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choose life : A National Strategy and Action Plan to Prevent Suicide in Scotland

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choose life: A National Strategy and Action Plan to Prevent Suicide in Scotland

APPENDIX 3 LINKED SCOTTISH EXECUTIVE POLICIES

This National Strategy and Action Plan is being launched, not as a single policy or initiative, but as one linked to other policies currently in place.

The Scottish Executive has a number of policies and initiatives underway which will have a direct and indirect impact on preventing suicide.

We also recognise that there are many excellent initiatives already being developed amongst a range of service providers (both statutory and voluntary, in the business community and self-help groups) which also address the issues identified within this strategy.

The main policies of the Scottish Executive and related bodies which link with and support this strategy and action plan are:

HEALTH

  • A Framework for Mental Health Services in Scotland (Scottish Executive, 1997)

  • Towards a Healthier Scotland - A white paper on Health 1999

  • Our National Health (ONH): a plan for action, a plan for change (2000)

  • Health Improvement Programme

  • National Programme for Improving Mental Health and Well-Being

  • Health Inequalities in the New Scotland (Health Promotion Policy Unit/Public Health Institute of Scotland, 2002

SOCIAL JUSTICE

  • Social Justice Strategy: a Scotland where everyone matters

CHILDREN AND YOUNG PEOPLE

  • For Scotland's Children. Better integrated children's services (Scottish Executive, 2001)

  • Sure Start

  • Starting Well

  • Standards In Scotland's Schools etc Act 2000

  • Health Promoting Schools

  • New Community Schools

OLDER PEOPLE

  • The Health and Well-being of Older People in Scotland (ISD, NHS in Scotland, 2001)

COMMUNITIES

  • Better Communities in Scotland: Closing the Gap (Scottish Executive, 2002)

RURAL AFFAIRS

  • Rural Scotland: A New Approach (Scottish Executive, 2000)

  • Rural Poverty and Inclusion Working Group

ECONOMIC DEVELOPMENT

  • The Way Forward: Framework for the Economic Development of Scotland (Scottish Executive, 2000)

SUBSTANCE MISUSE

  • Plan for Action on Alcohol Problems (Scottish Executive, 2002)

  • Alcohol Problems Support and Treatment Services Framework (Scottish Executive, 2002)

  • Drug Action Plan, Protecting our Future (Scottish Executive, 2000)

OFFENDERS

  • Health, Social Work and Related Services for Mentally Disordered offenders in Scotland (NHS MEL (1999) 5) Scottish Executive, 1999)

  • Services, Care, Support And Accommodation For Mentally Disordered Offenders In Scotland: Care Pathway Document HDL(2001)9

  • A Better Way: The Report of the Ministerial Group on Women's Offending (Scottish Executive, 2001)

  • Scottish Prison Service: Suicide Risk Management Strategy (1997) 'ACT to Care'

  • 'Suicide is Everyone's Business'. Suicide Risk Management and Custodial Care, An Inter-Agency Approach (2002)

HEALTH

Mental Health Services

In 2001-02, money invested in mental health services was 558.8 million by NHS Boards and 47 million by local authorities. Through the Mental Illness Specific Grant (MISG) and other grant schemes many voluntary bodies have been funded to provide services and supports in local areas for people with mental health needs and those who care for them. Through the MISG a further 19 million (soon to be increased to 20 million) is provided to support over 400 projects. In addition, the Scottish Executive provides direct grant funding of over 600,000 each year to support voluntary mental health bodies who receive further funding for services from local authorities and health boards.

An annual review of improvements to mental health accommodation born from the Our National Health (ONH) 5 million initiative asks, amongst other things, if local managers and staff are aware of Safety Action Notice (1998) regarding ligature points (SAN (SC 98/49)). Any deficiencies are followed up through the Performance Assessment Framework.

A Framework for Mental Health Services in Scotland (Scottish Executive, 1997)

The Framework for Mental Health Services in Scotland continues to offer a joint planning template for health, social work, housing agencies and voluntary sector partners for the provision of a comprehensive range of services and support for people with mental health problems and illness in both hospitals and the community. The Framework, along with ONH, sets out a modernisation agenda for change and improvement designed to put resources to best use in creating services and support that better respond to people's assessed needs. Progress in meeting the aims of the Framework is guided and monitored by the Scottish Executive's Mental Health and Well-Being Support Group (MHWBSG).

Consultations on a change in the focus for round three of the visits by the MHWBSG is currently underway. Mental health promotion and positive mental health is now an area of interest following the lead given in Our National Health.

Mental Health Legislation

The Scottish Executive is proposing to introduce new mental health legislation and is making available an additional 17.1 million per annum from 1 April 2004 for its implementation, much of this for service provision.

HEALTH IMPROVEMENT

Towards a Healthier Scotland - A White Paper on Health 1999

This White Paper sets out the Government's vision for improving health for all in Scotland. It is about investing in good health, for early health gain and for the longer term welfare of Scotland in the new millennium. It is about making a difference to the health and life of the whole population throughout their lives and about tackling the health inequalities which currently exist. This strategy has a particular focus on children - as action in the early years can have an enduring influence on health - but is equally committed to enabling those who are growing older to enjoy a full, healthy and productive life.

Our National Health (ONH): a plan for action, a plan for change (2000)

The Scottish Executive's twin track approach for improving health and improving health services, by combining the continuing modernisation of health services in Scotland with action for health improvement.

Health Improvement Programme

The Health Improvement programme reflects the Executive's ongoing commitment to health improvement and to reducing inequalities in Scotland's health record. The programme is supported by the Health Improvement Fund which, from 2000-01, provides 26 million each year to support national and local health improvement initiatives. The 2002 Scottish Budget more than doubled the money allocated specifically to health improvement. Over the next three years (2003-06), additional resources of 23 million, 50 million and 100 million across the Executive will be focused on improving health. Actions are focused on four priority groups: early years, teenage transitions, workplaces and community health.

The work of the National Programme for Improving Mental Health and Well-Being will be developed in consultation with the health improvement programme in order to develop complementary and cohesive programmes for health improvement. The National Programme has been allocated 20 million (for 2003-06) from the Health Improvement Fund for initiatives relating to improving mental health and well-being. (See Appendix 5.)

HEALTH INEQUALITIES

Health Inequalities in the New Scotland (Health Promotion Policy Unit/Public Health Institute of Scotland, 2002)

This report examines routinely collected health service and mortality information according to the priorities of the NHS in Scotland, illustrating the relationship between deprivation and health.

Health Education Board for Scotland (HEBS)

HEBS plays an integral part in the Scottish Executive's health improvement programme developing and supporting a number of initiatives designed to promote both physical and mental well-being, in particular in schools, and with children and young men.

From 1 April 2003, the Scottish Executive plans to bring together HEBS and the Public Health Institute for Scotland (PHIS) to form one new organisation. By building on existing strengths, this new organisation will deliver the health improvement programmes to a wide variety of audiences, employ knowledge about health and its determinants in a way that will influence policy and practice within Scotland and play a key role in the successful implementation of programmes of health improvement.

SOCIAL JUSTICE

Social Justice Strategy: a Scotland where everyone matters

This strategy sets out the Scottish Executive's commitment to the elimination of child poverty, achieving full employment, securing dignity in old age and building strong inclusive communities. The strategy sets targets at each stage of the lifecycle - children, young people, families, older people; as well as communities. Reducing the rate of suicide amongst young people is a key target for the Social Justice Strategy.

CHILDREN AND YOUNG PEOPLE

For Scotland's Children. Better integrated children's services (Scottish Executive, 2001)

Across the Health and Education departments there are a number of initiatives which have the common aim of both improving services for children and improving the integration of children's services. The For Scotland's Children report on better integrated children's services identifies the importance of all agencies working together to achieve the best outcomes, in particular for the most disadvantaged children. The report sets out ways in which local agencies can facilitate access to services and better co-ordination of effort and resources. The Executive has supported the development of better integrated services through a number of initiatives such as guidance on planning and the Changing Children's Services Fund, providing 81.5 million (2002-04) to help local agencies reorient their services to achieve better integration. Work resourced through the Fund will impact directly on mental health services, including suicide prevention. More generally, however, better integrated services are key to dealing with the complex problems often underlying suicide.

Starting Well

Starting Well is a national health demonstration project which aims to demonstrate that child health can be improved by a programme of intensive home-based support and a strengthened network of community-based support services in two disadvantaged areas of Glasgow. Led by the Glasgow Healthy City Partnership, the project was launched in 2000 with Executive funding of 3 million over a three-year period and will provide support to an initial 1,800 families. As part of the demonstration project programme, Starting Well is intended to be a testing ground for action; lessons learned will help to inform policy and practice throughout Scotland.

Sure Start Scotland

Sure Start Scotland targets support at families with very young children aged 0-3 years, with a particular focus on vulnerable and deprived families. The aim is to enable children to make a good start in life and make the most of subsequent opportunities. There is an emphasis on securing better integrated approaches to planning and delivering services across sectors to improve social and emotional development, health, ability to learn, and to strengthen families and communities. Provision is diverse and can include centre-based services, nursery and childcare services, and parent support.

By targeting early support, programmes such as Sure Start Scotland can help to reach families with the aim of preventing them from falling into crisis. Some local authority areas have developed more specialised services and projects for particular vulnerable groups and this includes projects working with families affected by mental health problems. The Scottish Budget 2003-06 will see a considerable expansion of support for early years interventions. By 2006, the Executive will provide an additional 31 million per year for Sure Start Scotland, bringing the total annual spend on the programme to 50 million in that year. There will also be additional resources for childcare.

EDUCATION

Standards in Scotland's Schools etc Act 2000

The Standards in Scotland's Schools etc Act 2000 places a duty on education authorities to ensure that school education is directed to the development of the personality, talents and mental and physical abilities of the young person to their fullest ability. This is underpinned by the National Priorities for Education.

Towards a Healthier Scotland recognised the importance of the concept of the health-promoting school and Our National Health: a plan for action, a plan for change, committed the Executive to establishing a Health Promoting Schools Unit. Working Together for Scotland: a Programme for Government published in January 2001 also committed the Executive to encouraging every school to become a health-promoting school.

Health Promoting Schools

The Scottish Executive's Scottish Health Promoting Schools Unit was established in May 2002 with the aim of providing a key national leadership role, championing, facilitating and supporting the implementation of the health promoting schools concept throughout Scotland.

A Health Promoting School is one which enables pupils, teaching and non-teaching staff, parents and the community it serves to take action for a healthier life, school and society. More specifically it takes action to promote the adoption of lifestyles conductive to good health, provide an environment which supports and encourages healthy lifestyles and enable pupils to take action for a healthier community and living conditions.

Education authorities are encouraged to address health education and promotion within a comprehensive programme of personal and social education. This approach is designed to ensure that information is given, not in isolation, but as part of a programme aimed at helping young people to develop sound lifestyle choices and healthy living and increase confidence and self-esteem.

New Community Schools

New Community Schools is a radical initiative with the twin aims of promoting social inclusion and raising educational standards in Scotland. It is founded on the belief that giving children the opportunity to realise their full potential, so that they leave school with motivation, self-esteem and the relevant skills, equips them for adult life and reduces the risk of social exclusion.

OLDER PEOPLE

The Health and Well-being of Older People in Scotland (ISD, NHS in Scotland, 2001)

The Executive is committed to improving the way it works with older people and set up its Older People's Unit in March 2001. Its main aim is to establish effective and inclusive ways of partnership working with older people, their organisations, and those with responsibility for older people's services. It aims to establish sustainable and inclusive working arrangements which enable older people's voices to be heard, to make a real contribution to policy for older people and to increase understanding of their needs, concerns and priorities to enable more effective responses.

ECONOMIC DEVELOPMENT

The Way Forward: Framework for the Economic Development of Scotland (Scottish Executive, 2000)

This report is designed to provide an integrated and coherent framework within which the promotion of Scottish economic development may be taken forward.

COMMUNITY DEVELOPMENT

Better Communities in Scotland: Closing the Gap (Scottish Executive, 2002)

The Scottish Executive's community regeneration statement published in June 2002. This includes a major strand of action 'to make sure people and communities have the social capital - the skills, confidence, support networks and resources - that they need to take advantage of, and to increase, the opportunities open to them'. To do this, we need to build the confidence of our communities to do more for themselves and to ask for the services they need, develop systems that get people involved and let them have a say in their communities and provide support and advice to individuals.

RURAL AFFAIRS

Rural Poverty and Inclusion Working Group

The report 'Poverty and Social Exclusion in Rural Scotland' recognises particular issues that rural communities face in dealing with mental health problems. The impact of physical isolation and the culture of self-reliance are thought to contribute to stress, anxiety and depression especially among young men, lone parents, older people and women from ethnic minority backgrounds.

SUBSTANCE MISUSE

Plan for Action on Alcohol Problems (Scottish Executive, 2002)

Alcohol Problems Support and Treatment Services Framework
(Scottish Executive, 2002)

This plan supports action to reduce alcohol-related harm in Scotland by influencing culture, attitudes and behaviour. Actions include devising a national communications strategy to achieve cultural change, prevention and education in a range of settings including work and schools, targeted support and treatment services for those affected, population wide controls, capacity building and co-ordination to support implementation. Published in September 2002, the Alcohol Problems Support and Treatment Services Framework specifically recognises the need to address those with mental health problems within the support and treatment services.

Drug Action Plan, Protecting our Future (Scottish Executive, 2000)

Tackling Drugs in Scotland: Action in Partnership. Scotland's Objectives and Action Priorities (Scottish Executive, 1999)

Drugs Action Plan: Protecting our Future

This Scottish Executive publication has committed to wide-ranging actions involving a number of different agencies to tackle the issue of drug misuse. The plan makes recommendations for improving the provision of drug misuse education and drug prevention and education targeted at young people who are most at risk.

Co-morbidity of mental health problems and substance misuse

The Executive recognises there is a need for further work to support those drug and alcohol users who have underlying mental health problems. It has set up a short-term working group to establish how their needs might best be met.

OFFENDERS

Mentally Disordered Offenders

Health, Social Work and Related Services for Mentally Disordered offenders in Scotland (NHS MEL (1999) 5) Scottish Executive, 1999)

Services, Care, Support And Accommodation For Mentally Disordered Offenders In Scotland: Care Pathway Document HDL(2001)9

A Better Way: The Report of the Ministerial Group on Women's Offending (Scottish Executive, 2001)

This policy sets out proposals for a co-ordinated range of services and accommodation for mentally disordered offenders designed to meet the needs of the individual and of public safety. It seeks to ensure that such offenders are cared for under conditions of security appropriate to the risk they present and emphasises the importance of rehabilitation in the care regime. In setting out these principles for safe services and accommodation, the guidance acknowledges the separate but linked roles and responsibilities for the health, social work, housing and other agencies. The co-ordination of required services was acknowledged as a special challenge and one that would rely on multi agency approaches to ensure that the right services, in the right locations, were available when required.

SCOTTISH PRISON SERVICE (SPS)

SPS Suicide Risk Management Strategy (1997) ACT to Care

'Suicide is Everyone's Business'. Suicide Risk Management and Custodial Care, An Inter-Agency Approach (2002)

In 1998 SPS introduced its Suicide Risk Management Strategy: ACT to Care. Its key aims were to assume a shared responsibility for the care of those 'at risk' of self-harm or suicide; to work together to provide a caring environment where prisoners who are in distress can ask for help to avert a crisis; and to identify needs and offer assistance in advance, during and after a crisis. The implementation of this strategy has brought about a significant change to the way that prisoners in crisis are managed, in that multi-disciplinary team meetings (case conferences) and care plans are the means by which support is organised and reflect the prisoner's needs and levels of risk. ACT to Care has (to some extent at least) influenced the downward trend of suicide in Scotland's prisons over recent years, which is in contrast to the upward trend experienced in other areas in Scotland.

SPS will be reviewing ACT to Care in coming months in light of the findings of a formal evaluation undertaken in partnership with University of Stirling this year. The outcome of this will be SPS's development and implementation of an updated Suicide Risk Management Strategy that is informed by this significant piece of research. There is little doubt however that the key themes of assessment, context, teamwork and care will remain in the revised strategy.