Creating Hope Together - suicide prevention strategy and action plan: outcomes framework

Part 1: Introduction

In September 2022 the Scottish Government and COSLA published Creating Hope Together: Scotland's Suicide Prevention Strategy 2022 to 2032 and the accompanying Action Plan for 2022 to 2025. The Strategy's vision is to reduce the number of suicide deaths in Scotland, whilst tackling the inequalities which contribute to suicide.

Why we adopted an outcomes approach

The Strategy and Action Plan have been developed using an outcomes based model for the following reasons:

• It recognises - and gives visibility to - the range of changes (outcomes) that we understand are needed to prevent suicide and achieve our vision. The range of changes recognises the complexity of suicide and the need to tackle the social determinants and inequalities which contribute to suicide, as well as ensuring our environment protects against suicide risk.
• It sets out a clear and evidence informed routemap of how we will realise our long term outcomes and overarching vision (for the 10 year Strategy), through a series of short and medium term outcomes. We expect the short term outcomes to have effect over the period of the first (3 year) Action Plan, and the medium term outcomes to have effect over the first 6 years of the Strategy.
• By linking every action to our vision, the framework acts as a practical tool to ensure that reducing inequalities in suicide and meeting the needs of people with higher risk of suicide, are central to our planning, monitoring and evaluation. We know this is critical to reducing suicide deaths.
• It reflects the long term nature of achieving significant social change, such as attitudes towards suicide (in line with our 10 year Strategy), whilst also supporting decision making on short term actions (in line with our 3 year Action Plan). Further, it allows for priorities to be reviewed in a systematic and ongoing basis, drawing on clear evidence of impact and any significant changes to the context in which we are operating. The approach we have taken to developing a rolling suite of action plans also provides built-in opportunities to refocus activity over the 10 year period, to ensure our approach is driving change across the long term outcomes and vision.
• It allows us to address both 'upstream' factors which affect suicide, such as poverty and homelessness, as well as 'downstream' actions, such as the provision of high-quality support for individuals, families and communities who are currently affected by suicidal behaviour. This is important as effective suicide prevention includes a range of prevention, intervention and postvention activities - to ensure the right responses are available for people when they need them.

It offers an active planning and evaluation tool, allowing short term programmes of work to be developed, measured and revised with a clear line of sight to achieving long term change through the achievement of outcomes (rather than the implementation of activities or the completion of outputs). It is important to highlight, that we expect many of our actions to contribute to more than one outcome (although there is likely to be a primary outcome where the change is anticipated to occur).

• Over the lifetime of the Strategy, we will use the following elements to guide and prioritise future actions and investment:
  • the short and medium outcomes themselves, and any revisions made to them over time;
  • data on progress made in achieving these short and medium term outcomes; and
  • evaluation data relating to specific actions that have been delivered.

This framework can be used to support national, local and sectoral partners to design and deliver their activities so that they contribute positively to improved outcomes. This complements our new integrated model for delivering the strategy through the Suicide Prevention Delivery Collective (which is called Suicide Prevention Scotland), where we will work across national, local and sectoral boundaries and partnerships to deliver change.

• Finally, the outcomes framework enables robust reporting on whether, how and for whom positive changes have been achieved through the Action Plan. This reporting will ensure the National Suicide Prevention Advisory Group (NSPAG) is able to fulfil its role in providing Scottish Government and COSLA with independent advice on progress in delivering the Strategy, as well as giving strategic advice to the Delivery Collective to support delivery.

Long term outcomes in the Strategy

Outcome 1: The environment we live in promotes conditions which protect against suicide risk – this includes our psychological, social, cultural, economic and physical environment.

Outcome 2: Our communities have a clear understanding of suicide, risk factors and its prevention – so that people and organisations are more able to respond in helpful and informed ways when they, or others, need support.

Outcome 3: Everyone affected by suicide is able to access high quality, compassionate, appropriate and timely support – which promotes wellbeing and recovery. This applies to all children, young people and adults who experience suicidal thoughts and behaviour, anyone who cares for them, and anyone affected by suicide in other ways.

Outcome 4*: Our approach to suicide prevention is well planned and delivered, through close collaboration between national, local and sectoral partners. Our work is designed with lived experience insight, practice, data, research and intelligence. We improve our approach through regular monitoring, evaluation and review.

* We recognise the 4^th outcome is an enabling outcome to the other 3 outcomes. Whilst technically a process, rather than a societal outcome, we consider it is critical to achieving the vision.

Development of the outcomes framework

This outcomes framework has been designed to guide the delivery, monitoring, evaluation and reporting of Creating Hope Together.

The outcomes framework will continue to be developed and enhanced as further intelligence, research, and evidence become available, or societal changes occur, ensuring it acts as the most effective planning, learning and reporting tool.

The framework has been developed and tested with key stakeholders. We will continue to engage with key stakeholders, including people with lived experience, as we further develop the measurement approach for the outcomes framework, as well as any refinements to the outcomes framework itself.

Monitoring and evaluating the Strategy and Action Plan

Given that we are currently in year 1 of the Strategy, the initial focus of the outcomes framework has been on developing clear and measurable short term outcomes, together with the identification of appropriate indicators and data sources. We have ensured that the short term outcomes connect to the medium and long term outcomes (based on the evidence that is currently available).

The short term outcomes relate to aspects of work which, we believe, the Strategy and Action Plan can directly affect over the three-year life span of the first Action Plan.

Focusing initially on progress toward these short term outcomes will:

• provide a framework for the ongoing planning, reporting and review of the Action Plan;
• consolidate baseline data which will benefit future measurement of progress (across all outcomes); and
• provide an early indication of the scope, quality, completeness and consistency of data and evidence currently available; this will support the development of plans for improvement where needed.

Further detail on monitoring, evaluation and reporting is covered in parts 3 and 4 below.