Suicide prevention leadership group: second annual report

What is United to Prevent Suicide?

On World Suicide Prevention Day 10 September 2020 the National Suicide Prevention Leadership Group launched a  new identity for suicide prevention in Scotland: United to Prevent Suicide.  This signalled the start of a campaign to make Scotland the most supportive country in the world on suicide prevention, and to create a social movement of people confident to ask for help and to give it.

The United to Prevent Suicide identity and campaign result from involving around 3,000 people across Scotland in face to face and virtual community focus groups, including specific sessions with the NSPLG, its lived experience panel, local suicide prevention leads and the views of many other people expressed in response to YouGov surveys. 

This broad range of feedback from people across Scotland:

• Gave us ideas of what a suicide prevention identity for Scotland should look and feel like
• Was clear that the word suicide needed to be front and centre of any identity and campaign as it can help save lives and help break down stigma
• Said stories from those with lived experience of thoughts or suicidal behaviour or of being bereaved through suicide should be at the core of any campaign
• Emphasised that if we want to make a difference, any social movement should be driven by everyone in Scotland.

The NSPLG’s opening public awareness campaign reflects these findings through supporting all of us to be confident to talk about suicide as well as being confident to listen and to connect someone to the help they need.  It also underpins our call to action: Together we can save lives, so let’s talk suicide.  Over the first days of United to Prevent Suicide more than a thousand people signed up to join the movement for change.

An important part of United to Prevent Suicide is its dedicated online hub, where people can sign up to signify their support and commitment to actively talking about suicide to remove the stigma of that word and give help. The online hub provides resources such as animations showing people how to start conversations about suicide, how to listen and what to do to get help.

Our partners across Scotland are promoting United to Prevent Suicide across their own agencies and networks. The NSPLG has provided promotional assets which have been displayed as email signatures, on digital display screens at mainline train stations including Edinburgh Waverley and Glasgow Central, and across social media.

In a hugely impactive contribution to the launch of the campaign, on World Suicide Prevention Day 10 September 2020 Transport Scotland displayed the words United to Prevent Suicide on its motorway overhead digital display boards for the whole day, reaching hundreds of thousands of motorway users across Scotland.

Plans are in hand for United to Prevent Suicide messaging to be displayed in football stadia across Scotland and for murals in key outdoor locations across the country. In addition, a television advertisement is planned for early October, to build the momentum of this social movement and bring the key message, that we need to talk to save lives, into people’s homes.

The launch of United to Prevent Suicide has only been possible because people with lived experience and those who care about saving lives from suicide have been at the heart of its development.  The NSPLG believes that this is only the start of the journey we must take in changing the way we address suicide prevention in Scotland.

We are grateful for the involvement of our NSPLG lived experience panel members, especially to those who shared their stories for the launch to underline the importance of getting involved in this new social movement. 

It is all about joining the conversation at www.unitedtopreventsuicide.org.uk because together we can save lives, so let’s talk suicide.

Support For People Bereaved By Suicide

Action 4 of the Suicide Prevention Action Plan and recommendation 9 of the First Annual Report of the NSPLG

To assist in the development of evidence-based support for those people bereaved by suicide in Scotland, in May 2020 the Mental Health Foundation (MHF) in partnership with the NSPLG undertook a qualitative research study examining models of suicide bereavement interventions and best practice.^[9] 

The MHF report supplemented other international research showing that support provided following a suicide (also known as postvention support) has a beneficial effect on people bereaved by suicide, with people who receive support less likely to be at high risk themselves of suicide.^[10]  In addition, people who received this targeted support reported lower levels of depression and anxiety.^[11]

The NSPLG welcomed these studies and recommended the development of a rapid early response bereavement support service to provide flexible access to practical support and advocacy for those most immediately affected in the early days following a suicide.  Discussions began between the NSPLG and partners in two areas of Scotland about taking part in a two-year bereavement support pilot, based on good practice identified elsewhere, to introduce a rapid response service for people who have been bereaved by suicide.  Its aim was to provide early advice and assistance to bereaved families, together with practical support, an assessment of need, a safety plan and signposting to local organisations who can offer appropriate additional support.  Evaluation and dissemination of early learning were intended to be key features of the pilot programme.

With the advent of the pandemic and its impact on local resources, this work was necessarily paused.  At the time of publication of this annual report work is in hand in collaboration with local partners in the two identified areas, to agree the shape of and roll out this important pilot and test this model of support for those bereaved by suicide.  The pilot will be independently evaluated, and any learning identified will be incorporated into any future recommendations for broader rollout.

Support For People In Suicidal Crisis

Action 5 of the Suicide Prevention Action Plan and priority 3 of the NSPLG’s COVID-19 Statement

In February 2020, a workshop was held with the NSPLG lived experience panel, to better understand the experiences and identify the needs of those in suicidal crisis. In parallel with gathering this evidence of experience, the NSPLG academic advisory group provided information from the evidence-base of effective interventions that support people at the point of suicidal crisis.

In July 2020, a further far-reaching stakeholder consultation on suicidal crisis was undertaken by the NSPLG.  The survey was developed and shared with stakeholder organisations representing those with lived experience and with diverse service providers and representative organisations, including those from the LGBTQ+ community, the National Rural Mental Health Forum, organisations representing children and young people, and those representing black and minority ethnic communities.

The NSPLG survey invited both professional stakeholders and service users to share their insights of seeking support during a suicidal crisis.  The survey posed questions such as:

• What does it mean when people are described as ‘seriously considering taking their own lives’?
• What help and support should be available for people seriously considering taking their own life?
• Where are there current gaps in suicide crisis support?
• What would prevent people seriously considering taking their own life from asking for help?
• What specialist help could be given to particularly vulnerable people, for example (but not limited to): those who experience financial stress, domestic violence, drink alcohol to excess or take drugs, feel isolated, lonely or who are bereaved?

In light of COVID-19, the consultation also included questions specifically exploring experiences during the pandemic.  The consultation received 455 responses and 70 of the responses were from people with lived experience of the impacts of suicide. 

Themes will be collated from the consultation results, together with the most up to date academic evidence (including evidence around COVID-19 and mental health), themes from wider literature on crisis services and policy, feedback from the NSPLG lived experience panel and from national suicide prevention co-ordinators. It is intended that the findings will be presented to the NSPLG for consideration in October 2020.  Further discussion will then take place with external stakeholders, with the intention of final recommendations being presented to the NSPLG for decision before the end of 2020.

Digital Technology To Support Suicide Prevention

Action 6 of the Suicide Prevention Action Plan

Stakeholder consultation, including initial workshops with the NSPLG lived experience panel, has taken place to establish what digital media are currently available in the field of suicide prevention, including websites, apps, blogs, online video, social media, podcasts and gaming, and how people are using them. 

This engagement work has resulted in a total of 455 responses, including 70 responses from people with lived experience of the impacts of suicide.^[12] Analysis of these responses has highlighted some overarching themes including: the need for practical provisions for engaging in digital resources; the need for access to free WiFi and access to internet-enabled technology particularly for those in rural areas or experiencing digital poverty; and significant interest in the use of video conferencing to speak to a mental health professional.

A short-life working group of key stakeholders has recently been established to consider the results of the survey and to identify digital priorities in suicide prevention. This work will enable the NSPLG to better understand and to progress work on:

• the most effective ways for people to access digital support if they are feeling suicidal
• what would be the most helpful developments around online suicide prevention support
• what barriers would prevent someone from using digital resources for suicide prevention
• what would be effective ways to manage harmful online content such as pro-suicide platforms
• what would be the most effective ways of meeting the online/digital suicide prevention needs of children and young people
• how access to online/digital suicide prevention services in rural areas could be improved.

It is clear that digital support for suicide prevention is a complex and fast-moving area with enormous potential, but it is also an area with substantial risks which must be given careful consideration and mitigation. 

Suicide Prevention For Groups Of People Who May Be At Elevated Risk

Action 7 of the Suicide Prevention Action Plan and recommendation 11 of the  First Annual Report of the NSPLG

Work in relation to groups of people potentially at heightened risk of suicide has involved stakeholder engagement, including focus groups with a broad range of participants. The impact of the pandemic has restricted this work to making contact online rather than face-to-face as planned. 

NSPLG lived experience panel members have taken part in a series of sessions to help develop a deeper understanding of the perspectives of people who identify with groups who are at heightened risk of suicide, and who have lived experience of suicidal crisis or of supporting others in that situation.

The NSPLG academic advisory group has completed a review of literature relating to people at risk of suicide. This, together with the findings of the focus groups and interviews, is intended to be used to inform recommendations to the NSPLG by the end of 2020.

The importance and potential for wide practical application of this work is illustrated by the engagement of a member of the NSPLG lived experience panel to advise and help the Police Scotland Negotiators Team understand how to engage effectively in supportive conversations with people in suicidal crisis, to keep them safe.

Meeting The Needs Of Children And Young People

Action 8 of the Suicide Prevention Action Plan and recommendation 10 of the First Annual Report of the NSPLG

Following the report and recommendations of the Children and Young People’s Mental Health Taskforce led by the late Dame Dr Denise Coia, the Scottish Government and COSLA are engaged in significant work to promote positive mental health among children and young people. The NSPLG aims to ensure that work includes and prioritises suicide prevention.  It is important that young people in Scotland are equipped to recognise suicidal crisis and have access to appropriate, timely support for themselves, their families and friends.

NSPLG members leading work to support action 8 of Every Life Matters are working closely with the Children and Young People's Mental Health and Wellbeing Programme Board (CYPMHW) to align its work with the work of the NSPLG and to ensure a consistent, nationwide approach.

The NSPLG recognises that significant work is taking place in schools to promote positive mental health.  We have identified, and agreed with the CYMPWB board, a need to develop a programme to work with parents and guardians of children and young people in schools, helping them to identify risk of suicide, know how to respond and where to find specialist support.

The NSPLG welcomes the pandemic extension of Distress Brief Interventions (DBI) across Scotland and would encourage consideration of its use in appropriate educational settings.  Work continues with Child and Adolescent Mental Health Services (CAMHS) to help them understand the challenges and potential barriers children and young people may face in accessing urgent support in the context of suicide prevention.

During the COVID-19 pandemic, the NSPLG has engaged with education policy teams in Scottish Government to ensure consistent signposting for children and young people in schools to mental health support services.  Our recommendation that such signposting be undertaken via online learning platforms was accepted and implemented with immediate effect, providing a direct link to the Young Scot website which offers a comprehensive list of resources for children and young people.

Recognising that digital technology can create risks as well as opportunities to support the mental health of children and young people, the NSPLG successfully lobbied a popular social media application to remove content which appeared likely to be detrimental to their mental health.  This included content which depicted and endorsed sexual violence, a trend that was spreading on the platform and reaching children as young as 13.  The NSPLG welcomes such positive responses to removing the risks of online harm leading to suicidal behaviour and will continue to build positive relationships with digital platforms and providers.

The NSPLG lived experience panel is currently exploring forming a sub-group with a particular interest in, and experience of, suicide prevention in children and young people to inform work in this area. In the meantime, panel members continue to share their compelling experience and passion for preventing suicide to enable us to engage with schools, colleges and universities, for example to offer stories, videos and other resources to raise awareness and offer support to children and young people across Scotland in ways which are known to be effective in influencing their safety.

The NSPLG members who lead in ensuring that the needs of children and young people are taken into account work with colleagues across all actions in the Suicide Prevention Action Plan, and influence all recommendations made by the NSPLG.  This is particularly important in the context of the new emotional, psychological, domestic, educational, financial and familial stresses placed on children and young people during the COVID-19 pandemic.

Using Suicide Data And Evidence Effectively

Action 9 of the Suicide Prevention Action Plan; recommendation 2 of the First Annual Report of the NSPLG; and priority 1 of the NSPLG’s COVID-19 Statement

Throughout this year the NSPLG academic advisory group has been involved in a broad range of support to the work of the NSPLG, including rapid literature reviews and analysis of surveys to support work on actions such as local suicide prevention planning; the development of support for those bereaved by suicide; suicidal crisis support; digital technology for suicide prevention; and work with specific groups at heightened risk of suicide.  Work was also started on revising SUPRESE (Suicide prevention at sub-national (regional/local) level: self-evaluation instrument) in order to further contribute to effective local suicide prevention planning across Scotland.

As the COVID-19 pandemic gathered pace, and as part of an international research collaboration, members of the NSPLG academic advisory group led and co-authored a systematic review of the evidence on the potential impact of previous infectious disease-related public health emergencies on suicide-related outcomes.^[13]  The findings of this review, which aims to provide comprehensive current knowledge that can inform suicide prevention during the COVID-19 pandemic, were disseminated to the NSPLG, Public Health Scotland and the Scottish Government’s Suicide and Self-Harm Policy Team.

The co-chairs of the NSPLG academic advisory group are also part of the International COVID-19 Suicide Prevention Research Collaboration that published guidance in Lancet Psychiatry on a public health response to mitigate suicide risk associated with the COVID-19 pandemic.^[14]  This evidence-based suicide prevention guidance was at the heart of the NSPLG COVID-19 Statement, the recommendations of which were accepted in full for action by the Scottish Government and COSLA.

The Research Collaboration guidance and related NSPLG recommendations have since been disseminated by the NSPLG to support the work of a range of organisations involved in suicide prevention action, including chief executives of local authorities and NHS boards; Police Scotland; universities and colleges; and chief officers of Health and Social Care Partnerships.

Reviews Of Deaths By Suicide

Action 10 of the Suicide Prevention Action Plan and recommendations 5-7 of the First Annual Report of the NSPLG

Progress on this work has been delayed due to pandemic pressure on the resources of partner agencies.  The NSPLG had been planned to carry out a mapping exercise in relation to existing reviews and, prior to the pandemic, organisations responsible for reviewing deaths from a range of causes potentially related to suicide were identified and approached to take part.  The aim was to agree a consistent set of data which should be collected during all these processes, thus reducing duplication of effort and improving consistency of data in local areas.  This work will now take place over the coming year.

Discussions were also held with stakeholders in areas where multi-agency local reviews of all suicides are currently undertaken with the aim of learning from these processes and exploring the opportunities for developing a single review system, regardless of whether the person who died by suicide had been in contact with mental health services or not.  Two areas have been identified to test this system with implementation due to be restarted after publication of this report, as resource restrictions have eased.

Audit And Evaluation

Recommendation 1 of the First Annual Report of the NSPLG

Progress on actions set out in Every Life Matters is described in this second annual report of the NSPLG.  It is intended that there will be a targeted audit of the 10 actions of the Suicide Prevention Action Plan, the results of which will be made available as early as possible in 2021.