National Suicide Prevention Advisory Group minutes: January 2024

Attendees and apologies

• Rose Fitzpatrick CBE QPM, Chair
• Dr Douglas Hutchison, President, Association of Directors of Education Scotland
• Peter Kelly, Director, Poverty Alliance
• Sheriff David Mackie, Board Member, Scottish Association Care and Rehabilitation of Offenders (SACRO)
• Catherine McWilliam, Nation Director for Scotland, Institute of Directors
• Brendan Rooney, Chief Executive, Healthy n Happy Community Development Trust
• Prof Andrea Williamson, Professor of General Practice and Inclusion Health, University of Glasgow

Apologies

• Cath Denholm, Acting Chief Executive, Equality and Human Rights Commission
• Dr Linda Findlay, Royal College of Psychiatrists Scotland
• Louise Hunter, Chief Executive, Who Cares? Scotland

In Attendance

• Prof Rory O’Connor, Co-Chair of Scotland’s Suicide Prevention Academic Advisory Group (AAG)
• Prof Steve Platt, Co-Chair of Scotland’s Suicide Prevention Academic Advisory Group (AAG)

Agenda Items 2 and 3

• Haylis Smith, Scotland’s National Delivery Lead for Suicide Prevention
• Neil Mathers, Executive Director, Samaritans Scotland

Agenda Item 4

• Hazel, Suicide Prevention Scotland Youth Advisory Group member
• Skye, Suicide Prevention Scotland Youth Advisory Group member
• Chris Ross, Suicide Prevention Scotland Youth Advisory Group (YAG) Co-Ordinator
• Jonathan Ellenor, Suicide Prevention Scotland Lived and Living Experience (LLEP) member
• Laura Junor, Suicide Prevention Scotland LLEP member
• Keir McKechnie, Suicide Prevention Scotland LLEP Co-Ordinator

Secretariat

• Morag Williamson, Scottish Government (Agenda Items 1, 2 and 3 only)
• Craig Wilson, Scottish Government

Items and actions

Welcome and Business Matters

The Chair welcomed members to the third meeting of the National Suicide Prevention Advisory Group (NSPAG) (“the group”), and thanked Dr Hutchison for hosting the meeting in Glasgow. 

Apologies

Apologies were noted.

Minutes

The Chair noted that the minutes from the group’s meeting in October had been circulated for comment and requested that any further comments be collated by the secretariat and sent to her to sign off Action 3.1.

It was noted that Ms Smith, National Delivery Lead for suicide prevention, would be present for the first two agenda items and Mr Mathers, Strategic Outcome Lead for Outcome One of Scotland’s national suicide prevention strategy Creating Hope Together (CHT), would be present for the second agenda item. At the group’s first meeting in May 2023, members had requested an engagement session with members of the Youth Advisory Group (YAG) and Lived and Living Experience Panel (LLEP). This would take place at agenda item three.

The group’s first annual report would be published in summer 2024 alongside the National Delivery Lead’s first annual report. It was noted that given this was the first year of reporting, the group would also consider the format of its annual report. The draft annual report would be brought to the group’s meeting on 29 May 2024 for formal sign-off. The Chair would engage with members in advance of the May meeting seeking their input and views on the report’s content, and members were asked both to consider any specific points they wished to include and advise the Chair accordingly, and signal if they wish to be involved with initial drafting of the report. Action 3.2

It was noted that this was Professor Platt’s final meeting before his retirement. The Chair thanked Professor Platt for his truly significant contribution to suicide prevention, in Scotland and globally, and for building key relationships across the suicide prevention network with great professional skill and personal kindness. In particular, she thanked Professor Platt for his work as co-chair of the Academic Advisory Group founded in 2018 to support the work of the National Suicide Prevention Leadership Group, and now supporting the entire Suicide Prevention Scotland network, including the NSPAG. His unique and positive legacy would endure.

The Chair reviewed outstanding actions from the previous meeting: 

• Action 2.2 work was ongoing to arrange suicide prevention training for the group.  Members were asked to contact the policy team with their needs. 
• Action 2.5 the whole of government and society prioritisation framework continued to be developed.
• Action 2.9 work was ongoing to develop a structured approach for bringing specific strategic issues to the group for consideration at, and between, meetings. The Chair would bring this to the group when finalised.

National Delivery Lead Update and Discussion

Ms Smith reported that work was ongoing to develop tailored approaches to support the needs of marginalised and equality groups who are at higher risk of suicide. An engagement event had taken place in November 2023 with partner organisations representing marginalised communities to understand how to effectively support these groups. Continued engagement and insights would inform how this work would be designed and delivered. Separately, Strategic Outcome Leads were developing the test of change approach which would also focus on addressing the inequalities which affect suicide. Lastly, strong engagement work was underway across government policy teams to embed suicide prevention. 

It was highlighted that a number of potential issues were being closely monitored given they could impact on delivery over the coming months. These included the number of asks for input from key partners/ stakeholders and staff capacity levels. 

There was a discussion on how inequalities could be effectively addressed across the strategy’s outcomes. In discussion the following points were made:

• Consideration should be given to how the strategy’s outcomes would address inequalities, rather than how inequalities would be addressed by the strategy. It was also noted that poverty was not an equality characteristic, which could be problematic as it would not be addressed directly if a narrow definition was used. 
• There were groups where poor mental health and suicide risk could be anticipated, such as children in care or in contact with the criminal justice system. Statutory services should anticipate need and work proactively to support people in these settings.
• Clear data and reporting was needed to understand the needs of suicide risk for different groups. The emphasis on men was essential given their prominence in deaths by suicide, however the suicide risk for women and people on low incomes also needed to be understood. 
• Ongoing engagement was needed to better understand communities of interest, to ensure all voices were being listened to.
• Given the complexity of both contextual inequalities and inequalities in the prevalence of suicide it may be helpful to develop clear definitions of inequalities in both dimensions, to assist with focusing on the vision of the CHT strategy to reduce inequalities.
• People from disadvantaged backgrounds could face additional challenges accessing statutory services. Given the current fiscal pressures, it was important to ensure person-centred support services which would enable these groups to access statutory services and support recovery (such as navigators), were not eroded. 
• Tests of change should not be short term and new programmes should be set up in a sustainable way, offering enduring support  for vulnerable groups. Ideally tests of change should be in place for at least three years and not be deficit-based or involve communities being “done to”.
• Benefits were recognized as one of the most direct ways to support people and families, and therefore inextricably linked to suicide prevention.  The Scottish Child Payment, minimum income guarantee, fair work and living wage policies were positive examples. The group would continue to consider its role in advocating for new benefit policies to support suicide prevention.
• It could be helpful to compare current and historical data (pre 1980) to understand key societal issues, and what approaches have driven change.  The Distress Brief Intervention work was cited as an example of positive policy action which had positively changed outcomes for people. Similarly mental health training in the 1990s successfully shifted attitudes and responses towards mental health.  
• In parallel, there were questions about what kind of society best protects against suicide, and how that compared to current society, including the provision of quality public services. It was noted that the primary purpose of suicide prevention – to save lives – was incontestable, and that this should provide a natural entry point to the whole range of policy initiatives.

Ms Smith undertook to put together a template which members of the group would be asked to populate with specific opportunities they saw to spread suicide prevention activity into other policy areas, including tests of change already happening which could provide opportunities for suicide prevention. Action 3.3

Creating Hope Together Outcome 1 – Update and Discussion

Mr Mathers led a discussion around outcome one of the suicide prevention strategy, which focussed on building a whole of government and society approach to address the social determinants and inequalities that impact on suicidal behaviour. Mr Mathers highlighted the importance of leadership driving this work so that policy ambition translated into action. The group were asked to consider how they could support this area of work and make outcome one more tangible and measurable in order to demonstrate progress.

The following points were made in discussion:

• Government policy action should be prioritised to areas where there was strong evidence on links to suicide prevention. The Academic Advisory Group (AAG) could support this process, including by identifying which actions would have the highest impact in preventing suicide.
• In creating this whole of Government and society approach it was important to be clear what we want people – as policy makers, leaders, practitioners and individuals – to do.  This must be specific, and be in addition to being more aware of suicide prevention, if it was to result in action. 
• Engaging with employers was considered essential, with an emphasis on employer action, not simply on raising awareness. Resources already existed which could be repurposed and The New Deal for Business and wellbeing economy initiatives would be useful levers to embed suicide prevention action in the business sector. Ms McWilliam and Mr Mathers would take this forward.  Action 3.4
• Time Space Compassion was an important approach, which could not be achieved without sufficient capacity within services and which also had meaning beyond health services themselves. In addition, whilst signposting advice and support was an important element of suicide prevention, actively wayfinding with people in order that they could navigate and access support – especially between services – was just as important.  

Ms Smith and Mr Mathers thanked the group for their thoughts and contributions. Mr Mathers undertook to produce and share a paper setting out next steps for implementing outcome one, and would welcome feedback from members of the group. Action 3.5

Ms Smith reported that the Creating Hope Together Conference would take place on 7 March in Glasgow. The event aimed to bring together Scotland's communities to build connections, showcase ongoing work and share evidence to achieve the vision of Creating Hope Together. The secretariat undertook to circulate details of the event to the group. Action 3.6 Members were invited to send any further advice and feedback on delivery to Ms Smith. Action 3.7

Lived and Living Experience – Meeting with Youth Advisory Group and Lived and Living Experience Panel Members

The Chair welcomed members of the Youth Advisory Group (YAG) and Lived and Living Experience Panel (LLEP) to the meeting. Following a short networking session over refreshments, the group took part in an icebreaking exercise and introductions were made round the table. The Chair invited the YAG and LLEP members to share their thoughts on what was important to them in our work together to prevent suicide; and what they wanted the group to think about in its advisory role.

The members of the YAG highlighted two key areas to address: stigma and support. 

The YAG members were clear that breaking down stigma opened up space to talk about mental health, and having discussions in an informal space made it easier to open up. Ending stigma would also make it easier to improve knowledge and confidence to talk about mental health in schools. It was highlighted that having support in schools was important as children and young people often felt more secure at school when there were issues at home.  In addition, young people would benefit from having the option of leaving classrooms and having access to safe spaces when required. It was highlighted that young people could have difficulty accessing school counsellors and mental health services due to long waiting times. 

The YAG members asked the group to advocate for progress and change, and take learning from lived experience. They emphasised that everyone had different experiences and support should therefore be person focused.

The LLEP members shared their individual experiences relating to suicide.  They highlighted the vulnerability of those, particularly men, who were unable to talk about how they were feeling and described experiencing stigma attached to death by suicide, whereby the loss would not be acknowledged or the deceased talked about afterwards. 

The LLEP members asked the NSPAG to help end stigma and the silence it caused. They also spoke of the importance of tackling not only immediate suicidal crisis but also the circumstances which could continue to put people at risk over longer periods of time, taking them into crisis again.  It was highlighted that services should be joined up so that people in crisis can go on a journey from feeling suicidal to having good wellbeing, and that wellbeing could be maintained with peer support. It was felt that we should aim for a system where no one felt alone, where mental health services were ready for people when they needed them and where people were not simply held in place in the system waiting for those specialist services. 

LLEP member Kasia Nightingale had been unable to attend the meeting and provided the following input in writing:

“Whilst we might share some similar experiences and circumstances, it’s vital to consider the diversity of those that would benefit from suicide prevention. This includes different cultures which may have a different set of values or awareness levels around mental health, differences in social status and all other factors. I would like to see the consideration of different stages of life during which people might be exposed to suicide risk- there might be a need for different safety strategies for a person who has been affected by something at young age perhaps due to school circumstances, a new parent embarking on a massive shift in life after child arrival, an executive at work losing one of their subordinates etc.”.

The YAG and LLEP members were asked how they found being members of their specific group. They described personal highlights such as meeting people with similar experiences, making friends, having peer support, having a safe space to talk about challenging issues, and gaining good experience. It was also noted that, while they believed they were using their experience to make positive change, they had found that making change was slow and takes time. 

All members thanked the YAG and LLEP representatives  for sharing their experiences and ideas with the group, and for their participation more broadly. It was agreed that the NSPAG would continue to listen carefully to YAG and LLEP members’  experiences, act on their advice and engage with them regularly as the work progressed.

Actions and Close

The Chair thanked everyone for their contributions at the meeting and in anticipation for their contributions to extending the work into their areas of professional expertise. The next meeting of the group would take place on 29 May 2024 at COSLA in Edinburgh.