National Suicide Prevention Leadership Group minutes: May 2019

Attendees and apologies

Attendees

• Ms Rose Fitzpatrick (Chair)
• Mr George Dodds
• Mr Toni Giugliano
• Mr Nigel Henderson
• Mr James Jopling
• Dr Amy Knighton
• Chief Superintendent John McKenzie
• Dr John Mitchell
• Ms Nicky Reid
• Ms Angela Scott
• Dr Michael Smith
• Mr Billy Watson

Apologies

• Dr David Hall
• Ms Lara McDonald
• Ms Ruth Moss
• Ms Jane O’Donnell

In attendance

• Professor Steve Platt, Academic Advisory Group
• Professor Rory O’Connor, Academic Advisory Group
• Ms Lynsey Brown, Scottish Government
• Ms Innes Fyfe, Scottish Government
• Mr Andrew Grierson, Scottish Government
• Mr Allan Steele, Scottish Government
• Ms Lyndsay Wilson, Scottish Government

Items and actions

1. Welcome from the Chair

Apologies

1.1. The Chair of the National Suicide Prevention Leadership Group (NSPLG) (the Group) welcomed Members to their eighth meeting and thanked the Scottish Association for Mental Health (SAMH) for hosting today’s meeting.

1.2. Apologies had been received from Dr David Hall, Ms Lara McDonald, Ms Ruth Moss, and Ms Jane O’Donnell.

1.3. Chief Superintendent John McKenzie would be attending from 1pm.

1.4. The Chair introduced Ms Lynsey Brown, policy manager and Mr Andrew Greirson, programme manager as this was their first meeting.  

Minutes

1.5. The Group approved the minutes from the March meeting for publication with no amendments. Action 8:1

Action log

1.6. Ms Fyfe gave a brief update on actions of previous meetings. These were all either complete, on track or in hand. The importance of the resource plans was highlighted to Members and it was agreed that these would need to be completed in advance of the next meeting. Action 8:2

1.7. Mr Dodds updated the Group following discussion at the previous meeting regarding transition away from Choose Life as an identity (Action 7.17) noting that NHS Health Scotland would produce a paper on the background, reach, and utilisation of Choose Life in advance of the June meeting. Action 8:3

1.8. Ms Fyfe noted that the format of the action log would be amended for easier identification of the status of actions. Action 8:4

Forward look

1.9. The Forward Look document was circulated to Members prior to the meeting. The Group was again encouraged to update the Secretariat with any other important dates.

1.10. The Group discussed Suicide Prevention Week in September.  It was agreed that the Secretariat would collate information from Members’ home organisations about their general approach to the week and any material scheduled for release during that week. This would allow consistency of messaging where appropriate for the NSPLG. Action 8:5

1.11. The Chair also updated the Group on the Expert Review of Mental Health at HMP & YOI Polmont. A draft report has been reviewed and drafting observations submitted. 

1.12. The Review of Forensic Mental Health Services was mentioned.  Ms Fyfe reminded the group that the Chair intended to write to the Chair of this review once appointed to highlight the issue of  criminalization of suicidal behaviour.

1.13. Dr Mitchell updated the Group on a recent meeting at Dumfries House with His Royal Highness Prince Charles (2nd May 2019). This had been a positive meeting with opportunity for further awareness and communication. Dr Mitchell and Mr Dodds would work together on utilising these opportunities. Action 8:6 

2. Delivery plan progress

Highlight report

2.1. The Highlight Report of the Delivery Plan was circulated the week before the meeting and Members were invited to speak to this and provide any further update.

Update of National Suicide Prevention Action Plan actions

Action 1 (local planning)

2.2. Mr Jopling reported that as part of the mapping exercise of existing activity, NHS Health Scotland had begun analysing responses to the questionnaire that had been circulated to regional stakeholders. There were still a small number of questionnaires to be returned.

2.3. The Group requested that the results of the questionnaires be circulated to all Members given the broad value of insight they would provide. Action 8:7 

2.4. The picture built by the questionnaire responses would be augmented by interviews with Choose Life Coordinators around the country. This would be drawn up in a report by the Action 1 Sponsors.

2.5. It was noted that the work was slightly behind on the timescale of the Delivery Plan. Projected timeframes for future work would bring this back in line.

2.6. Thought was also being given to possible mechanisms of dissemination, such as the potential for issuing local planning guidance to authorities at the point of any grant payment.

2.7. During the Action sub-group meeting, resource commitments for implementation were considered and a pilot approach for introducing guidelines was being proposed (between three and five regions). At present the indicative costs attached to this approach were in draft, though would be confirmed prior to the July meeting.

2.8. The Group discussed the progress made by the Sponsors and the importance of linking work streams together. Of specific note was the link to Action 10 (Reviews) which was also looking at a test or pilot approach. It was suggested that the test sites could be aligned in a structured approach. Possible areas for consideration could include Ayrshire, West Dunbartonshire, Shetland, and North East Scotland.  

2.9. The interdependencies of the Actions was raised again. Sharing information between the Sponsors and ensuring a shared understanding of the Suicide Prevention Action Plan (SPAP), and the NSPLG place within it, would inform a coherent work programme. Action 8:8 

Action 2 (suicide prevention training update)

2.10. Mr Dodds and Ms Reid updated the Group on the progress of the first phase of their Action. This included a new universal online awareness raising resource (in the form of an on-line animation) which would be accessible in a wide range of settings; a Workforce Development Plan; and an updated Knowledge and Skills Framework.

2.11. The animation would be ready for viewing on the 21st May 2019, prior to an official launch on the 28th May 2019. Action 8:9

2.12. Mr Dodds and Ms Reid also indicated that the second phase of Action 2 would continue through to 2021.  

Action 3 (public awareness)

2.13. Mr Dodds and Mr Watson reported that progress had been made on the engagement plan and resourcing for this Action.

2.14. The importance of coordinated messaging by public service leaders was re-emphasised during the Action 3 update.

2.15. The link between this Action and the ongoing discussion on Group communications and engagement was highlighted.  This was in terms of the Group’s communication and engagement strategy and the consideration of the future of the ‘Choose Life’ identity and future suicide prevention activity in Scotland.   

2.16. The Group discussed that any consideration of the ‘Choose Life’ identity would consist of two broad stages. Firstly the strategy for concluding ‘Choose Life’, which as noted in para 1.7 would be presented by Mr Dodds and would cover the existing state of play and potential options moving forward. Work on the communication and engagement plan by the Secretariat would then feed into the decision on what could and should replace this along with a transition plan to a refreshed identify for suicide prevention in Scotland. Action 8.10

Action 4 (support for those affected by suicide)

2.17. Mr Giugliano noted that the Highlight Report gave a good overview of the status of this action. The work to deliver the research agreed at the Group’s March meeting was now underway, jointly funded by Scottish Government and the Mental Health Foundation (MHF). 

2.18. Mr Giuliano indicated that there had been a delay to the work progressing and the Secretariat undertook to explore why this had happened.  [Post meeting note: A small Research Advisory Group had been established between the Scottish Government and MHF and included Prof O’Connor from the AAG.  That met for the first time on 24th April 2019 where MHF advised of its intention to apply for Ethical Approval for this work. Scottish Government supported this approach though noted the possible impact on timescales.  MHF agreed to keep Scottish Government updated on this and any impact on timings.] 

2.19. The Members also noted that the Sponsors  have continued to engage with stakeholders with regard to trauma and distress response.

Action 5 (crisis support)

2.20. Mr Henderson and Dr Knighton reported that they had formed a sub-group which had met for the first time the previous week. This was productive in terms of linking other relevant pieces of work concerning crisis support, including the Mental Health Strategy, NHS 24, Children and Young People Mental Health Taskforce (CYPMH Taskforce), and Distress Brief Interventions and would also fill this picture out further.

2.21. With  regard to resourcing it was proposed that a literature review take place to scope the work outside of local and national government.

Action 6 (digital)

2.22. Mr Jopling outlined recent work including stakeholder engagement, the literature review of online apps by Professor Steve Platt of the AAG, and a proposal for funding of £750 - £1000 for analysis of the use of suicide prevention apps in Tayside, Highlands, and North East Scotland.

2.23. This funding proposal was considered by the funding sub-group last week. They mutually agreed that this would be beneficial and agreed to recommend approval to the Group. The Group did approve this and the analysis would proceed. Action 8:11

2.24. This combined work would provide a picture of the existing services in Scotland and point to any obvious gaps. The first sub-group meeting would discuss these results. It was noted that the progress of the other Actions of the SPAP would provide the direction for further substantive work.

2.25. The Online Harms white paper published by the UK Government was also discussed. It was noted that Scottish Government would be responding to the consultation and Members agreed that they would wish to submit a separate response reflecting the views of the Group. Action 8:12

Action 7 (at risk groups)

2.26. Dr Smith and Mr Watson had had a number of discussions in the past month about the conceptualisation of ‘at-risk’. After considering the merits of defining this by setting or demographic, the Sponsors now advised that framing this using the Integrated Motivational-Volitional model put forward by the AAG would allow a targeted approach which could help to avoid stigma.

2.27. Using this perspective, three areas of work emerged. These included: improving self-recognition in individuals affected by suicidal thoughts or behaviour; ensuring help seeking is encouraged; and that the service response to requests is useful. This would require ongoing and consistent engagement with people with lived experience of suicidal thoughts.

Action 8 (children and young people)

2.28. Dr Mitchell noted that there was significant work being done for children and young people’s mental health including the Children and Young People’s Mental Health Taskforce and Distress Brief Interventions.

2.29. With regard to the NSPLG work in particular, a proposal was put forward for qualitative research around how young people interact with suicide prevention online content and applications.  The Group agreed that this proposal should be revised and considered by the funding sub-group .Action 8:13

2.30. The funding sub-group had not seen this proposal prior to the meeting and therefore were not able to recommend approval or disproval. The Chair proposed that the funding group should have delegated approval for recommendations to Scottish Government to fund small pieces of work (estimated to be under £2,500).  This would allow these proposals to be processed more regularly and efficiently. The Group agreed to this. Action 8:14 

2.31. Ms Reid asked if the group could receive a regular report on the recommendations that they had made to the Scottish Government and what had been spent from the budget to support the SPAP.  Ms Fyfe reiterated that the governance and process of funding remained with the Scottish Government. She also agreed that transparency on recommendations and the resultant spend was important.  Action 8:15

Action 9 (evidence)

2.32. Professors Platt and O’Connor updated on Action 9 during the afternoon session.

Action 10 (reviews)

2.33. Ms Scott updated on the progress made following meetings of a sub-group of organisations who currently had a formal role in reviews of suicide in particular settings/circumstances. A paper was circulated in advance of the meeting and this identified the various current reviews and the criteria for each.

2.34. A draft of a second part of that paper was tabled at the meeting and this identified circumstances in which reviews did not currently take place and began to highlight potential recommendations. The Group were asked to feedback any comments on this paper to the action Sponsors or Secretariat.

Delivery plan update

2.35. The Chair proposed that there should be a revision of the Delivery Plan which could be published by the end of June. This would keep the promise that the current Delivery Plan would be regularly revised and allow the Group to provide an update on emerging detail of the Delivery Plan as well as report on what had been achieved. The Group agreed that a six-month revision was timely. Action 8:16

3. Lived experience engagement update

3.1. Ms Wilson updated the Group about engagement with individuals with lived experience moving forward. The Alliance would host a follow-up event with those people who attended the Delivery Plan discussion in December 2018. This would allow the NSPLG to provide an update on progress so far, outline plans for future engagement and seek views. The event was due to take place on Tuesday 21st May 2019 and Sponsors were asked to let Ms Wilson know if they would like to attend.

3.2. Ms Wilson advised that the lived experience sub-group have agreed to establish a competitive grant process seeking a third sector organisation to set up and provide support for the lived experience panel. Organisations would be invited to bid for this work. Sponsors were asked to identify any organisations who may be interested in this work and ask them to let Ms Wilson know by the end of the week. Ms Wilson reiterated the need to keep pace with this piece of work.

4. Themed discussion: data

4.1. Professor Platt presented on ScotSID data (Appendix A).

4.2. Members were grateful to Professor Platt for the presentation and reflected that the information in his presentation was helpful, particularly to those Members who were not familiar with the range and methods of collection of data on suicide. Professor Platt advised the Group of the limitations in the data and spoke of imminent improvements to data collection, particularly by including Unscheduled Care data from the current year. Action 8:17

4.3. Some Members of the Group were concerned that the ambition of a 20% reduction in the rate of suicide by 2022 as expressed in the Suicide Prevention Action Plan would be difficult to achieve and should not be the only measure of achievement in preventing suicide.  Discussion followed about the importance of measuring the outcomes across the individual SPAP Actions to understand the progress and impact of work being done to help reduce the suicide rate, through an outcomes framework which reflected the complexity of drivers, actions and stakeholders.  The Group agreed that supplementary and interim measures would be needed to know the impact of delivery of the Actions within the Suicide Prevention Action Plan.

4.4. Following from this discussion, Professor Platt and Professor O’Connor updated the group about their view that an evaluability assessment should be undertaken for the SPAP  which would then allow evaluation.  They described that a similar exercise had been undertaken for the Distress Brief Intervention programme.  Mr Dodds described that his organisation had particular capabilities in conducting evaluability assessment, but that capacity may be a delaying factor.  The Group agreed that the assessment should be done, and asked that Prof O’Connor and Mr Dodds work to progress this.  Action 8:18

4.5. Professor Platt, with contributions from Mr Jopling and Professor O’Connor, informed the Group of work being done in Japan to identify local data trends. This was done in ‘dashboard’ style and the Group recognised how helpful this appeared to be in informing action to reduce suicide rates and reflected that local data is key to informing Actions 1 (Local Planning) and 10 (Reviews) and the development of local profiles should be considered in the medium term.

4.6. The Group reflected on the difficulties experienced across agencies in data sharing, particularly between the Police / Crown Office and Procurator Fiscal Service and ScotSID. Professor Platt advised that this had been an ongoing issue for many years but was clear that the issue did not arise through an unwillingness to share, simply incompatible IT systems. This issue has been discussed with the Action 10 Sponsors and would be considered as part of their work moving forward.

4.7. Professor Platt advised the Group that the Academic Advisory Group met for the first time on Monday 29th April. This was an introductory meeting but there was a willingness by the AAG Members to assist wherever they could add value. Professors Platt and O’Connor informed the Group that they would be proposing to recruit a dedicated researcher on a full or part time basis to meet the needs of the multiple requests from the Group for research / literature searches. The Group were in agreement that this would facilitate the work of the NSPLG and the delivery of the SPAP Actions and would expect to view favourably a detailed proposal for funding.  Action 8:19

4.8. Dr Mitchell presented on NCISH data (Appendix B). Members found this helpful and complementary to the previous presentation. Dr Mitchell offered to provide members with his presentation in full to inform further discussion at a later time. Action 8:20

5. Annual report

6. Meeting close

6.1. The Chair thanked Members for their attendance, their valuable contributions and for the progress being made to support delivery of the SPAP Actions.  She reminded Members that the Minister for Mental Health would be attending for part of the next NSPLG meeting on 19 June 2019. 

6.2. The Chair let members know that there would be a change to the theme for the next meeting.  It was initially proposed to be Children and Young People with the Youth Commission to be invited to present its findings to the Group.  However, it would important to have Action 8 sponsors attend and Dr Mitchell had given his apologies.  This theme would be moved to the July meeting.  [Post meeting note: The Chair decided that that next meeting’s themed discussion would focus on the Annual Report]

 
Summary of actions:

• 8:1. Secretariat to publish March minutes
• 8:2. Members to provide resource plans in advance of the June meeting
• 8:3. Health Scotland will produce a paper on the background, reach, and utilisation of Choose Life in advance of the June meeting. This will also cover options on how to transition away from Choose Life as an identity
• 8:4. Secretariat to update format of the action log for easier identification of the status of actions
• 8:5. Secretariat to collate information from the Members’ home organisations approach to suicide prevention week in September
• 8:6. Dr Mitchell and Mr Dodds to work together on utilising awareness raising opportunity raised by HRH Prince Charles’ Dumfries House visit
• 8:7. Action 1 Sponsors to circulate questionnaire response report to other Group Members for information
• 8:8. Secretariat and Members to map Action interdependencies.
• 8.9. Secretariat to inform Members of learning and awareness resource release dates
• 8:10. see action 8:3
• 8:11. Mr Jopling and Secretariat to take forward recommendation for analysis of the use of suicide prevention apps in Tayside, Highlands, and North East Scotland
• 8:12. Members to send feedback on Online Harms Whitepaper to Secretariat for collation by 19th June 2019
• 8:13. Dr Mitchell to submit a proposal to the funding subgroup for qualitative research around how young people interact with suicide prevention online content and applications
• 8:14. Secretariat to establish a delegation limit for funding sub-group recommendations
• 8:15. Secretariat to provide a regular report on the recommendations that the NSPLG had made to the Scottish Government and what had been spent from the budget to support the SPAP
• 8:16. Secretariat to work with members to produce an updated Delivery Plan for publication before the end of June
• 8:17. Professor Platt to provide his presentation for circulation to the group
• 8:18. Prof O’Connor and Mr Dodds to progress and evaluability assessment for the SPAP
• 8:19. Professors Platt and O’Connor bring a proposal for a dedicated researcher on a full or part time basis to meet the needs of the multiple requests from the Group for research / literature searches.
• 8:20. Dr Mitchell to provide his presentation for circulation to the group
• 8:21. Chair to circulate initial thoughts on what the September annual report should contain

Future meeting dates:

2019

2020

15 January: venue TBC