Self harm strategy and action plan 2023 to 2027

Ministerial and Spokesperson Foreword

Our vision is for people who have self-harmed or are thinking of self-harm, to receive compassionate, recovery-focused support, without fear of stigma or discrimination.

This is Scotland’s first ever self-harm strategy, and we believe the first in the world. As such we have approached this work carefully and sensitively, building our understanding every step of the way.

The Scottish Government first issued dedicated guidance on responding to self-harm in 2011,^[1] but following the publication of the Samaritans’ Hidden too Long Report in 2020^[2] which called for a new strategy, the then Minister for Mental Health and Wellbeing announced that the Scottish Government would develop this strategy and action plan.

Over the last 18 months, we have engaged extensively with people with lived and living experience of self-harm, and with families, and professionals. They have told us that support around self- harm needs to improve, and that there are still significant barriers that stop people from accessing support, including a level of stigma that is attached to self- harm that can both prevent people from seeking help and have an impact on the quality of the support they receive.

Over this time, our understanding of self-harm has also developed; self-harm takes many forms, it can be experienced across the life course, but it is currently understood to be more prevalent in some groups, for example: young women, LGBT+ people, and neurodiverse people. Self- harm is now more widely recognised as a response to distress or trauma, and while self-harm can indicate a greater risk of suicide, it is understood that many people who self-harm are not suicidal.

It is for these reasons that the Scottish Government and COSLA have worked together to create a dedicated self- harm strategy. However, our approach retains an important connection to our joint work on suicide prevention through our Suicide Prevention Strategy, and to improving population level mental health and prevention through our Mental Health and Wellbeing Strategy. Within the Mental Health and Wellbeing Delivery Plan there is a set of actions in Priority 4 on improving our response to people in distress. All of this work aims to embed a person- centred approach to mental health, which recognises and responds to the needs of people and communities, whilst tackling population-level issues such as stigma, and access to information and support.

We also want to ensure that commitments across this suite of strategies are aligned with the National Trauma Transformation Programme and underpinned by a diverse, skilled, supported and sustainable mental health and wellbeing workforce. Our new Mental Health and Wellbeing Workforce Action Plan sets out the steps we will take to strengthen our workforce.

While we have been developing this strategy and action plan, we have also begun to strengthen the provision of compassionate support for people who self-harm. The Scottish Government has funded new pilot self-harm services, delivered in three local areas and an online portal, which hosts support, resources and information for people who self-harm, their families, and other professionals. These services are already supporting many people and early evaluations show they are having a positive impact. This work is also helping to build our understanding about self- harm and the interventions that are most helpful. Local supports and services also continue to give consideration to how they can provide support around self- harm.

We recognise that there is still a lot we do not know about self-harm. It is often hidden and there are gaps in data that limit our current understanding. However, the learning from the pilots, as well as from previous reports on self-harm in Scotland, along with our engagement for this strategy puts us in a strong position to make real improvements. This is reflected in our decision for this strategy and action plan to run for three years, which will allow us to both act now on what we know, and take an approach which embraces continuous learning. We will review progress after 18 months to take stock, working in partnership as we move forward.

We also acknowledge that the way people seek support and discuss self-harm is changing. Many now turn online for help but this can present additional risks, especially for young and vulnerable people. We have worked with stakeholders to develop a balanced approach to make the internet a safer place where people can share their experiences and seek support for self-harm, while also taking steps to protect people from serious harm. The Scottish Government has worked with UK Government to extend provisions in the Online Safety Act 2023 to Scotland that will make it a crime to communicate encouragement or assistance to someone else to self-harm. It is believed this new law will act as a strong deterrent to anyone who sets out to deliberately cause others to self-harm.

Collaboration is key to improving outcomes for people who self-harm, or who are at risk of doing so. We are publishing this strategy jointly, reflecting our commitment across national and local government to support and strengthen the mental health and wellbeing of our communities. This joint approach is also in the spirit of the recent Verity House Agreement. It recognises the importance of both national and local leadership, and the role of local services and communities in delivering the best outcomes for people. However, we know that this work must extend beyond government, and we are grateful for the contribution of people with lived experience and the many stakeholders who have helped us to reach this point: it has been a truly collective effort. The successful delivery of the strategy will continue to be dependent on working together with wider partners and our communities. We fully commit to continuing to work in this collaborative way, taking forward the programme of work set out in the action plan, together.

Maree Todd MSP - Minister for Social Care, Mental Wellbeing and Sport

Cllr Paul Kelly - COSLA Health and Social Care Spokesperson