Suicide prevention action plan 2018 - 2020: review

1. Introduction

1.1. Introduction to the review

Every Life Matters, Scotland's Suicide Prevention Action Plan (SPAP) 2018 - 2021 (Scottish Government, 2018), sets out the Scottish Government's cross-sectoral plan to further reduce the suicide rate by 20% by 2022 (from the 2017 baseline). Its vision is of a Scotland where "suicide is preventable; where help and support is available to anyone contemplating suicide and to those who have lost a loved one to suicide; [and where] suicide prevention is everyone's business." To support the realisation of this vision, the Plan contains 10 'Actions' (see table 1).

Over the past two years, much effort has gone into developing and implementing these Actions. What has been achieved, and recommendations for building on these achievements, are set out in two annual reports produced by the National Suicide Prevention Leadership Group (NSPLG) (NSPLG, 2019; NSPLG, 2020a). To provide a more in-depth understanding of the processes involved in delivering the Actions, the achievements to date, and factors which may have inhibited or supported progress to date, the NSPLG commissioned members of its Academic Advisory Group (AAG) and Public Health Scotland (PHS) to undertake a rapid review of progress over the period September 2018 to October 2020.

The aim was to draw out, and reflect on, the lessons from the implementation process to date. COVID-19 has clearly had, and will continue to have, an impact on what Actions can be taken forward through which processes. Moreover, the pandemic has reinforced the imperative for effective actions to prevent suicide in the face of the likely direct and indirect impacts on population mental wellbeing. Within this context, the findings and conclusions of this review are intended to provide a timely contribution to support the ongoing work of the SPAP. They also offer learning to inform the development and implementation of any future suicide prevention strategy and action plan.^[2]

A draft version of this Review was sent to delivery leads, the Chair of the Lived Experience Panel, members of the Scottish Government Suicide Prevention & Self Harm Policy Team and the SPAP Programme Manager for comment, and was discussed at a meeting of the National Suicide Prevention Leadership Group on 2 December 2020.^[3]

1.2 What is the SPAP (Every Life Matters)?

Every Life Matters was launched in August 2018. In addition to further reducing the suicide rate in Scotland, the key strategic aims of the SPAP are:

• People at risk of suicide feel able to ask for help, and have access to skilled staff and well-coordinated support
• People affected by suicide are not alone
• Suicide is no longer stigmatised
• Better support is provided to those bereaved by suicide
• Through learning and improvement, the risk of suicide is minimised by delivering better services and building stronger, more connected communities.

The SPAP sets out the Actions that national, regional and local leaders "must take to transform society's response and attitudes towards suicide" (table 1). As this table indicates, some of these Actions are quite concrete or specific, while others are more 'thematic', cross-cutting actions.

Table 1. The 10 actions of the Suicide Prevention Action Plan

1 The Scottish Government will set up and fund a National Suicide Prevention Leadership Group (NSPLG) by September 2018, reporting to Scottish Ministers - and also to CoSLA on issues that sit within the competence of local government and integration authorities. This group will make recommendations on supporting the development and delivery of local prevention action plans backed by £3 million funding over the course of the current Parliament.

2 The Scottish Government will fund the creation and implementation of refreshed mental health and suicide prevention training by May 2019. The NSPLG will support delivery across public and private sectors and, as a first step, will require that alongside the physical health training NHS staff receive, they will now receive mental health and suicide prevention training.

3 The Scottish Government will work with the NSPLG and partners to encourage a coordinated approach to public awareness campaigns, which maximises impact.

4 With the NSPLG, the Scottish Government will ensure that timely and effective support for those affected by suicide is available across Scotland by working to develop a Scottish Crisis Care Agreement.

5 The NSPLG will use evidence on the effectiveness of differing models of crisis support to make recommendations to service providers and share best practice.

6 The NSPLG will work with partners to develop and support the delivery of innovations in digital technology that improve suicide prevention.

7 The NSPLG will identify and facilitate preventative actions targeted at risk groups.

8 The NSPLG will ensure that all of the actions of the Suicide Prevention Action Plan consider the needs of children and young people.

9 The Scottish Government will work closely with partners to ensure that data, evidence and guidance is used to maximise impact. Improvement methodology will support localities to better understand and minimise unwarranted variation in practice and outcomes.

10 The Scottish Government will work with the NSPLG and partners to develop appropriate reviews into all deaths by suicide, and ensure that the lessons from reviews are shared with NSPLG and partners and acted on.

1.3 Key roles in the oversight and delivery of the SPAP

The National Suicide Prevention Leadership Group (NSPLG) was established in September 2018 by the Scottish Government to support the delivery of Every Life Matters. Membership reflects a broad range of delivery partners involved in suicide prevention and from key national (leadership) agencies, and includes those with lived experience of the impacts of suicide. The NSPLG's remit, minutes and other publications of interest are available online.^[4] The NSPLG reports, and makes recommendations, to Scottish Ministers and CoSLA on matters under the responsibility of local government.

The Academic Advisory Group (AAG), established in April 2019, provides expertise, advice and support to the NSPLG in respect of research evidence and evaluation methodology relevant to the successful implementation of the SPAP. It aims to keep the NSPLG informed of cumulative and recent research findings as well as contributing to the development, implementation and evaluation of the SPAP. The AAG is co-chaired by Professor Rory O'Connor, University of Glasgow and Emeritus Professor Steve Platt, University of Edinburgh.

The Lived Experience Panel (LEP), established in September 2019, informs the work of the NSPLG and supports delivery of the Actions in Every Life Matters, together with any subsequent recommendations. The panel comprises 14 people who responded to a national advertisement and who give their time as committed volunteers. "Panel members have been immensely generous in sharing their personal experiences of the impacts of suicide, and hugely influential in the work of the NSPLG" (NSPLG, 2020a, p. 6). Panel members come from a diverse range of professional and social backgrounds, and each has a different connection to suicide. Some are survivors of bereavement from suicide, others have been suicidal in the past or have been carers of family members or friends living with suicidal thoughts and behaviours. They are supported with respect and sensitivity by a co-ordinator hosted by SAMH. A wider network of over 100 people across the country with lived experience of the impacts of suicide is also involved in supporting the work of the NSPLG through a range of activities.

The Scottish Government Suicide Prevention & Self Harm Policy Team has overall policy responsibility for the NSPLG and the SPAP, and has financial oversight of any budget proposals and spend. The Policy Team provides the link between the Minister for Mental Health (and CoSLA) and the NSPLG, in addition to the NSPLG Chairperson's regular meetings with the Minister. They have facilitated the Chairperson's input to ongoing wider policy discussions, such as the development of the Mental Health Transition and Recovery Plan (Scottish Government, 2020a).

In July 2019, a Programme Manager was appointed specifically to support the NSPLG activity over and above the inputs from the Policy Team.

Action Sponsors: For each Action, there are two sponsors drawn from the NSPLG. They provide direction to, and overall support for, the development of each Action and act as a conduit between delivery leads (see below) and the NSPLG. The sponsors for the AAG play a more hands-on role in the outputs/activities of Action 9 due to the nature of the work involved.

Action delivery leads: At the time of the review, each Action, with the exception of Action 8, focusing on children and young people, had a dedicated delivery lead resource. The role of the delivery leads is to develop and implement agreed plans to achieve the aims of the Actions for which they are responsible. Those who undertake the delivery lead role, and the organisations from which they are drawn, reflect the knowledge and skills required to achieve the intended objectives of their specific Action. The work on developing workforce learning resources, for example, is being undertaken jointly between NHS Education for Scotland (NES) and Public Health Scotland (PHS), while the development of support for local action plans is led by a delivery lead hosted by CoSLA in recognition of the key role played by Chief Officers Groups and Community Planning Partnerships in local suicide prevention activity. The delivery leads meet monthly to review progress, share thinking and forge cross-collaborative working.

Detailed planning for Action 8 and the appointment of a delivery lead were postponed initially while awaiting the recommendations from the Children and Young People's Mental Health Taskforce. Following publication of the Taskforce's recommendations in July 2019,^[5] a Children and Young People's Mental Health and Wellbeing Programme Board was established. The NSPLG and the Board jointly proposed a policy mapping exercise to identify any gaps in relation to suicide prevention. The COVID-19 pandemic meant that this exercise had to be delayed. When completed in September 2020, this identified the specific areas of work which could appropriately be progressed under Action 8. The recruitment of a delivery lead to take this forward began in December 2020.

1.4 SPAP Year 1 and Year 2 Annual Reports: summary of findings and recommendations

The NSPLG has produced two annual reports which provide an overview of activities undertaken during 2018-19 (NSPLG, 2019) and 2019-20 (NSPLG, 2020a) to deliver the 10 Actions of Every Life Matters.

The first annual report covered the following topics:

• Embedding suicide prevention in local planning
• Increasing suicide prevention awareness, knowledge and skills
• Improving support for those in crisis or bereaved by suicide
• Improving understanding of what works, particularly for those at risk
• Meeting the needs of children and young people.

The report made 11 recommendations (appendix 1), all of which were accepted by the Scottish Government and CoSLA as part of plans to move ahead from the progress made to that point.

The second annual report was published during the COVID-19 pandemic. In addition to highlighting the impact of the pandemic on progress in delivering the SPAP (see section 2.3 below), the report provided an update of progress relating to the 10 SPAP actions, the 11 recommendations made in the NSPLG's first annual report, and the four priorities of the NSPLG's COVID-19 Statement (see section 2.3.2 below). The key event was the launch of Scotland's new United to Prevent Suicide visual identity and public awareness campaign^[6] - the start of a 'social movement'- on 10 September 2020, World Suicide Prevention Day.