance misuse, self-harm, problematic gambling, disconnectedness, family breakdown, personal resilience, help-seeking and the availability of social/peer support, feelings of hopelessness, defeat or entrapment.

It is important also to recognise that economic conditions and policy decisions impact over the long term on suicide risk for particular groups in society. These impacts need to be considered generationally and suicide prevention action understood in terms of the personal, social and economic costs of suicide.

The NSPAG believes that a strategy and implementation plans built soundly on evidence by experience and academic evidence, on data and research, and on the insights of suicide prevention practitioners stand the best chance of achieving a reduction in the number of suicide deaths in Scotland. We are therefore heartened to have heard directly from people with lived and living experience of the impacts of suicide, from academics and from practitioners that they were directly engaged in the development of Scotland’s Suicide Prevention Strategy 2022-2032 and its various delivery plans to date, and continue to be actively involved in implementation.

We welcome the prominence given in the suicide prevention strategy to a set of specific guiding principles which represent important commitments to the values intended to govern this work over its ten year span. We have seen the influence of the guiding principles on work throughout 2023/24 and note that the recently published Delivery Plan 2024/25 is intended to be more explicit in terms of focussing on those guiding principles relating to stigma, discrimination and inequalities.

We commend also the strong working relationships evident between the Scottish Government and COSLA as the joint owners of the Suicide Prevention Strategy 2022-2032. We have seen at every level a genuinely respectful and collaborative approach and a clear commitment to ensuring this is the culture in which plans are developed and delivered with communities and other partners.

4.4 Suicide Prevention Strategy 2022-2032 - Delivery Infrastructure

“This is a humbling time to be involved in the suicide prevention agenda. The recognition of the need for collective, collaborative leadership across multiple areas, the coming together of people and communities across all sectors, and the focus on health and all inequalities is what creates the hope that a difference can and will be made and that we all have a part to play.” Dr Linda Findlay, NSPAG member

The creation of a delivery collective – Suicide Prevention Scotland – to provide both a partnership hub for implementing the suicide prevention strategy and a community for geographical, sectoral, national and local partners has clearly been welcomed. As has the appointment of a National Delivery Lead for suicide prevention whose role it is to oversee and co-ordinate the work of the five social/third sector organisations appointed as Strategic Outcome Leads for the strategy’s four strategic outcomes.

We have observed at first hand the expertise and commitment of each of the Strategic Outcome Lead organisations – Samaritans Scotland, SAMH, Penumbra, Change Mental Health and Public Health Scotland – and their willingness not only to work in partnership and within the funding provided to support the strategy, but also to lever in their own knowledge, expertise and discretionary effort. We commend this collaborative approach and note that it will be a critical success factor in ensuring connections and opportunities across and between outcomes are identified so as to optimise the use of resources, rather than working solely in parallel and thereby risking duplicating effort or creating gaps in delivery.

The appointment of a National Delivery Lead to oversee and co-ordinate the work of the delivery collective Suicide Prevention Scotland has given strong impetus to the work as well as clarity in terms of leadership and accountability to the Scottish Government and COSLA for progress on delivery of the suicide prevention strategy. It is important to be clear, however, that ownership of the strategy itself and therefore ultimate accountability to Scotland’s communities for achieving the strategy’s vision remain with the Scottish Government and COSLA.

The scale of work carried out by Suicide Prevention Scotland in 2023/24 has been impressive. It has included the continuation and scaling up of work begun under Scotland’s previous Suicide Prevention Action Plan 2018-2022: Every Life Matters and working with the Public Health Scotland suicide prevention team to create new opportunities for individuals, community groups, national and sectoral partners and local suicide prevention leads to come together, as well and developing and delivering the suicide prevention strategy’s formal implementation plans.

We consider that the new delivery infrastructure created to realise Scotland’s ten-year suicide prevention strategy offers real and potentially sustainable opportunities to harness the passion and skills of individuals, communities, practitioners and sectors across the country to reduce deaths by suicide and tackle the inequalities which contribute to the tragedy of suicide.

If Suicide Prevention Scotland is to build on the willingness of all involved to break down cultural, sectoral or organisational barriers in the spirit of promoting an environment in which every person, community and organisation sees and is enabled to play their part with others in reducing suicide, it will require effective resourcing over the long term. Only then will its impact be able to match its potential.

4.5 Suicide Prevention Strategy 2022-2032 - Vision for Tackling Inequalities

“These discussions have given me insights into how we turn the ambitions in Creating Hope Together into reality, explore the links between poverty and suicide prevention and what more we can practically do as anti-poverty groups and organisations. They also reminded us of the importance and urgency of efforts to better address the ‘social gradient’ associated with suicide.” Peter Kelly, NSPAG member

The NSPAG welcomes the explicit connection made in the Suicide Prevention Strategy 2022-2032 between reducing lives lost to suicide and tackling the inequalities which evidence shows contribute to suicide. We understand this to be an internationally innovative approach to suicide prevention. It is clearly also an ambitious approach, and we believe ambition should always be high in the context of saving lives.

During 2023/24 we have considered the complex interplay across the wide range of social, economic, health and individual inequalities people experience and how these relate to the risk and prevalence of suicide. There is clear evidence of the correlation between these societal inequalities and the inequalities of suicide itself and we have advised Suicide Prevention Scotland that to make measurable progress in realising the strategy’s vision a clear definition of the markers of inequalities in relation to suicide prevention should now be developed. This will provide clarity for prioritisation of actions and the allocation of resources, giving greater impact to the important work ahead.

We understand that while the prevalence of suicide is higher in certain groups of people, the risk of suicide for people within those group varies. We advise that work be undertaken to identify policies and interventions to improve protective factors and remove or mitigate risk factors for people most at risk of suicide within those high risk groups.

This work will require a strong focus on the most disadvantaged in society and those most vulnerable to the risk of suicide. Our NSPAG members have contributed their professional views and advice on this approach: for example on the importance of understanding intersectionality and how it can compound risk; on the value of exploring a cross-cutting health equity approach which will contribute to suicide prevention; and on recognising that while poverty is not in itself an equality characteristic it should be specifically addressed through the suicide prevention strategy and its implementation plans. We have offered advice on opportunities to progress this approach, such as working with the Tackling Child Poverty Programme Board.

A key challenge to preventing suicide through tackling the inequalities which contribute to risk is the current strain across public services. In our view this could be mitigated by all services taking action specifically to prioritise individuals and groups most at risk of suicide, assisted by the Suicide Prevention Scotland lens on inequalities and based on the absolute priority of saving life.

This focus on communities of geography, background and interest where evidence shows suicide rates are higher should lead to the redirection of service delivery resources and to tackling barriers to partnership working. It should also lead to better support for the wellbeing of workforces, including across health services such as primary care where people at risk of suicide so often come to notice, and for example across education and social work.

We welcome the early engagement of Suicide Prevention Scotland with organisations representing and supporting marginalised communities. Improving understanding of the needs and intersectionality of people experiencing stigma, disadvantage, inequalities, minority stress is essential as a first step.

It is clear that the work required to operationalise this understanding will need to take place at scale and whilst managing significant complexity. We therefore welcome work by Suicide Prevention Scotland during 2023/24 to produce an evidence-based prioritisation framework, aimed at ensuring action in other policy areas and services is focussed on work most likely to protect groups of people at high risk of suicide, whilst also focussing on equalities and human rights.

However, if the vision of the Suicide Prevention Strategy 2022-2032 to tackle the inequalities which contribute to suicide is to be achieved it is now necessary for engagement to shift in 2024/25 into active testing and delivering real change with these communities through co-design and co-delivery approaches.

Based on data and evidence (by experience, practice and research) the new prioritisation framework should be used early in 2024/25 to identify which specific groups and communities are to be prioritised and lead to tangible actions being undertaken to reduce suicide risk, with progress being specifically tracked and evaluated against the suicide prevention strategy’s outcomes framework.

This should include focussing on practical ways in which specific groups can access services in the way they need them; for example, the needs of those living in poverty, of LGBTQ and care experienced people, people in the asylum system or those seeking refuge from domestic abuse, while they may intersect at points, may also differ.

In any consideration of tackling the inequalities which contribute to suicide it is important to note the long term reality that around two thirds of those who lose their lives to suicide each year in Scotland are men. It is quite right therefore that work should continue to focus on reaching, supporting and enabling men to be protected from the drivers of suicide. However, we understand that women make proportionately more suicide attempts than do men, and that there are signs of an increasing trend in women losing their lives to suicide. We therefore expect to see gender inequalities addressed in suicide prevention action plans.

Recommendation 1: The NSPAG recommends that, using its new tackling inequalities prioritisation framework, Suicide Prevention Scotland’s engagement work should move as early as possible in 2024/25 to testing and delivering measurable action with the specific groups and communities most at risk of suicide and impacted by the tragedy it brings.

4.6 Suicide Prevention Strategy 2022-2032 - Vision for a Whole of Government and Society Approach

“Creating Hope Together has been received very well in the community development fraternity. That gives me cause for hope and optimism for the success of the national strategy and action plans.” Brendan Rooney, NSPAG member

The NSPAG believes that action to reduce rates of suicide and the tragedy suicide brings to the estimated 135 people affected by that suicide death is the responsibility of our society as a whole, and of every part of national and local government. We therefore welcome recognition in the vision of the Suicide Prevention Strategy 2022-2032 that all sectors must come together and all communities be supported to achieve suicide prevention in Scotland.

As members of Scotland’s society we can all, whatever our role or situation, be enabled firstly to understand that we each have a role to play in removing stigma and preventing suicide, and then to act with knowledge and confidence. As individuals, family members and friends, as communities, in places of work and education, in organisations and social systems, as service designers and providers, and as leaders and policy makers we can all help to reduce the risk of suicide, reduce the loss of life and prevent the associated tragedy suicide brings.

We consider that the primary purpose of suicide prevention – to save lives – is incontestable, and that this should provide a natural entry point to the whole range of policy initiatives in Scotland. It should promote action including and beyond mental health policy. It will require leaders in government and across society – including our NSPAG members – to take responsibility for action which has previously not always been seen in terms of its potential to prevent suicide.

Our NSPAG members recognise that the intention set out in the suicide prevention strategy to build a whole of government and society approach to addressing the social determinants which have the strongest links to suicide risk is both complex and ground-breaking.

Embedding this approach will be extremely challenging, and require huge leadership energy, focus and tenacity across government and society in all their iterations. It will require a strong focus on the most disadvantaged and most vulnerable in Scotland’s communities. It will also require changes in attitudes and behaviour in every dimension of society, reaching beyond the specific label of suicide prevention.

We are clear that, at the same time as a whole of government approach is embedded and extended, a strong focus must also be maintained in communities, where the whole of society approach will take effect only if people have the knowledge and confidence to ask and talk about suicide using language that works for them. Society in Scotland is not fixed in time; this will require working alongside and providing training and other resources to people in communities, adapting delivery approaches as often as necessary to make them resonant and relatable intergenerationally for communities of place as well as of interest.

We will observe closely during 2024/25 work being undertaken by Suicide Prevention Scotland with the Scottish Community Development Centre to support two geographical communities and two communities of interest. We understand this will design and undertake action research intended to lead to practical tests of change in suicide prevention.

It will be important that this work is properly resourced, that learning is used to spread effective adaptive practice across Scotland, and that tests of change approaches are also developed with high risk groups and in high risk settings.

Without doubt, embedding suicide prevention in wider national and local government policy and associated service delivery will require visible leadership, significant resource and sustained effort, but it is also true that some avenues for this change already exist. As individuals and professionals our NSPAG members have been glad to play our part during 2023/24 in facilitating connections with our own policy areas and networks so as to raise awareness and create opportunities to spread the whole of government and society approach to suicide prevention.

We have advised for example that the National Trauma Transformation Programme could and should prioritise suicide prevention touchpoints in its roll-out plans.

Similarly, we recognise that benefits are one of the most direct ways to protect people and families against many of the pressures which contribute to the risk of suicide. We have advised that initiatives such as the Scottish Child Payment, minimum income guarantees, fair work and living wage policies therefore provide clear opportunities for suicide prevention action.

Cycles of policy development take significant time, and we therefore welcome early work by Suicide Prevention Scotland which has identified substance misuse, poverty and homelessness as key policy areas for a whole of government and society approach. Alongside these, we advise that consideration should be given to exploring opportunities to work with the criminal justice sector. We also welcome action by the Scottish Government to progress this approach, including working to reduce the number of people with problem drug use in Scotland through drugs education and prevention activity, expanding access to childcare services to support low-income parents into work and taking forward homelessness prevention legislation.

We also note and commend the opportunities already taken by the Scottish Government to meet the commitment made in the suicide prevention strategy to incorporate suicide prevention into the development and design of government policies. We note, for example, that suicide prevention is now part of the National Planning Framework 4, meaning that all new applications for development are now assessed for suicide safety. In addition, Social Security Scotland are introducing a process for staff to alert local authorities where they have a concern that a client may be at risk of suicide, so that support can be provided and risk mitigated.

While we support wholeheartedly the intention of the suicide prevention strategy to build a whole of government approach to suicide prevention, we are very clear and offer our strongest advice that this cannot hope to be successful unless it builds on a firm foundation of effective core mental health provision.

We are aware of the Audit Scotland report published in September 2023 on Adult Mental Health Services and the subsequent Scottish Parliament Public Audit Committee scrutiny report published in February 2024. We note that the Scottish Government acknowledged these reports to be comprehensive, balanced and to highlight issues in need of improvement; and that the joint Scottish Government and COSLA Mental Health and Wellbeing Strategy, its Delivery Plan and Workforce Action plan all focus on a programme of work to address that improvement. Core adult mental health services must provide effective assessment and care for people at risk of suicide, and we will therefore follow progress closely.

In the meantime it is of particular concern to the young people and YAG members to whom we have spoken, to parents and to us as Scotland’s NSPAG that much-needed improvement in the capacity and performance of Child and Mental Health Services (CAMHS) to meet the needs of young people – a group for whom suicide risk is increasing - continues to be very slow.

We understand that the systemic issues identified in previous examinations of CAMHS in Scotland have resulted in recommendations for change which have been accepted, and we do not therefore repeat those here. What we urge is that those recommendations are implemented without delay and with the highest priority. They should of course be matched by similar investment in universal types of support for children and young people who do not need a formal referral (Tier 1) and in early intervention services for those experiencing mild and moderate problems (Tier 2).

As the NSPAG it is our responsibility to highlight the continuing difficulties experienced by vulnerable children and young people in accessing mental health services which can protect them from the risk of suicide, and advise that these issues must be addressed effectively and urgently. Lives will continue to be at risk and work to deliver the vision of the suicide prevention strategy will be hampered until the issues with CAMHS are urgently addressed.

Recommendation 2: The NSPAG recommends that urgent attention and resourcing be focussed by the Scottish Government on improvement in the capacity and performance of Scotland’s Child and Adolescent Mental Health Services (CAMHS), in order to reduce the risk of and prevent suicide among children and young people.

4.7 Suicide Prevention Strategy 2022-2032 - Outcomes Framework

The NSPAG considers that transparency and accountability are essential to achieving the vision of the Suicide Prevention Strategy 2022-2032. We welcome the development and inclusion in the strategy of an innovative outcomes framework, as recommended in 2019 by the then NSPLG, against which achievement can be assessed and reported publicly over time.

We also welcome clear lines of responsibility and accountability for implementation against the outcomes framework through the Strategic Outcome Leads of Suicide Prevention Scotland to the National Delivery Lead, and onward to the Scottish Government and COSLA as owners of the suicide prevention strategy.

We note that the suicide prevention Delivery Plan 2023/24 aligned actions to shorter term outcomes set out in the suicide prevention Action Plan 2022-2025. We understand this approach has also been taken in the Delivery Plan 2024/25, and that progress will be informed by a new reporting tool – known as Outnav – commissioned from Matter of Focus.

We welcome the introduction of a specific reporting tool for implementation of the suicide prevention strategy. It should lead to a meaningful set of measurable steps for 2024/25 and beyond. This will enable us over the next year and in our annual report for 2024/25 to make a first detailed assessment of impact and progress on achieving explicit short term outcomes, and by extension on progress towards the overall outcomes set out in the Suicide Prevention Strategy 2022-2032.

This tool should also enable and be used by the Scottish Government and COSLA over the years ahead to keep under review the underpinning assumptions on which each set of short term outcomes are based and to make any planning, infrastructure and/or resourcing adjustments necessary to achieve the overall strategic outcomes.

We understand that, alongside all those involved in and passionate about suicide prevention in Scotland, the international suicide prevention community is also observing these developments closely to see how this internationally innovative outcomes framework approach is implemented and how it makes a difference in saving lives.

4.8 Suicide Prevention Strategy 2022-2032 - Funding and Resourcing

“Strong relationships between clinicians and patients need to be hardwired back into the health care system so that people can feel professionals know them and ‘have their back’. This is embodied in the ‘time, space, compassion’ approach but too many services are not set up to be able to deliver this – despite desperately wanting to. Time and person resource is needed.” Professor Andrea Williamson, NSPAG member

Scotland’s Suicide Prevention Strategy 2022-2032 sets out a long term and rightly ambitious vision to reduce lives lost to suicide together with tackling the inequalities which contribute to suicide. Each life lost to suicide causes incalculable tragic personal and social costs. In addition, the NSPAG understands the current figure used to estimate the economic cost of suicide to be £1.46m for each life lost. 762 people lost their lives to suicide in Scotland in 2022 and the five year average of deaths by suicide in Scotland is currently 771.

We welcome the commitment of the Scottish Government which accompanied the launch of the suicide prevention strategy in September 2022 to doubling its annual suicide prevention budget to £2.8m per annum by 2026. We understand that this commitment is on track to be met, with the National Delivery Lead reporting that £2.5m was allocated and spent in 2023/24, including funding for continuing work under Scotland’s previous Suicide Prevention Action Plan 2018-2022 in addition to work under the current strategy and implementation plans.

We note that the Delivery Plan 2024/25 (unlike the Delivery Plan 2023/24) includes budget allocation for planned work and actions at the outset of the plan. We welcome the transparency of this approach, and the increased certainty it will give particularly to the Strategic Outcome Leads to enable their own planning across Suicide Prevention Scotland activity.

However, in terms specifically of the Suicide Prevention Strategy 2022-2032 the NSPAG considers it critical to success to determine whether funding is sufficient to match the intention of the strategy and to support plans for its implementation. For clarity and certainty it is essential that all action and delivery plans are fully costed during development in order to establish the true cost of what is required to turn strategy into implementation, and where necessary then to prioritise and make choices – including on the scale and/or pace of implementation - in an evidence-based way. This will require a different approach than setting a budget then allocating spend to actions so that the budget is met.

It is important to acknowledge that separately funded strands of work such as those led by local suicide prevention leads delivering local suicide prevention action plans across the country also contribute significantly to reducing suicide, as does other work led and funded by local authorities, NHS Boards and social/third sector organisations. In parallel, Scotland’s Mental Health and Wellbeing Strategy and separate Self-Harm Strategy each have their own funding allocation, against a background of the Scottish Government commitment to spending 10% of the total NHS budget on mental health provision by the end of the current Parliament in 2026.

The NSPAG recognises that long term strategies – including the Suicide Prevention Strategy 2022-2032 – do not align well with shorter government funding cycles. We also recognise that current pressures on national and local finances create constraints on public funding across the board. At the same time, the cost-of-living crisis and post-pandemic consequences are putting significant financial pressure not only on individuals, families and communities, but also on the social sector organisations who are at the heart of implementing the suicide prevention strategy.

Against this challenging background, implementation of the ten-year suicide prevention strategy requires medium and long term financial and workforce planning by every delivery partner, each of these in turn needs financial stability and certainty for the future to plan effectively. This applies across both the social sector and all connected public services.

We welcome the decision of the Scottish Government and COSLA to appoint Suicide Prevention Strategic Outcome Lead organisations for three years, mirroring the duration of the first Action Plan 2022-2025. We note however that grant funding is presently awarded to the Suicide Prevention Scotland Strategic Outcome Leads on an annual basis and we take the view that, if the suicide prevention strategy is to achieve its vision, longer-term multi-year funding is required for them, and indeed for all social/third sector partners, to enable their longer term planning, including investment in the recruitment and retention of staff to support work with the most vulnerable, marginalised and disadvantaged communities. We therefore welcome the Scottish Government commitment to embed a multi-year grant making approach for all social/third sector grants by 2026.

As acknowledged above and as we have advised during the course of this year, in addition to funding provided directly for work set out in the Suicide Prevention Strategy 2022-2032 and implementation plans, clarity is required in understanding what indirect funding also supports suicide prevention so that it can be protected and where necessary enhanced.

We consider it particularly important under current fiscal pressures to ensure that funding for person-centred support services in both the private and social sectors is not eroded. Those support services are crucial in enabling the most vulnerable people and those at greatest risk in our communities to access the statutory services and recovery support which help to protect them from suicide.

For example, in tackling the inequalities which contribute to suicide, people experiencing severe and multiple disadvantage and those from marginalised backgrounds often face additional challenges accessing statutory services. Community link workers and welfare advice workers who are at the heart of supporting such vulnerable people are often in posts subject to bidding for cyclical funding streams, creating uncertainty which increases turnover and vacancies in these critical roles.

A specific and compelling example of work critical to suicide prevention is that of primary care, where the majority of those affected by poor mental health and other suicide risks often present first and subsequently receive their care. We note ongoing Scottish Government commitments to spending 11% of the total NHS budget on general practice and to recruiting an additional (i.e. achieving a net increase of) 800 GPs into primary care. We believe these investments should be prioritised as having a direct impact on achieving the outcomes of the suicide prevention strategy.

Specifically in relation to mental health support, the national Mental Health in Primary Care Short Life Working Group recommended in 2022 the establishment and embedding of mental health and wellbeing services which provide assessment, advice and support in primary care in areas served by a group of GP practices. We understand there has been limited funding for this multi-disciplinary approach to date and that it is not therefore fully implemented. Again, this is a direct enabler of suicide prevention in Scotland and we strongly support its implementation.

The core primary care and social sector provisions described above are part of the whole of government and whole of society approach and as critical to saving lives from suicide in Scotland as all those specified in the Suicide Prevention Strategy 2022-2032. In addition, the suicide prevention Time, Space, Compassion approach threaded through the strategy and its implementation can only succeed if those in primary care and other such services are effectively resourced and therefore have the necessary capacity to deliver it.

In the context of post-pandemic pressures, a global economic downturn and the cost-of-living crisis, funding for suicide prevention must match ambition. Effective funding is the foundation for effective resource allocation. The key factors of clarity of spend against budget, effective prioritisation, and evaluation of progress towards the outcomes of the strategy and implementation plans should regularly influence planning cycles and action.

Recommendation 3: The NSPAG recommends that in 2024/25 work is undertaken by Suicide Prevention Scotland to develop and introduce a process for costing implementation plans under the Suicide Prevention Strategy 2022-2032. This should begin with the Delivery Plan 2024/25 and the results should inform both the resources allocated by the Scottish Government and COSLA to support the plans and the process of prioritising action.