National Suicide Prevention Leadership Group minutes: December 2020

Attendees and apologies

Attendees:

• Ms Rose Fitzpatrick (Chair) 
• Ms Rachel Cackett
• Dr Alastair Cook
• Ms Fiona Drouet
• Chief Superintendent Davie Duncan
• Dr David Hall 
• Mr Nigel Henderson
• Dr Amy Knighton
• Ms Jane O’Donnell
• Ms Angela Scott
• Dr Michael Smith
• Mr Alan Thornburrow
• Mr Billy Watson 

In attendance:

• Professor Rory O’Connor (Academic Advisory Group)
• Professor Steve Platt (Academic Advisory Group)
• Mr Dan Curran (Scottish Government)
• Mr Andy Grierson (Programme Manager)
• Mr Niall Kearney (Scottish Government)
• Ms Amy Kirkpatrick (Scottish Government)

Guest speakers:

• Ms Haylis Smith (COSLA, NSPLG Actions 1 & 10 Delivery Lead)
• Sgt. Laura Gibson (Police Scotland, NSPLG Action 6 Delivery Lead)

Apologies:

• Mr George Dodds
• Mr Toni Giugliano
• Mr Warren Hawke
• Ms Lara McDonald

Items and actions

Welcome and introductions

The Chair welcomed Members to the nineteenth meeting of the National Suicide Prevention Leadership Group (NSPLG) (“the Group”) and thanked everyone for attending via videoconference. The Chair welcomed Mr Kearney, Interim Head of the Distress Intervention and Suicide Prevention Unit at Scottish Government to the first half hour of the meeting. The Chair offered congratulations to Professor O’Connor on his election as the new President of the International Association for Suicide Prevention (IASP).

The Chair noted that Ms Smith and Sgt. Gibson would join the meeting to talk to their respective agenda items.

The Group noted that the 2019 National Records of Scotland suicide statistics had been published on 24 November 2020 and reflected on the loss of 833 people to suicide in that year, and the deep impacts that had on those who knew them.

The Chair reported the broad themes of her recent meeting with the Minister for Mental Health. The Minister had expressed thanks to members of the Group for their work. There had been a discussion about the Scottish Government and COSLA’s new suicide prevention strategy and the Minister had welcomed the Group’s offer to be directly involved in developing the strategy, including work to set out initial options. The Chair informed the group that she had been in discussion with the policy team on this. The February meeting will be devoted to a workshop which will allow members time to reflect on priorities for a new strategy as well as supporting infrastructure and other matters. Papers will be provided well in advance of the workshop meeting to allow time for proper consideration by members.

Apologies

Apologies were noted.

October 2020 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 19.1

Action 1 – local suicide prevention planning – proposal

Ms O’Donnell introduced the agenda item on SPAP Action 1 noting that the pandemic had caused a delay in this work, and recognising the hard work and effort put into this by the Delivery Lead, Ms Smith. The aim was to get guidance out to local areas early next year. 

Ms Smith gave a description of the approach she had taken in this work, including undertaking a SWOT analysis of resources from across the world and reviewing similar guidance produced by Public Health England as well as other supportive resources. A decision was made to produce the guidance in independent sections which could then be picked up by local areas depending on what stage they were at. The draft material presented to the Group had been through a process of iteration and testing, and the Lived Experience Panel had also been involved. The Group was asked to make any comments on the content directly to Ms Smith by 9 December 2020. Action 19.2

Ms Smith noted the need to identify an organisation to host this information and guidance in order to ensure that it was continuously updated and improved. Group members discussed the importance of ensuring that any pilot for this work would cover both urban and rural test sites. Ms Smith noted that pilot areas would be decided in part by their progress on their own local action plans, as well as in terms of where other SPAP pilots may be taking place. It was noted that it was important to get good leadership around this work and members made suggestions in respect of ensuring clarity of leadership at a national and a local level, recognising that this was sometimes difficult to achieve in multiagency situations. Ms O’Donnell and Ms Smith agreed to draft an appropriate recommendation for the Group to consider making in respect of leadership, hosting and updating of this work. Action 19.3

The Chair expressed her view that the issue of hosting this work was connected to a broader issue about how work on suicide prevention becomes mainstreamed and this itself linked to work on development of a new suicide prevention strategy. Delivery mechanisms would be part of that discussion and responsibility for hosting the outputs of existing workstreams, such as the work under Action 1, could be considered at that point.

Action 10 – reviews of all suicides – update

Ms Smith updated the Group on her work on suicide reviews and highlighted some key areas of recent focus, including work on datasets and sharing information between organisations, and meeting with other leads on related death-review processes. Work is ongoing with Mental Welfare Commission and Healthcare Improvement Scotland to align review processes and where possible gather a consistent dataset. Ms Smith said that the three pilots (in Grampian, the Scottish Borders, and Dumfries and Galloway) would be concluded and evaluated by Easter of 2021 with the hope of a national roll out from June 2021. 

Group members noted the importance of local and national leadership on this work and commented on the issue of who would ultimately have oversight of the review process. It was again noted that the discussion on development of a new strategy would be relevant to this work in terms of supporting infrastructure. The work to identify a digital system for hosting of this data could not be progressed until an appropriate agency to hold this had been identified. Likewise, there was also a need to identify who would host and disseminate the learning from these reviews. Ms Scott asked and it was agreed that Ms Smith and policy team colleagues explore the possibility of recommending that this responsibility be placed alongside other public protection responsibilities in the guidance for local Chief Officer Groups. It was agreed that the reviews could potentially be very helpful for families, as well as the wider benefits of feeding into learning and improvement for systems and processes. Action 19.4

The Chair asked members to think about how they could provide input to the process of piloting the reviews, specifically in terms of providing local support to families involved in the review process, and to provide any feedback to Ms Smith by 9 December 2020. Action 19.5

More timely data on suicidal behaviour

Professor Platt introduced his paper on more timely data on suicide and self-harm and described the problem of trying to compare trends for previous years with more recent data that had not been yet finalised.  

Members were given an update on the work that Public Health Scotland is doing with Police Scotland on data-sharing in order to try and put together a dataset on suspected suicides using the Police Scotland STORM database. This work would hopefully allow for comparison of pre- and post-COVID suicide trends.

Professor O’Connor referenced a recent summary published by the Covid International Suicide Prevention Research Collaboration that states that during the first months of the pandemic, in high income countries, there is no evidence of a change for the worse in suicide rates.

The Group discussed the merits of using data on suspected suicides as a starting point for suicide reviews. There was also discussion on what sort of dataset would be produced as a result of work between Public Health Scotland and Police Scotland. If the data were to be disaggregated then it would be helpful in picking up on trends in particular groups, or in certain locations of concern.

The Chair asked that she be made aware of any resourcing issues in relation to this work as it is was one of the Group’s priorities for a pandemic-specific suicide prevention response, accepted for implementation by the Scottish Government, and would need to be resourced accordingly.

Action 5 – suicidal crisis support – update

Mr Henderson introduced the agenda item and gave an overview of work to date, describing the lack of robust research evidence on effective service types for people in suicidal crisis. The recommendations discussed at a previous meeting of the Group had been set aside for the moment and a new approach taken that focused on principles of human response. This removed the focus from prioritising diagnosis and assessment and moved towards making a human contact, making building rapport and a relationship in the moment of crisis with the person in suicidal crisis the main focus of the contact. The question considered was how do we get a human response to crisis embedded across Scotland? Mr Henderson described the ‘time, space, compassion’ approach and how that might prompt others to think about how it reads across to some of the other actions in the action plan. 

The Group agreed that this change in direction towards a more human response was a very welcome one. Mr Henderson set out four questions for the group to consider: Do you think this new direction has merit?  What would you change/sharpen? How does the Time, Space, Compassion approach work with your SPAP Action – can we weave this together? Should we keep some of the previous suicidal crisis support recommendations/themes?

Group members responded positively to the new approach and agreed that the it was very person-focused. They remarked on its resonance with the style of the Distress Brief Intervention Programme, as well as commenting on the opportunities to link it to other parts of SPAP work, including the United to Prevent Suicide campaign. A note of caution was offered in ensuring that the new approach would not be seen as a burden for staff at a time of great pressure on resources. Members were asked to provide any comments to Ms Kirkpatrick by 9 December. Action 19.6

The new deadline for the report and recommendations to be finalised was agreed as the end of January 2021.

Action 6 – digital support – workshop

Mr Thornburrow began by outlining recent work in this area and noting that there was already a crowded market in respect of apps and online support services for mental health and suicide prevention. He introduced a presentation from Sgt. Gibson on the Action 6 work to date. This outlined the findings from the Action 6 consultation survey which provided useful insight on the benefits of digital technology for suicide prevention as well as some of the barriers to getting and finding support. The presentation also set out the research work that had been undertaken and she outlined the emerging themes from this work. This included the rapid systematic literature review by Professor Platt which had concluded that, on the basis of the evidence available in mid-2019, it would be difficult to promote digital technology as an effective intervention to prevent and reduce suicidal ideation.

Three potential areas of work were offered: an innovation fund, i.e. an award-based scheme encouraging creative thinking in the world of suicide prevention and technology; an NHS Inform Google-Ads campaign and revitalised suicide prevention information; and/or partnership with the Scottish Tech Army to help deliver any digital elements to proposals in other SPAP actions.

Members participated in a workshop session. The discussion brought a range of comments from members around issues such as the wide availability of existing apps and online support services; the potential for confusion about what’s available; the need for digital to be viewed as a medium for intervention rather than an intervention in itself; and the benefits of digital in being a relatively inexpensive way to access a wide audience. It was recognized that digital support should also provide a route to crisis support when needed. There were also comments about opportunities to use United to Prevent Suicide as the core digital platform, and in support of partnership with the Scottish Tech Army. It was noted that social media was a very useful tool in engaging with specific groups of people, such as children and young people and this could be an advantage in providing smaller, more focused initiatives. Research around how digital could influence behavioural change was also referenced as something worthy of consideration.

Following the workshop sessions and discussion, the Chair asked that the next steps outlined at the meeting be brought back by correspondence to the group as a specific proposal. Action 19.7

Suicide Prevention Action Plan review

Professor Platt introduced the work that had been taken forward to review the first two years of the Suicide Prevention Action Plan. The original aim had been to provide a formal evaluation but the approach that the group had taken on this was to produce something that better fitted with the way in which the action plan had been written.

The review described the clear progress of implementation as well as setting out the evidence of extensive engagement, collaboration and partnership. It also importantly described how the Group had involved people with lived experience throughout its work.

The review suggested that clearer processes for governance, delivery and resourcing at the outset would have increased the pace of delivery. The key learning points in the review would be important in informing the new Scottish Government and COSLA suicide prevention strategy. It was suggested that a future strategy could be written so as to be evaluated by regular reports every one or two years. It was agreed that the report should be sent to the Scottish Government and COSLA to provide context for the Group’s upcoming input into the development of a future strategy. The intention was then to publish the report on the Group’s website.

The Secretariat would email the Group requesting any comments on the review of the Suicide Prevention Action Plan be sent to Ms Fiona Myers, Public Health Scotland. Action 19.8

Member and policy updates

Mr Henderson asked that consideration be given to looking at having meetings more frequently, some with less formality, and on occasion including delivery leads and lived experience panel members. Action 19.9

The Scottish Government policy update was noted. The Chair offered all present her best wishes for Christmas and for a brighter new year after the pandemic-related challenges of 2020.

Summary of actions from the NSPLG Meeting held on 2 December 2020

• 19.1 - members to send any further comments on the October 2020 minutes to the secretariat
• 19.2 - members to send any comments on the content of the Action 1 guidance directly to Ms Smith by 9 December 2020
• 19.3 - Ms O’Donnell and Ms Smith to draft an appropriate recommendation for the Group to consider making in respect of leadership, hosting and updating of Action 1 work
• 19.4 - Ms Smith and policy team to explore the possibility of recommending that oversight of the review process be placed alongside other public protection responsibilities in the guidance for local Chief Officer Groups
• 19.5 - members to give their feedback, and any views on how they could contribute to the Action 10 pilot of suicide reviews, to Ms Smith by 9 December
• 19.6 - members to send any comments in response to the questions around Action 5 to Ms Kirkpatrick by 9 December
• 19.7 - action 6 sponsors and delivery lead to set out Action 6 proposals for consideration/agreement by Members, by correspondence
• 19.8 - secretariat to email the Group requesting any comments on the review of the Suicide Prevention Action Plan to be sent to Ms Myers, Public Health Scotland
• 19.9 - the Chair to further discuss having meetings more frequently and with less formality with Mr Henderson and Mr Grierson

NSPLG meeting dates in 2021:

• Wednesday, 10 February (9.30 am to 1.00 pm, including a half-hour break)
• Wednesday, 31 March
• Wednesday, 26 May
• Wednesday, 21 July