Suicide prevention action plan: public engagement analysis

4. Action 3: Establishment of a Suicide Prevention Confederation

4.1 The engagement asked four questions about the third proposed action - the establishment of a Suicide Prevention Confederation. The majority agreed with the establishment of a confederation (see Table 4). Two hundred respondents explained their answer under question 3b and the main themes are summarised below.

Table 4: Responses to Question 3a - Do you agree that we should establish a Suicide Prevention Confederation?

Note: 96% of respondents (n=278) answered this question.

Structure, Membership and Purpose

4.2 The most frequently discussed theme concerned the structure, membership and accountability of the proposed confederation. There was a desire for wider participation and varied membership. In particular, there were calls for greater involvement from the third sector, clinical professionals, the education sector and from those with lived experience of suicide. Some respondents suggested that the private sector should also be involved, although a couple of respondents were reticent about the "for profit" sector being part of the confederation. Some respondents mentioned the need for strong leadership, but others wished for a flatter hierarchy in the confederation, so that the views of smaller organisations and service users are given as much weight as policy-makers and clinical professionals. A small number of third sector respondents asked for the proposed confederation to report to Scottish Ministers, to ensure impact and accountability.

4.3 The next most common points were around work planning. Respondents suggested that the confederation should be a force for improved collaboration and cooperation between suicide prevention stakeholders. A number of respondents commented that the group would need to be action-focused, with agreed objectives and activities. Perceived advantages of the proposed confederation were developing a consistent approach across Scotland and realising efficiencies. Respondents had a range of ideas about what the priorities should be, including tackling stigma, early intervention, focusing on specific groups at higher risk of suicide, or on risk factors (e.g. deprivation, substance use, depression and self-harm). A number of respondents asked for assurance that any decisions made are data-driven and founded in evidence.

Concerns

4.4 There were also concerns regarding the proposed confederation. The most common critique was the lack of clarity and detail around the proposals. Some respondents queried how a confederation would practically reduce suicide and felt there was a risk of it merely being a "talking shop". Some felt that setting up a confederation was not the best use of resources. Respondents also expressed concern that local issues could be overshadowed by outcomes or activities set by a national leadership group.

4.5 A number of respondents were concerned about unnecessary duplication or wondered how the confederation was different from the Knowledge Into Action group. Some respondents mentioned that they preferred the ChooseLife branding and would prefer that this name was retained, rather than rebranding any collective activity as a Confederation. A few mentioned that they disliked the proposed name.

Local Leadership Preferences

4.6 Question 3c asked where local leadership of suicide prevention is best located and offered 6 response options. The responses are shown in Table 5. A total of 181 respondents gave a further explanation for their answer at question 3d, which are summarised below.

Table 5: Responses to Question 3c - Where do you think local leadership for suicide prevention is best located?

Note: 93% of respondents (n=270) answered this question.

Views on Leadership

4.7 Those who selected Health and Social Care Partnerships (HSCPs) commented that they have the necessary expertise and experience to lead on suicide prevention, and that they already lead on mental health services. Some noted that HSCPs are not limited to office hours. However, others were more critical of HSCPs, for example for their tendency to prioritise physical health over mental health.

4.8 Those who supported Community Planning Partnerships (CPP) leadership pointed to their broader, less clinical scope. The CPPs were also credited for giving a platform to community voices and being effective at bringing agencies/partners together to collaborate. The arguments in favour of leadership by Local Authorities (LAs) were that they have the expertise, resources and facilities to lead on suicide prevention. Some individuals mentioned that suicide prevention could be led by specific departments, such as social work. A major criticism was that this could create a "postcode lottery" of suicide prevention.

4.9 In relation to the third sector, the most common view was that third sector organisations should be part of a collaborative leadership, rather than being led solely by a HSCP, CCP or LA. One respondent mentioned the key role the third sector has had historically in the provision of support to people affected by suicide and this should be reflected within any leadership model. The third sector was seen to have more freedom and flexibility compared to the more rigid public sector.

4.10 Respondents who answered "other arrangements" were given the opportunity to specify what they thought that should be. The most popular suggestion was a hybrid leadership between partners/agencies, particularly joint leadership between Health and Social Care Partnerships and Community Planning Partnerships. Other suggestions included involving third sector organisations, local GPs, regional coordinators and joint integrated boards. There were also calls for leadership to be localised in communities rather than centralised and for a new independent public body to be created to lead any confederation, rather than any existing organisations.

Maximising Impact

4.11 A total of 103 respondents gave additional comments about maximising the impact of national and/or local suicide prevention activity (question 3e). There were different views, although a common point was that activities should be community-focused, with local ownership of activities. Respondents also underlined that it is vital to include lived experience within any activities in order to maximise impact. As noted in response to other questions, there were also calls to focus on particular risk factors or groups at risk.

4.12 More collaboration and better local to national coordination were also seen as key to maximising impact. Suggestions of how this might be achieved included: increasing collaboration with education services in suicide prevention activities; fostering more third sector support; co-designing services with those that use them; more corporate/employer engagement; and more sharing of information and good practice. Additional points were that there should be increased funding, resources and facilities for awareness raising/campaigning, so that key suicide prevention messages are communicated with more clarity.