Suicide prevention strategy development: early engagement - summary report

Theme One - Suicide Prevention

Some of the suggestions that were made in this section are more relevant to later sections dealing with early or crises intervention particularly in relation to the comments on resources. However, they are included here because they were considered by respondents to relate to preventative activities.

Resources

Participants in both the workshops and surveys emphasised the need for adequate resources to be provided. Definitions of what constituted resources encompassed increasing support staff numbers and reducing waiting lists. In addition, there were several references to a lack of awareness of existing resources which, it was suggested, could be overcome through better signposting and publicity. This view was much more frequently expressed by participants from organisations.

“Scoping exercise in Glasgow showed services exist but people don’t know about them and long-term resources are not there yet!”

“Local mapping of services and ease of access to this - community learning development staff are brilliant at this.”

“Long waiting times for some benefits and support can lead to suicidal ideation – systems need to be appropriate and prompt social service support provided to allow independent living etc.”

Whilst not directly addressing resourcing issues, there were practical suggestions that might help and which could be introduced quickly, such as using recordings of people with lived experience who have survived suicide attempts when help lines are busy.

Service Provision

Comments were received in relation to how organisations should work together to provide services particularly in relation to greater collaboration between public and third sectors.

In both the workshops and survey responses it was suggested that there should be a greater focus on multi-agency/interdisciplinary approaches based on clear organisational responsibilities being established and put in place. This included ensuring that when multiple agencies were involved individuals were enabled to gain access to all using a single point of contact. This was considered to be especially important and would provide a ‘safety net ’when individuals were transitioning between services especially from child to adult services.

“People seem to be moved between services before we find the right support for them with no safety net while the right support is found.”

“There should be no wrong door – no matter where you turn up you should be supported to find the right part of the system without having to retell your story,”

Better information sharing between organisations was seen as a key element in improving joint working.

“Are we sharing the right information, often bogged down in the red tape rather than focusing on the things which are important – a national approach would be useful so the right information is shared - especially for someone who has a history of self-harm or suicide attempt so that wherever they are in ‘the system’ people who may support them are aware.”

There were mixed opinions on the type of service provision, with some appealing for more face-to-face access and others for web chat (and other digital options). It is clear that offering a menu of different options will encourage engagement of different individuals, for example it was suggested middle aged men may be reluctant to engage in face-to-face therapy whilst young people may feel more comfortable with digital options.

Creating a clear concise map of options and ensuring there is awareness of these in primary care/schools/workplaces to help direct people would be helpful.

Adopting a person-centred approach was considered to be essential with services tailored to meet individual needs. There was a general agreement that someone to talk to or who would listen was more important to people than self-help resources. This view was expressed most strongly by individuals.

“Wide ranging holistic interventions taking account of a number of different lenses”

“Need to work together and not put people in ‘boxes’ look at what is in communities to help, signpost or refer and take person to the service/appointment.”

The challenges experienced by people in rural communities were highlighted.

“Rural communities are a difficult place to hide - if you talk about it then others will know and that puts people off talking about it in these communities.”

“Consider implications of rurality on prevention (limited access to social support networks) – also farming/fishing as at-risk occupations”

It was suggested that there would be benefits in raising awareness of the existing national Mental Health Improvement and Suicide Prevention Knowledge & Skills Framework, so that it becomes as well known as the National Trauma Training Framework.

Enhance the Role of Preventative Health Measures

In addition to the wider links with mental health, it was suggested that social prescribing and integrating mental health into activities such as sport, art and music could make a significant contribution to improving health and wellbeing. Whilst this can, and does, happen locally, there is a need to raise awareness of this approach at a national level. This was highlighted as a priority by respondents participating in a personal capacity but to a much lesser extent by participants representing organisations.

“Social prescribing and community building helps people take control of their own mental health.”

“Support could be integrated into locality plans - this would bypass the need to medicalise normal experiences and build resiliency.”

Concerns were expressed about the processes currently used by GP practices. Respondents described how they felt they “were not listened to” and that services were acting as “gate-keepers”. As a result, some people, and their families, stated that they had missed opportunities for support at an early stage. There was a general consensus that “you have to be in crisis to get help”. While some individuals acknowledge this is a resource issue, resulting often from a lack of time to listen, others felt that their treatment by medical professionals when raising concerns about their mental health was “cold” and even “callous” and as a result made them reluctant to speak out.

Individuals stated that when people seek medical assistance or ask for help from medical services, the support provided does not seem to work. There appeared to be a disconnect between expectations and the reality of the support that was provided. For many individuals the response to their request for help was to be prescribed medication by their GP or added to a very long waiting list for support services.

“Waiting lists are very long and require a GP referral (if you meet the threshold), all that is on offer is prescription of medication and the Samaritans crisis line.”

“People are not sure what their options are, what’s out there, and what to expect”.

“More robust action in primary care rather than medicating and referring.”

“Should be able to self-refer and not be reliant on GP referrals when there are capacity issues for GPs.”

“Access to crisis services can only be referred by GPs, this should change.”

The support received from third sector organisations, in particular Samaritans, was rated highly. It was suggested that there should be better collaboration between third and public sectors which would result in a joined up holistic approach to service provision.

“When people cancel appointments, no-one follows up with them and they can fall through the cracks”

Contextual Considerations

Preventative strategies and approaches should take account of the current context, particularly from a socio-economic perspective. Concerns were expressed about the impact of cuts in universal credit and other welfare reform aspects on vulnerable individuals. There was a widespread recognition of the adverse impact of the COVID-19 pandemic on mental health, particularly as a result of social isolation. At the same time, limitations on service delivery had been necessitated, especially in relation to those provided on a face-to-face basis. However, it was also suggested that the pandemic may have resulted, for some individuals, in improving their self-reliance and reducing their need for support from services.

There was recognition that the Scottish Government is not in a position to address many of the socio-economic issues that were identified as they are reserved matters.

“Covid has shone a light on mental health but people don’t always know where to go for help.”

“Health poverty is a big issue – demand can be bigger in some areas than others.”

Improving the Evidence Base

Decision making in relation to suicide prevention measures should be driven by robust evidence. Concerns were expressed about the quality and relevance of the data and information that was currently available.

“Suicide data needs to be improved; we need to know more …. to help prevention work.”

“Current research evidence is equivocal, and more is needed to determine which actions will be most effective.”

It should be noted that this was highlighted as an issue by representatives of organisations but not by individuals.