Time, Space, Compassion Three simple words, one big difference: Recommendations for improvements in suicidal crisis response

Introduction

Every Life Matters: Scotland's Suicide Prevention Action Plan (2018) sets out 10 actions which aim to achieve the vision of a Scotland where suicide is preventable and where help and support is available to anyone contemplating suicide and to those who have lost a loved one to suicide. Suicide prevention is everyone's business.

Action 5 of Every Life Matters states that the National Suicide Prevention Leadership Group (NSPLG) will use evidence on the effectiveness of differing models of crisis support to make recommendations to service providers and share best practice. Further, it asserts that people in distress, including those who self-harm, need to find a respectful, compassionate response when they present to services for support. This action is at the core of achieving the vision of Every Life Matters, ensuring the right support is available for people in distress and actively contemplating suicide at a time of crisis.

Improvements to suicidal crisis response, wherever that response is found, will contribute to two outcomes. Firstly, that by receiving compassionate, timely support fewer people will go on to attempt, or die by, suicide. Secondly, that because people have a positive experience of response at a time of crisis, they will be supported to develop effective coping skills and be less likely to experience future suicidal crisis. Providing responses which are more accessible and meet the needs of those at risk may ultimately increase the numbers of people who seek help at the point of suicide. This too would be a positive outcome for this work, ultimately saving lives by ensuring more people are able to access help rather than acting on their thoughts of suicide.

Of course, this report now sits in the context of the impact of the COVID pandemic on people's mental health and wellbeing. Whilst there is no evidence of a rise in suicide rates in Scotland since lockdown, we note that the Scottish Government's Mental Health Transition and Recovery plan states: "One of the early impacts of Covid-19 was a higher level of distress. Over time, there is expected to be a worsening incidence of mental health disorders. Rates of traumatic reactions, substance misuse, self-harm and suicide are expected to increase."^[1] The NSPLG statement on COVID made suicidal crisis a priority area of response in the action plan. This report sets out a number of recommendations which support a medium to long-term change, and also a small number of short-term recommendations to ensure more immediate preparedness for any future increase in suicidal distress.

The report deliberately does not recommend a particular model of crisis support. Instead, it sets out an approach, based on the principles of Time, Space and Compassion. These may, on the surface, appear to be simple principles. If embedded effectively into existing and new responses, however, they would radically change the experiences of those who need support at a time of crisis.